Does Medicare Cover Long-Term Care?

Periodically, we get this question from either an agent or a Medicare beneficiary: Does Medicare cover Long-Term Care? During a training event a few years back, an agent was sure that Medicare covered long-term care, and we needed to discuss that benefit. While it can cover a few days of care, it is extremely limited and slightly fickle. That’s why it’s so important to discuss long-term care with your clients, preferably before they begin Medicare. However, if they’re already on Medicare and do not have a long-term care plan or a policy, it’s still not too late for them to get coverage.

What Does Medicare Cover?

Before discussing coverage options, let’s talk about what Medicare covers and the stipulations around what qualifies. Original Medicare will cover days 1-20 at no cost in a skilled nursing facility. If Medicare-approved, days 21-100 are partially covered with a co-pay of $200 per day in 2023. Medicare will only provide this coverage for a skilled nursing care stay if it begins with an inpatient hospital stay of at least three days. If the stay is less than three days or any part of the three days is considered observation, Medicare will not cover the costs associated with skilled nursing care. Some supplemental coverage through an Advantage Plan might waive this requirement, but anyone on Original Medicare with or without a Medigap plan does currently need to meet this requirement to have coverage.

In addition, for Medicare to continue covering skilled nursing care, the patient must show measured improvement from therapies and care. Otherwise, Medicare will discontinue the coverage. This stipulation, along with the short number of covered days for skilled care, illustrates the importance of planning for how to pay for long-term care in the event a person needs care beyond the Medicare-covered allotment. In most cases, having a Long-Term Care Insurance policy is in the client’s and their family’s best interest since it will provide the most flexibility while also providing financial peace of mind.

Read More: The Risk of Longevity

Planning for Long-Term Care

Here are a few options for clients planning for long-term care costs:

Self-Insure: This is not considered a great option, and it’s often an excuse used by clients who want to avoid buying a policy. Most people consider Long-Term Care Insurance premiums to be expensive, so it is important to have a sincere conversation with your clients about the true costs of long-term care services and their options for funding a policy.

Traditional Long-Term Care Insurance: This type of plan functions like a typical insurance policy with premiums paid in exchange for future benefits with each policy tailored to a client’s specific budget and projected needs. This can include state partnership protection, inflation riders, spousal discounts, and anonymous pre-screening.

Asset-Based Long-Term Care Insurance: This type of plan consists of a life insurance or annuity contract with a long-term care benefit attached. Typically funded with a single premium, it offers premium flexibility and can also be customized to fit the client’s needs. Features can include tax-deferred growth, guaranteed premiums, and a guaranteed death benefit.

Short-Term Care Insurance: This type of plan typically does not require underwriting. However, it will not cover a pre-existing condition within the last six months of the policy, so it’s important to purchase one of these plans prior to a care need. As the name suggests, these policies are designed for short-term events—usually lasting about one year. Depending on the plan, it can be flexible to pay for a facility or for care given at home.

Medicaid: Medicaid benefits cover custodial care, including room and board, pharmacy, and incidentals, in a Medicaid-approved facility. Medicaid rules and regulations vary by state and include strict financial and non-financial qualifications. Typically, in order to qualify, a person needs to deplete their life savings on long-term care costs before qualifying. Fortunately, we offer crisis planning products and services if you have a client who has already begun receiving long-term care. Contact us for more information.

So, when you sit down with your clients—preferably well before they are on Medicare or need care—don’t be afraid to ask if they have a plan in place to pay for long-term care. The earlier you have this conversation with your clients, the more options they have and the lower their premiums. While Medicare does cover a very limited amount of long-term care, it is not something to fall back on or count on to take care of these needs. It is best for your clients to purchase a Long-Term Care Insurance policy well before they need care.