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Does Medicare cover long-term care services like nursing home care?
Medicare Part A Coverage for Skilled Nursing Facility Care:
- The SNF care must be medically necessary and related to the condition for which you were hospitalized.
- Medicare Part A covers the first 20 days of SNF care in full. For days 21 through 100, you are responsible for a daily coinsurance amount.
- After 100 days, Medicare coverage for SNF care ends, and you are responsible for all costs.
Medicare Part A may cover skilled nursing facility (SNF) care under certain circumstances.
To qualify for Medicare-covered SNF care, you must have a qualifying hospital stay of at least three consecutive days (not counting the day of discharge) before entering the SNF.
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Medicare Part B Coverage for Limited Skilled Care:
Medicare Part B may cover certain skilled care services delivered in your home or in an outpatient setting, but this is generally not for long-term care.
Examples of covered services include physical therapy, occupational therapy, and some home health services. These services must be deemed medically necessary and ordered by a doctor.
Custodial Care and Non-Medical Assistance:
Medicare does not cover custodial care, which includes assistance with activities of daily living (ADLs) such as bathing, dressing, and eating.
Long-term care services primarily focused on assistance with ADLs and other non-medical care are typically not covered by Medicare.
For long-term care services beyond what Medicare covers, individuals often turn to other sources of coverage, including:
1. Medicaid: Medicaid provides significant coverage for long-term care services, including nursing home care, for low-income individuals and families. Eligibility requirements vary by state, but Medicaid is a primary payer for long-term care services in the United States.
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2. Long-Term Care Insurance: Some individuals purchase long-term care insurance policies to help cover the costs of nursing home care and other long-term care services. The coverage and premiums vary based on the policy.
3. Personal Savings and Assets: Many people pay for long-term care services out of pocket using their savings and assets. This can be a significant financial burden, and individuals often seek advice on financial planning for long-term care needs.
MedHelpCenter.us recommends that you call the Senior Health Insurance Agency at 813-592-8568 for further explanation.
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