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long-term-care-insuranceAsk aging clients about their plan to pay for long-term care services and many will say they are relying on Medicare. That expectation however, does not align with the reality. Medicare cannot be counted on to pay long-term care expenses. Clarify for your client just what government assistance for long-term care they can expect. It’s time to separate fact from fiction by clearing up the two crucial misunderstandings outlined below.

Misunderstanding #1: Medicare pays for long-term care. This is false!

Many people honestly believe that Medicare will cover their long-term care costs. These people may be confusing “long-term care” with “post-acute care” – an expense that may be partially covered by Medicare. To help you clear up the confusion, below are two ways to help clients understand the limited situations Medicare can be counted on to help with long-term care expenses:

  • Define long-term care: Long-term care, also called custodial care or long-term support and services (LTSS), is assistance with personal activities such as mobility (moving from one place to another e.g. bed to bathroom, getting in and out of a chair), bathing, dressing, eating, using the bathroom, and continence. These services do not require skilled nursing care.
  • Explain qualifying skilled nursing facility (SNF) care: There are seven conditions that must be met for Medicare to cover care delivered at a skilled nursing facility. Medicare publishes a downloadable booklet, Medicare Coverage of Skilled Nursing Facility Care, that outlines each condition. Essentially the requirements are:
  1. The client must have Medicare Part A and have days remaining in the benefit period.
  2. The care must be due to a condition associated with a qualifying hospital stay of at least three days.
  3. A physician has ordered inpatient care that requires professional, skilled, providers.
  4. Skilled care is delivered daily.
  5. The ongoing condition requiring care at a skilled nursing facility was treated during the qualifying three-day hospital stay.
  6. The services requiring professional, skilled providers must be reasonable for the diagnosis.
  7. Skilled care is delivered in a Medicare approved skilled nursing facility.

Misunderstanding #2: Medicare will pay for unskilled nursing care on an ongoing basis. Also false!

Under Medicare, the benefit for skilled nursing facility (SNF) care is limited to 100 days, and that’s only for those who meet the strenuous eligibility qualifications. The benefit period begins on the day inpatient hospital care begins or the day admission to the SNF begins. So let’s say a patient had a five-day hospital stay, and the reason for the hospital stay or a condition treated during the hospital stay required post-acute skilled care. In this scenario, the maximum period Medicare would cover in a skilled nursing facility during this benefit period is 95 days.

Additional information

There are definitely more details about Medicare and long-term care that are best addressed by a specialist. This article provides a high-level overview to help you address the folly of expecting government benefits to cover the cost of long-term care.

Make sure to talk to both your older clients about how long-term care might impact their adult children, and encourage your younger clients to protect their own assets by starting the long-term care conversation with their parents now.  Our all-new Conversation Starter is a great resource to offer. Also use this infographic to help both audiences understand the heavy burden that long-term care represents.

Thinking about adding long-term care insurance to your practice?