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Medicare Probably Doesn’t Cover Something You’ll Need

Medicare Probably Doesn’t Cover Something You’ll Need

Long-term care is one of the most needed services for Medicare enrollees, but in most cases it is not covered under Medicare plans. 70% of Americans over the age of 65 will need some long-term care at some point during their lives. Many Medicare participants are surprised to discover that their coverage will not pay for their long-term care.

Long-term care can be one of the biggest parts of your healthcare budget. According to the National Spending for Long-Term Services and Support report, the average nursing home will cost over $80,000 every year for a semi-private room. Depending upon the situation, this could be a bill that Medicare won’t cover.

Medicare And Long-Term Care: What’s Included?

The difference in what Medicare does and doesn’t cover when talking long-term care is confusing. Determining what your coverage will pay for is important when planning long-term medical plans for you and your loved ones. Medicare only covers long-term care expenses if it is “medically necessary”, often called, “post-acute care.” These medically necessary long-term care facility and experts are different from “custodial care”, which is the more common type.

Medicare covers long-term care for particular situations. Medicare will pay the bill for an extended stay in a skilled nursing facility. The one requirement is that you must have been admitted to the hospital for at least three days before entering the skilled nursing facility.  Medicare will pay for health care or rehabilitation after any major illness or surgery. Medicare will pay skilled nursing facility for up to 100 days, but only pays for 100% of the cost for the first 20 days.  After the first 20 days, you’ll have to pay a daily copay of $157.

Medicare covers the cost of skilled nursing facilities within 30 days of you being admitted to the hospital. You costs will be covered by a Medicare-approved skilled nursing facility if you need physical therapy or some other supplemental health therapy.

Medicare will also cover Hospice care expenses. Medicare will cover the costs if the enrollee has a terminal illness and is expected to live less than six months. Medicare will cover the costs of Medicare inside of the enrollee’s home, a nursing facility, or in a Hospice center.

What’s Not Covered?

Many enrollees believe that most long-term care is covered, but the typical long-term plan is not covered under traditional Medicare. The long-term care that is classified as “custodial care” isn’t paid for my Medicare. Custodial care is assistance with anything not medically necessary or everyday care. This usually involves things like eating, bathing, cooking, cleaning and other household actions. Custodial care is the majority of assistance that most seniors need. While long-term custodial care can become expensive, it’s not the only option for ensuring safety and freedom.


Long-term care can quickly add up to a high price tag, but there are several alternatives based on your preferences. Depending on what assistance is needed, there could be several different options to choose from that will allow for independence and savings.  In some cities, community services could give the assistance needed. Some communities have programs that will assist with shopping, meals, or transportation.

Subsidized senior housing is an excellent option for the elderly with little to no income. These homes usually offer seniors a private apartment and will assist with cleaning, shopping, and meals. The monthly rent for the seniors is based upon their income, making these house facilities excellent options if they are offered in your area.

When deciding on long-term care options, consider all aspect of every choice. Each senior is different, meaning that is situation will call for different assistance and accommodations. It’s an easy discussion, but discussing long-term care is critical for every family. Planning for long-term care can help migrate the high costs you could be facing.

MedicareWallet.com is an unbiased, online resource for individuals turning 65 or already on Medicare. Our utmost goal is to provide information in a way that is user-focused, informative and ethical. With a combined 40 years of experience in the Medicare market, we can answer any questions about Medicare and Medigap insurance. Feel free to reach out to us at 800.376.0824 or by email at[email protected].

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