No coverage for long-term care one of the top 10 things Medicare won't tell you

Good SmartMoney list from the WSJ about Top 10 things Medicare won't tell you. Not paying for long term care ranks in the top 10:   Here's a link to the article., and the #7 reason below:

7. "We don't cover a lot of the care seniors need most."

If your aging mother needs full-time care in a nursing home or a significant amount of home health care, she will have to meet some strict criteria to make it happen. For the most part, Medicare doesn't pay for nursing home care except for people who were hospitalized for at least three days within the previous 30 days and require "skilled" care, which is care that only a medical professional like a registered nurse could provide. Even then, it only covers up to 100 days per benefit period.

Qualifying to get reimbursement for home health care is also difficult, as you must meet all of following criteria: Be homebound (which means that a doctor has advised you not to leave home due to your condition, that leaving home takes considerable effort or you need help like special transportation to leave home); require skilled nursing care, physical therapy, speech-language pathology services or continued occupation therapy; and be getting regular services from your doctor under a plan of care that he or she has ordered. Medicare does not cover meals delivered to a home, cleaning and laundry services or, in most cases, personal care like help bathing, dressing and using the bathroom. "A lot of people don't realize it but these kinds of care are very limited," says Muralidharan. A spokesperson for CMS notes that the organization wants to engage with members of Congress, aging/disabled community members and experts to "explore solutions to the nation's long term care needs."

This gap in Medicare coverage can be financially devastating for many families. The average nursing home, for example, costs about $77,000 per year, according to a study by the MetLife Mature Market Institute. Home health care is also expensive, with rates ranging from about $17 to almost $30 per hour, according to the American Association for Long-Term Care Insurance, significantly more for a trained nurse or therapist.

 

Comments

[physical therapy documentation]

Thanks for the informative article. It's unfortunate that the ones that need the most attentive care (children and seniors) always seem to get thrown to the way side when money is tight.