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The role of Medicare and Medicaid in long-term care

Last week, we explained the options to pay for long-term care are very limited. Adding to the problem is a significant amount of incorrect information about what those options are. For example, many seniors erroneously believe Medicare will pay long-term care costs. This is not correct.

On the other hand, upon meeting certain conditions, Medicaid will pay for long-term care. We understand why people confuse the two. Not only do the terms sounds similar, but, in some cases, Medicare provides assistance for some of the same types of health issues as Medicaid. 

For example, Medicare Part A (hospital insurance) covers care in a “long-term” care hospital. However, the coverage is only for treatment of conditions that will improve and allow the patient to return home. In other words, the focus of Medicare is to treat short duration conditions which are expected to improve.

For those who need skilled care, Medicare can help pay for those costs, but only up to 100 days. Medicare covers other services for a longer period so long as the doctor continually certifies that those services are necessary to treat an illness or injury expected to improve. Finally, Medicare can provide services for patients certified by a doctor as terminally ill (those will probably live no longer than six months) even if the patient does in fact continue to live longer than six months.

By definition, the conditions in which Medicare provides benefits are not “long-term.” If the condition is not going to improve, or is not terminal, Medicare is not an option. Unfortunately, there are many seniors whose ailment is not terminal, but will also not improve. They need help with the most basic of activities of daily living such as personal hygiene, dressing and eating. 

If certain conditions are met, Medicaid is an option. Next time, we will explain the role of Medicaid for seniors in need of long-term care, as well as its advantages and disadvantages.

Garrett Forsgren is a local attorney who provides free estate planning presentations. His office at Griff, Larson, Laiche and Wright can be reached at 245-8021 or .(JavaScript must be enabled to view this email address). Steve Wright is an attorney in Idaho Falls, Idaho.

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The role of Medicare and Medicaid in long-term care
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