What Does Medicare Pay For

Author: Medicare
Published: 2010/06/29
Topic: U.S. Medicare System - Publications List

Page Content: Synopsis - Introduction - Main

Synopsis: Medicare covers a wide array of medical needs very well including long term care.

Introduction

Main Item

Medicare covers a wide array of medical needs very well, but one area that it does very little to address is long term care.

There is a common misunderstanding among many people that Medicare does cover long term care costs, but actually it provides very little protection in such cases. Medicare is mainly concerned with providing health care for acute needs. In other words, if you have an illness or accident that requires a visit to the doctor, hospital, or care facility, and your health is expected to improve as a result, Medicare is there to help out.

However, if your health situation deteriorates to the point that you need assistance with activities of daily living including eating, bathing, dressing, continence, toileting, and transferring, it is now a long term custodial care situation that Medicare is not designed to cover.

So what exactly does Medicare do to assist with the cost of long term care? It only covers the cost of skilled care while you are in a nursing facility for the first one hundred days (paying fully for only the first twenty days), and pays for home health care visits only when skilled care is involved. Once again, skilled care is care for situations where you are expected to get better as a result, such as IVs, changing dressings, physical and speech therapy, and so forth. Once the progress stops, the care is no longer skilled, and becomes custodial instead. And that is where Medicare's assistance ends.

Interestingly enough, the average number of days that Medicare actually pays for nursing home care is only twenty three days according to the 2001 Nursing Facility Sourcebook. That means that the vast amount of facility care that is received is NOT paid for by Medicare funds.

When you consider that facility care is now reaching an average of $6,000 per month across the country, and home care costs can often be around half of that amount as well, it's clear that Medicare is not much help when it comes to long term care in an ongoing setting.

So why is it that Medicare does not pay more for long term care? Simply stated, the federal government simply cannot afford it. Long term care costs are among the highest medical expenses that any person can face in their lifetime. And as the baby boomers age and need more custodial care there will not be enough government funds from either state or federal sources to properly cover the care that will be needed.

As a result, both state and federal governments are actively trying to encourage more people to take responsibility for their own long term care needs in advance to insure that quality care will be received when it is needed. It is vital that Americans find out more about the important issues related to long term care now to secure their future health care needs.