How much will the government actually pay?


Medicare is not designed to cover long term care. It was designed primarily to help with 'short term' rehabilitation. Medicare does not pay for long term care expenses. Medicare does cover some limited convalescent skilled nursing care and some limited home health care under restrictive, short-term conditions, but not for long term care. This short-term care is usually limited to 100 days, and to get it the following conditions must be met:

  • You must have been in a hospital for at least three days immediately prior to entering the nursing facility. This eliminates most Alzheimer's and Parkinson's cases.

  • You must go into the facility for the same condition for which you were previously hospitalized, and it must be within thirty days of discharge.

  • You must be getting better each day. Once you level off, Medicare stops paying.

In any case, Medicare covers only Skilled Nursing care and does not cover Intermediate or Custodial care at all!

Susan L. McGloghlon, president of the American HealthCare Institute National Medicare Recovery Services, Inc. states, "There are no limits to the number of benefit periods (100 days) that a Part A Beneficiary is entitled to in a Skilled Nursing Facility, provided you meet the criteria as set forth by HCFA." That means you can get skilled nursing care benefits from Medicare for only 100 days, as many times in your life as you are eligible.

But the catch is in "the criteria as set forth by HCFA". If you study the fine print you'll find: If you ever need prolonged, "long term" care, say for Alzheimer's or Parkinson's... It will not be covered by Medicare.

Medicare, HMO's, Major Medical and Medigap insurance do not pay for long term nursing home care stays. Only Long Term Care insurance will pay for that.

In 2006, a one year stay in a nursing home could cost anywhere from $42,000 - $192,000 per year, depending upon the nursing home's locale. To figure out what it might cost now, increase that cost by at least 6% per year. Insurance can be purchased to help pay for these costs. Without it, your family nest egg can be wiped out. The well spouse can be left without financial resources for their living expenses.

Long term care issues are bound to become more contentious as budget balancers seek to slow the growth of federal Medicare and Medicaid... Many proposed cuts have already passed. If we accept the fact that the cost of long term care is going to continually rise and that programs such as Medicare are realizing marked reductions in funding, we also must accept that the responsibility for long term care expenses will rest squarely on us. In fact, with the Deficit Reduction Act of 2005, that is exactly the message from Washington.

The message: Take care of yourself, and look out for your own. Don't count on Uncle Sam.