A client recently asked me if his wife's Texas medicare supplement would cover her long term care stay. She has recently had a fall which caused a fracture, and during her recovery, it has been decided that she isn't really able to live alone any longer because she has beginning signs of dementia.
Medicare will cover it's share of the first 100 days in a skilled nursing facility if certain criteria are met, such as a 3 day hospital stay prior to the stay in the facility. The reason only 100 days are allowed is because ths care is designed to help the beneficiary to recover fully from an illness or injury and return to daily life. Medicare is not designed to cover long term care, which is care that is needed when someone has lost the ability to perform activities of daily living, such as bathing, dressing, toileting, eating. Medicare considers this custodial care, and it does not qualify for coverage.
This comes as a surprise to many people, as there is a general myth or idea among the public that once you turn 65, you get Medicare and it covers everything. This is simply not true. A good medicare supplement is important to fill in the gaps that Medicare doesn't cover, and if it's afforable, people should buy long term care insurance when they are still healthy. My parents have a long term care policy that will cover 3 years stay in a nursing home or assisted living facility, but will also allow them to have care in their own home. If one of them gets sick and exhausts the 3-year benefit, he or she can dip into the other's benefit using a shared care rider on the policy. they purchased this in their early 60's when they were still healthy enough to qualify. This gives them great peace of mind, knowing that their care is paid for in advance, which under Texas partnership laws, will also protect a portion of their assets if they exhaust all 6 years of benefits and need to do a spenddown to qualify for Medicaid.
Please spread the word to anyone that you know that Medicare does NOT cover long term care. this common misconception causes surprise and financial anxiety to many people every year, and if we can just spread the word about that, people would make arrangements in earlier years when they can still qualify for insurance, or as an alternative, they can put aside money during their working years that is designated for this care, which can be very expensive.
So in the scenario above, my client is making arrangements to transfer his wife to an assisted living facility, and because they have assets saved for their retirement, she cannot yet qualify for Medicaid.
To learn more about Medicare and Medicare supplements do cover, please click here to visit our website about Medicare.