Long Term Care
MEDICARE

Medicare is health insurance that pays for skilled and rehabilitative care for those over 65 who have paid into the program and those under 65 who are disabled. Medicare will never, ever, ever, never pay for custodial care. It does however, provide limited benefits in the very place you don't want to go and are not likely to need! A skilled nursing home.

Medicare pays for a small fraction of long-term care because about 90% of all care is custodial or unskilled care. Medicare will only cover up to 100 days for skilled care. The patient must be getting better and there is a daily out of pocket coinsurance you are responsible for. You cannot rely on Medicare to pay for your long-term care expenses if it is not skilled care!

• Medicare only pays for long-term care at the Skilled level
• If you are receiving skilled care, Medicare will pay a maximum of 100 days and you must be getting better to receive the benefits
• Approximately 90% of long-term care received is custodial not skilled. Medicare will not pay for custodial care

  For example: Betty had a stroke during an operation. She lost some of her ability to use her left arm and can not walk without assistance. Betty can no longer dress herself, cook or bathe. She is place into a rehabilitation and Medicare pays for her care, for a period of time, as long as she is getting better.
  
  Betty can now walk on her own, but can not dress herself, nor bathe herself. She lives with her son but, he can not care for her full time. As time goes on, Betty's legs get weaker and she can no longer walk without assistance. She needs help walking, bathing and going to the bathroom since she can not walk independently. This is too much for her son and she is sadly sent to a nursing home. The nursing home admits her and puts her into physical therapy to help her walk.
  
  Medicare pays for her skilled nursing home stay for approximately 43 days because she was receiving skilled care and was improving for those 43 days.
  
  However, after 43 days, she is no longer improving and therefore, no longer needs skilled care. Although she had therapy, she still can not walk on her own and continues to need full time custodial care (help dressing, bathing and walking). Medicare will no longer pay for her nursing home stay. She must pay for nursing home care herself. Once her assets are depleted, she must rely on Medicaid.