Legal Blog

The Weekly Scenario: Does Medicare Pay For Most Long Term Care Needs?

Question: Does Medicare pay for most Long Term Care needs?

Answer: Many people believe this to be the case, but in fact, this is far from being true. Medicare does not pay for most long term health needs (in fact the statistic I see is that Medicare pays less than 2% of the cost). Medicare will pay for long term care in a nursing home only if the following requirements are met: 1. Skilled care is being provided to the individual in the nursing facility. Skilled care is continuous 24 hour per day care provided by licensed medical professionals under the direct supervision of a physician. This care is different than intermediate level care (roughly 4.5% of nursing home residents) or “custodial” care (95% of nursing home residents). Intermediate care refers to occasional nursing and/ or rehabilitative care under the supervision of skilled medical personnel. Custodial care often involves non-medical personnel such as nurses’h aides who provide assistance with the activities of daily living including bathing, eating, toileting, transferring and dressing. 2. The nursing facility is a “Medicare participating” nursing facility (many don’t qualify). 3. The nursing home care must follow (within 30 days of discharge) at least a three day hospital confinement. In many cases, those who require nursing home care do not enter directly after a hospital stay. Rather, individuals, or their families realize they cannot manage any more at home or in a relative’s home. 4. For those who have read by column in the past, there used to be a requirement that the care the individual received had to be “restorative” in nature (i.e., some improvement needs to happen). It is no longer the case that Medicare provided skilled has to meet the expectation of improvement. If these requirements are met, Medicare will pay all of the costs of the first 20 days and the individual pays $157.50/day (2015 but inflation adjusted) for an additional 80 days (Medicare pays the rest). After day 100, Medicare will pay nothing. Comment: It is important to go in armed with the facts and find someone who is knowledgable on the subject. If you have any questions or would like more information please contact Steve Shane at: | 301.575.0313.


Steve Shane Head Shot for webSteve Shane provides strategic counseling to clients in need of estate administration, charitable giving and business continuity planning while minimizing estate, gift, and generation-skipping transfer tax exposure. He offers legal guidance to clients on asset protection and the proper disposition of assets in accordance with the client’s objectives, while employing tax planning techniques such as the use of irrevocable trusts, life insurance planning, lifetime gifts and charitable trust. He is also experienced with drafting documents for business planning, the incorporation and application for exemption for Private Foundations and the administration of decedents’ estates.   You can also connect with Offit Kurman via Facebook, Twitter, Google+, YouTube, and LinkedIn.