Does Medicare Cover the Cost of Long-Term Care?

Elderly parent

Does Medicare cover the cost of long-term care?

No it does not. This is one of the most common misconceptions of seniors. Medicare covers short-term rehabilitation but does not cover custodial care at home or in a nursing home. Medicare covers acute illnesses such as heart surgery or strokes, but not chronic illnesses such as Alzheimer’s disease or Parkinson’s disease. Medicare is the main insurance for people 65 and older and also provides coverage for some people with disabilities.

In some parts of Wisconsin, people covered by Medicare can receive their benefits through a managed care plan. People with Medicare can enroll in plans that cover some prescription drug costs. For more information on plans, please refer to the Wisconsin Department of Health Services website.

What Are Specific Limitations Under Medicare?

Medicare was not designed to pay all your health care expenses. It does not cover long-term care expenses. Medicare provides limited coverage for skilled nursing care and for home health care. Medicare does not pay for personal care, such as eating, bathing, dressing, or getting into or out of bed. Most nursing home care is not covered by Medicare.

If you meet strict requirements, you may receive up to 100 days of Medicare coverage for skilled nursing care in a nursing home; however, there are significant co-payments that will be due. Some people have Medigap insurance policies which cover these co-payments.

Are you confusing Medicare and Medicaid?

Medicaid is an umbrella term under which a variety of subprograms exist. Medicaid is primarily intended to provide medical assistance to low income elderly people, people with disabilities including blindness, and children.

In Wisconsin, the Medicaid Community Waivers Plan helps people who are elderly, blind or have a disability to continue living in their own home or in the community, instead of a state institution or nursing home. If you are enrolled in Medicaid through the Community Waivers Plan, Medicaid may pay for certain supportive services. The Title 19 portion of Medicaid is designed to assist in paying for Skilled Nursing Facility expenses and many other medical expenses for individuals who have minimal assets and inadequate income to pay for these expenses.

Although these programs sounds similar they are vastly different. Even after families have hired the Senior Planning Group they continue to use the names interchangeably. We typically know which program they have intended to talk about, but the confusion is quite common. Our staff works to help families understand the difference.

For more specific information about Medicaid eligibility, please contact our office at (262) 670-888 with questions. Article was written by Erika LaPean, Benefit Specialist at Senior Planning Group.


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