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Does Medicare pay for long-term care? Will Medicare pay for skilled nursing home care? The answer is YES and NO. In 2020, Medicare spending on skilled nursing home services was $28.1 billion. That’s quite a bit. However, Medicare does NOT cover all long-term care needs for many. Here are some key facts regarding Medicare payments for long-term care.
Yes. But not for the reasons you might think.
The following is directly from the Medicare.gov website. “Medicare doesn’t cover long-term care (also called custodial care) if that’s the only care you need. Most nursing home care is custodial care, which is care that helps you with daily living activities (like bathing, dressing, and using the bathroom). You pay 100% for non-covered services, including most long-term care.”
Also – when care is needed, most people want to avoid a nursing home stay. Why? Because most people want to be cared for in their own home. And, that’s why you should consider having some long-term care insurance. Because two-thirds (66%) of all long-term care insurance claim benefits are for care in the policyholder’s own home.
It costs nothing to learn more about long-term care insurance. Our sister organization the American Association for Long-Term Care Insurance can connect you with a specialist. For no cost and with no obligation, they will educate you about this important protection. And, if you want, they will give you a price quote.
Click here to submit information for a free long-term care insurance quote.
The following data all comes from the March 2022 Report to Congress from MedPAC. The Medicare Payment Advisory Commission (MedPAC) is an independent congressional agency established by the Balanced Budget Act of 1997 to advise the U.S. Congress on issues affecting the Medicare program.
In 2020, about 15,000 skilled nursing facilities (SNF) furnished 1.7 million Medicare- covered stays to 1.2 million beneficiaries.
Medicare spending on SNF services was $28.1 billion. This was a 2.7 percent increase over the prior year.
Between 2019 and 2020, Medicare-covered admissions per 1,000 fee for service (FFS) beneficiaries dropped 7.9 percent. Likely associated with the lower number of admissions in the early days of the COVID-19 pandemic for hospital stays lasting at least 3 days.
The 3 day prior hospital stay is normally required for Medicare coverage.
Medicaid finances the majority of long-term care services provided in nursing homes.
Between 2020 and 2021, the number of Medicaid-certified facilities declined less than 1 percent, to 14,720.
Spending was $39.8 billion in 2020, 3.8 percent less than in 2019.
In 2020, about 3.1 million Medicare FFS beneficiaries received care.
Medicare spent $17.1 billion on home health care services.
Learn more about Medicare Home Care Services.
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