Paying for Long-Term Care
The U.S. has a fragmented policy for dealing with long-term care
needs. Medicare, the health insurance program for the elderly and disabled,
covers acute medical care and very limited nursing home care as long as it's
linked to a hospital stay. Federal Medicare rules allow coverage if:
Medicare pays the full bill for the first 20 days of a skilled nursing stay; 80
percent up until the 100th day. After day 100, Medicare doesn't pay anything.
- a patient has a prior hospital stay of at least three days and is admitted to a
nursing home within 30 days of discharge for the same condition;
- the patient requires daily skilled nursing or rehabilitation services;
- the nursing home is Medicare certified; and
- a medical professional certifies that skilled nursing is needed.
Home Care Services
Medicare does cover home care services as long as they are
"medically reasonable and necessary." That means coverage applies for the
services of skilled nurses, home health aides, medical social workers, and
physical and occupational therapists. Medicare also will cover the full cost
of some medical supplies and 80 percent of the approved amount of durable
medical equipment such as wheelchairs, hospital beds, oxygen supplies, and
Medicare pays for home care when a patient requires intermittent skilled
nursing care, physical therapy, or speech pathology, under the following
- a patient is confined to his or her home;
- the doctor determines that home care is necessary and sets up a plan for receiving
- the home health agency participates in Medicare.
Although most Americans think of Medicaid as the health program
for poor welfare mothers and children, 44 percent of the program's outlays
are for long-term care. Medicaid picks up about half the nation's $70
billion nursing home bill. Private insurance accounts for about 2 percent of
that bill. Two of every three nursing home residents receive assistance from
Medicaid; most are elderly.
About 14 percent of residents who enter nursing homes pay the cost themselves
and end up qualifying for Medicaid within a year after spending their entire
net worth. To become eligible for Medicaid, a married couple must exhaust
their life savings. In most states, nursing home residents cannot receive
Medicaid coverage until they have less than $2,000 in liquid assets (this
does not include a house). Spouses who remain in the community like Mary
Webb are entitled to keep a minimum monthly allowance and a minimum set of
assets up to a capped amount.