Medicaid for Long-Term Care Nursing

medicaid for Long-Term Care

NURSING HOME]

Long-term care is described as "a variety of services that includes medical and non-medical care to people who have a chronic illness or disability." (HHS.gov, 2009) Medicare is stated to have "contributed substantially to the well-being of the nation's elderly and people with disabilities. Over the past four decades, Medicare has helped to improve the health of its beneficiaries and assure their financial well-being. But Medicare also has significant gaps. Key among them is the fact that Medicare does not pay for long-term care. Medicare pays for nursing home and home care services, but Medicare is designed to pay for the treatment of acute, short-term illness. These services are available only to beneficiaries who need skilled nursing care or therapies, and are often time limited." (Georgetown University, 2007)

Nearly one-third of individuals receiving Medicare benefits "has some physical or cognitive limitation that makes it difficult for them to perform certain activities of daily living, such as getting dressed, moving around the home, and using the bathroom. Medicaid is available to provide assistance to some Medicare beneficiaries who are poor, or who cannot afford the high cost of long-term care services, but most long-term care is a family responsibility. Individuals and families provide a substantial amount of unpaid care and pay for care out of personal resources. Long-term care accounts for the single largest out-of-pocket expense of Medicare beneficiaries." (Georgetown University, 2007)

I. Medicare -- Long-Term Care Benefits

Georgetown University reports that Medicare "pays for most of the medical care costs of people who need long-term care service providers -- home health agencies and nursing homes. However, Medicare's coverage of home care and nursing home care is very limited." (Georgetown University, 2007) Medicare pays for one hundred days of nursing home care "for beneficiaries with a prior hospital stay who need skilled nursing care or rehabilitative therapy." (Georgetown University, 2007) Additionally paid by Medicare is the full costs of care "for the first 20 days of a nursing home stay." (Georgetown University, 2007) After the first twenty days the "beneficiaries make a substantial copayment of $124 per day (in 2007)." (Georgetown University, 2007)

II. Medicare -- Home Health Care Benefits

Medicare also pays home health care however, these services are limited "to people with skilled care needs." (Georgetown University, 2007) Requirements include that the beneficiary must be "homebound, need intermittent skilled nursing or therapy services and be under the care of a physician who prescribes their plan of care." (Georgetown University, 2007) Home health aide services include:

(1) assistance with dressing;

(2) assistance with transferring;

(3) assisting with toileting; and (4) other activities of daily living. (Georgetown University, 2007)

Individuals who do not have skilled care needs but who nevertheless require assistance in completing daily activities are not eligible under Medicare to receive home health care. (Georgetown University, 2007) the following chart labeled Figure 1 shows Medicare Spending by Service (2005).

Figure 1

Medicare Spending by Service (2005)

Source: Georgetown University (2007)

Medicare Spending by Service (2005) the following chart labeled Figure 2 shows Medicare's Share of Long-Term Care Spending (2005).

Figure 2

Medicare's Share of Long-Term Spending (2005)

Source: Georgetown University (2007)

III. Eligibility for Medicare

The Center for Medicare & Medicaid Services (CMS) administers Medicare. Medicare is the United States' largest health insurance program, which covers nearly 40 million Americans." (HHS.gov, 2009) One may check for their eligibility to be covered by Medicare by going online to the webpage as follows: http://www.medicare.gov/MedicareEligibility/home.asp?version= default&bro wser=IE%7C7%7CWindows+Vista&language=English and following the prompts to enter personal information that will serve to assist the establishment of eligibility for Medicare. Generally, one is eligible for Medicare if they or their spouse "worked for at least 10 years in Medicare-covered employment" and if the individual is at least 65 years of age or order and is a permanent resident of the United States.

IV. Medicare Premiums

One qualifies for Medicare Part a at age 65 without the requirement of paying premiums if: (1) They already get retirements benefits from Social Security of the Railroad Retirement Board; (2) They are eligible to get Social Security or Railroad benefits but haven't yet filed for them; or (3) They or their spouse had Medicare-covered government employment.

If the individual is under the age of 65 they can receive Part a without the requirement of paying premiums if they have: (1) Received Social Security or Railroad Retirement Board disability benefits for 24 months; or (2) End-Stage Renal Disease and meet certain requirements. (HHS.gov, 2009)

Premiums for Medicare are stated as follows:

Part a: (Hospital Insurance) Premium - Most people get Part a automatically when they turn age 65. They don't have to pay a monthly payment called a premium for Part a because they or a spouse paid Medicare taxes while they were working. You pay up to $443.00 each month if you don't get premium-free. The Part a premium is $244.00 for those individuals having 30-39 quarters of Medicare covered employment.

Part B: (Medical Insurance) Premium - $96.40 per month.

Part a: (Hospital Insurance) Deductible - $1,068.00 (Per Benefit Period)

Coinsurance - $267.00 a day for the 61st - 90th day each benefit period. $534.00 a day for the 91st - 150th day for each lifetime reserve day (total of 60 lifetime reserve days - non-renewable). All costs for each day beyond 150 days.