Raymond Levine Update on LTC Insurance - Right at Home North of Boston
Raymond Levine Update on LTC Insurance - Right at Home North of Boston
Got this in e-news today from Raymond Levine LTC Insurance.
2014 Medicare Long Term Care Update
Ask 10 people who will pay their or their parents’ care giving bill and the answer you will likely hear from 6 or 7 is Medicare. Let’s be clear about this: Medicare does not cover most community or home-based care for chronic conditions or illnesses and Medicare does not pay for expenses in an acute-care facility after 100 days.
Historically, in order to qualify for Medicare coverage at an acute-care facility (also known as a “skilled-nursing facility”), not only must daily skilled care be required, but the beneficiary must also have spent at least three consecutive days hospitalized as an in-patient.
The takeaway? When a loved one is receiving care in a hospital and the next care setting may be a nursing home, ask about the patient’s status: Does the hospital consider that the individual is simply being held for observation or has the person been admitted?
This distinction has serious implications for long-term-care insurance policy design. Many individuals choose a 90- or 100-day elimination period because they believe that Medicare will pay for the first 100 days of care. While this assumption is sometimes partially true, it has never been guaranteed. Relying on this assumption now is riskier than ever.
Medicare does not cover deductibles and co-payments even when it does cover the first 100 days of skilled-nursing facility care. For 2014, Medicare provides only the following limited benefits and only if the nursing home care was proceeded by a 3-day in-patient hospital stay:
-
Days 1 through 10: No Medicare coverage.
-
Days 11 through 100: Medicare pays for care except for a $152 per day deductible.
For a 100-day stay, the patient will be responsible for the full cost of the first 10 days and a total of $13,680 for the remaining 90 days. And if the patient fails to meet Medicare’s explicit 3-day in-patient hospitalization requirement, Medicare will pay nothing at all.
The importance of taking these limitations into consideration as you plan for long-term care insurance cannot be overstated.