Providing funds for long-term care is the role of Medicaid and LTC. Medicare is not designed to provide assistance with ADL or to provide assistance and aid to keep you in your home or in an assisted living facility. The exact levels and locations for receiving skilled care vary from state to state. If you are homebound and need skilled care, Medicare may pay to have a caregiver come to your home to tend to your needs.Īnother exception is end-of-life or hospice care. With some exceptions, Medicare pays for medically necessary skilled care in a nursing home setting. (For related reading, see "Taking the Surprise Out of Long-Term Care.") The bottom line is determining whether you need assistance with activities of daily living (ADL) or custodial care. There's a difference between care that is skilled and medically necessary and care that is custodial. Places where care can be given: In almost all cases, patients leaving a hospital go straight to a nursing home for further care. And it must result from the condition for which you were hospitalized. It must be care that can only be given in a nursing home, in most cases by skilled personnel. Medical necessity: Your care must fulfill the following requirements. For example, you might go in for a hip replacement on Monday morning and leave Wednesday afternoon. Many hospital stays are three days and two nights. The 72-hour rule: You must have been hospitalized for at least three full days and three full nights. In order for Medicare to pay for your LTC costs at all, you must meet three criteria: But how can you safely choose the best ETFs from a blizzard of more than 400 choices available today? Download Jim Lowell’s free report, "Three ETFs for the Current Market," and avoid dangerous ETF investor traps. They are rapidly replacing mutual funds as the smartest-packaged investment products available to investors. Special Offer: Exchange-traded funds have exploded on Wall Street. Once 20 days have passed, you must pay a hefty co-insurance amount for days 21 through 100 for each benefit period. Assuming you qualify, Medicare may pay up to 100% of your costs in a nursing home for the first 20 days in a benefit period. As such, Medicare's coverage for long-term needs is extremely limited. The Medicare program is designed to provide for medical care, not the cost of long-term care (LTC). Participants in Part C do not need to purchase medigap coverage Part C enables them to select medical coverage that addresses most needs. This supplemental insurance, often referred to as "medigap" coverage, pays for expenses that are not covered by Medicare. Participants in Medicare Part A and B can choose to participate in Part C and/or D, or they can choose to purchase supplemental insurance from a private carrier. (To learn more about Medicare coverage options, see "Getting Through The Medicare Part D Maze.") Many people find the array of coverage options and pricing to be particularly confusing. While Part D is a voluntary program, Medicare recipients have to seriously review their health care needs in advance because the cost of Part D increases each year for individuals who choose not to participate immediately upon eligibility.Īlthough prescription drug coverage is particularly important for many senior citizens and Part D does help, the program has drawn heavy criticism. 31 each year, during which program participants can choose to change their coverage options. Like employer-provided health care plans, Part D holds an open enrollment session Nov. The monthly cost varies widely depending on the coverage options you choose. Part D is an optional insurance program that charges a monthly fee in exchange for prescription drug coverage. In 2006, the program expanded again to offer prescription drug coverage (Part D). Part C is available in most areas and provides a convenient way to receive medical services. The private provider also covers services not provided by Parts A and B. A menu of offerings is available with a variety of coverage options, co-payments and monthly costs. It operates like the health care coverage provided by most employers. Part C gives Medicare beneficiaries the opportunity to enroll in private health care plans and receive all Medicare services, including Part A and Part B, from a private provider. Click here for a free trial of the Turnaround Letter and to get his current buys. Special Offer: Turnaround Letter Editor George Putnam told subscribers to buy Apple at $7.82 in 2003, turning $10,000 into more than $250,000 in four years. The Medicare program still fulfills its original role but was expanded in 1997 and refined in 1999 to include Medicare+Choice (Part C), now known as "Medicare Advantage."
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