Medicare is our country’s health insurance program for people age 65 or older. The program helps with the cost of health care for seniors, but it does not cover the cost of most long-term care or all of a person’s medical expenses. 

Medicaid provides medical coverage and the cost of most long-term care for those who qualify for the program. By contrast, Medicaid nursing home services are only provided for those who qualify for the program and are either aged (65 or older) or disabled. While the federal government pays all the costs of the Medicare program, the state and federal government share the cost of the Medicaid program.  

Many Florida seniors are surprised to learn that Medicare will not pay for all of the expenses associated with long-term care. There are many restrictions that apply to Medicare coverage for skilled nursing facility care. Skilled nursing care requires that the care be provided by or requires the supervision of skilled nursing personnel or other skilled rehabilitation persons, which, as a practical matter, can only be provided in a skilled nursing home facility on an inpatient basis. 

Medicare never extends coverage to a patient who needs custodial care only.

For each spell of illness, Medicare Part A will pay all the costs for a covered skilled nursing home stay for the first 20 days. After this, Medicare can cover $170.50 per day in 2019 for up to an additional 80 days as long as the individual was a patient in a hospital for three consecutive days, not including the day of discharge. 

In addition, these conditions apply:

– The patient must be admitted to the skilled nursing facility within 30 days of discharge from the hospital;

– A doctor must certify that the patient needs skilled nursing home care; the services are provided by or under the supervision of a trained individual; 

– The services are received on a daily basis, which means therapy services at least 5 days per week and/or nursing care 7 days per week; 

– The services are provided by a Medicare-certified skilled nursing facility and the skilled services must be provided on an inpatient basis.

The key to successfully planning for long-term care is to not put it off. Although there are solutions in a crisis, often our clients are not in a position to make these decisions for themselves. Instead, they must rely on the power of their adult children and the authority they granted to their decision makers through their durable power of attorney. We encourage you not to wait to schedule a meeting with attorney Allen Poucher, to discuss your questions on these issues today.