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Unlike the needs-based Medicaid program discussed in the previous blog, the Medicare program is an entitlement program. If you meet all of the eligibility requirements, you will be covered by the program, even if you’re a multimillionaire.
As a general rule, Medicare will not pay for long-term care. This includes both medical and nonmedical care for those who have a chronic disease or disability. Nonmedical care would be help with activities of daily living, such as bathing, eating, dressing, toileting, and getting in and out of bed. This “custodial care” may be needed for years, but, again, isn’t covered by Medicare.
Medicare will pay for skilled nursing care—any care performed by a licensed nurse—but only if all of the following conditions are met:
If all of those statements are true, Medicare will pay for all of the nursing home costs for the first 20 days, and some of the costs for the next 80 days (you’ll need to pay the first $133.50 per day as coinsurance). After day 100, you’re on your own.
Because of these restrictions, the vast majority of nursing home residents need alternative funding. The three possibilities are self-funding, long-term care insurance, and Medicaid. The next blog series will cover these options in more depth.
By Deborah Hoskins, JD, CFP
The Wise and the Wary Blog