Understand Long-Term Care and Medicare Coverage
Our needs change as we age. While many older Americans choose to age in place, others opt for settings with additional care, especially in our later years. Planning for the future is essential to ensure you and your family have the resources and care you need as you age. Recent studies show that more than half of Americans turning 65 today will require long-term care services in the future. Knowing what to expect will help you assess your current financial situation and make a game plan should you need these services.
What is long-term care?
When most people think of long-term care, they think of nursing homes and assisted living facilities. However, long-term care encompasses a much more comprehensive range of services that help you live safely, comfortably, and independently as you age. You can receive long-term care in a variety of settings, including in your home. Services, including help with daily activities like bathing, dressing, meal preparation, and transportation, are all part of long-term care. Medication management, physical therapy, and other medical services are also included.
Home Health Care
Home health care consists of part-time medical services ordered by your health care provider for a specific condition. Home health services are typically provided by trained medical staff such as nurses or certified nursing assistants. Common reasons for needing home healthcare include wound care, cardiac rehab after open heart surgery, and recovery after a stroke. Home health care can consist of physical therapy, occupational therapy, and speech therapy.
Personal Care Services
Anyone can receive personal care services without an order from your healthcare provider. These services are not medical in nature, and therefore don’t require medically trained staff. Things like meal preparation, cleaning, and other household chores fall into the category of personal care services.
Companion Services
Loneliness is a serious problem among older adults and increases the risk for multiple chronic conditions. More than one-third of adults aged 45 and older feel lonely—and about one-fourth of adults over 65 are considered to be socially isolated. If you’re feeling lonely or isolated, companion services can help you receive socialization and companionship. These services are often staffed by volunteers and are popular for those who are unable to leave their homes or do not have the opportunity to interact with others frequently. No medical care or therapy is involved in companion services. Volunteers or staff members pay short visits to spend time with those in need.
Senior Transportation
Many companies provide transportation for seniors who are unable to drive themselves. Senior Transportation services take patients to medical appointments, shopping centers, and recreational facilities. These services are common in rural areas where public transportation is not available.
Adult Daycare
Adult daycare services are provided during the day at a community-based center. These centers offer social support in a protected environment for seniors who cannot be left alone for long periods. Most facilities provide opportunities for participation in games, movies, and other group activities catered to your needs. Some adult daycare centers also offer healthcare services.
Assisted Living Facilities
Assisted Living facilities are similar to apartment complexes. Unlike apartment complexes, they’re staffed with medical professionals who can provide additional care, like managing medications and assisting with meals and other needs. Residents can live independently while also having the option for daily check-ins, health services, and assistance with daily activities.
Nursing Home
Nursing homes provide the highest level of care. They are inpatient facilities where residents are supervised and cared for by medical staff around the clock. Some nursing homes include skilled nursing units that provide specific care, such as rehabilitation after surgery or major illness.
Who needs long-term care?
Approximately 12 million Americans receive long-term care services—and as our population ages, the need will only increase. Older Americans often seek long-term care due to physical or cognitive impairment. Impairment may be caused by an acute issue, such as recovery after a heart attack or stroke, or by gradual decline in physical or mental health due to an illness (or simply aging). The average person receiving long-term care services requires at least three years of long-term care.
Long-term care is necessary for people who need assistance with activities of daily living (ADLs) or instrumental activities of daily living (IADLs). ADLs include basic self-care activities like bathing, dressing, eating, and mobility. IADLs include meal preparation, money management, medication management, and household chores.
Certain factors can increase the risk of needing long-term care in the future. The most common risk factors include age, gender, marital status, and lifestyle choices. The likelihood of needing long-term care services increases with age. Women are at a higher risk for long-term care than men, in part due to women having a longer average life expectancy. People who are single, divorced, or widowed are also more likely to need long-term care, especially if they live alone. Finally, lifestyle choices such as poor diet, exercise habits, or smoking can put you at risk for health conditions that lead to a need for long-term care.
While needs vary, many people will need long-term care at some point in their lives. Having a plan before the need arises makes it easier for individuals and their families to provide the appropriate care when needed.
How much does long-term care cost?
Long-term care costs depend on many factors, including where you live, the type of care you need, and how long you need care. Inpatient care is generally more expensive than outpatient or home care. Differences like private rooms versus semi-private rooms can also significantly impact costs.
The national average cost of a semi-private nursing home room is $225 per day, or $6,844 a month. A private room averages $253 daily, or $7,698 a month. Assisted living facilities cost less, with an average rent of around $119 per day (not including things like meals or laundry services). You can expect to pay approximately $20 per hour for home care services.
From 2020 to 2021, the average cost of an assisted living facility went up by 4.65%. These costs are rising every year, so it is essential to consider economic factors like inflation when planning for long-term care. By the time you need long-term care, the price may rise significantly.
Does Medicare cover long-term care?
Generally speaking, Original Medicare does not pay for long-term care. However, in certain situations, Medicare will pay for nursing home care. If your healthcare provider prescribes it, Medicare will cover up to 100 days of skilled nursing care in a nursing home after a hospital stay. Original Medicare will also pay for hospice care and physical therapy when it’s considered medically necessary.
Some Medicare Advantage plans provide additional long-term care coverage. Coverage may include in-home support, home safety, and personal care. For example, your Medicare Advantage plan may pay for safety bar installation in your bathroom to make aging in place safer. Some Medicare Advantage plans also have transportation and adult daycare benefits.
From transportation benefits to long-term care support, Medicare Advantage plans can help you limit your out-of-pocket costs. When selecting a Medicare Advantage plan, it’s important to first be sure that your doctors and prescriptions are covered. Especially if you have a chronic condition that requires you to see your doctors often, you want to be sure they’re in network. You should also be sure you understand how Medicare Advantage compares to Medigap to be sure you’re making the right decision for your unique needs.
Not sure how to choose the right Medicare coverage for your specific situation? Chapter Advisors are on-hand to help you understand when to enroll in Medicare, which parts and plans will fit your needs, and how you can get the most value from Medicare. Pick a time to chat and get all your questions answered. Our advice is always free.