MoneyMindedMoms: Will Medicare Supplements Pay for Long-Term Care?

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Will Medicare Supplements Pay for Long-Term Care?
Feb 27 2011 08:00 PM | Phyllis Shelton  in Protecting Your Family -----
No. It is a misconception that Medicare supplements pay whatever Medicare doesn’t. The reality is that a Medicare supplement won’t pay anything for care at home or in a skilled nursing facility unless Medicare pays first.

Medicare supplement policies are designed to pay the deductibles and co-pays after benefits from the traditional Medicare program have been provided. Here are amounts patients who are enrolled in traditional Medicare have to pay in 2011:

• the first $1,132 deductible for a hospital stay
• a $162 deductible before receiving benefits for doctor bills then 20% after that deductible is met. (Important: Be sure and go to doctors who accept what Medicare approves as a reasonable charge. Those doctors have to write off any amount above that and you don’t have to pay for those “excess charges”.)
• a co-pay of $141.50 per day for days 80-100 of an approved skilled nursing facility stay.

Medicare only approves payment for care at home or in a skilled nursing facility for short-term recovery care necessary to help people get back on their feet after a health problem.

My cousin had a hospital stay and many doctor bills a couple of years ago due to acute kidney failure. Medicare approved about $57,000 of the charges. He was paying $160 a month for his Medicare supplement policy, which only had to pay about $1700, as that was all that was left over after Medicare finished paying his claims. So he actually spent more on his Medicare supplement premium than it paid out for him that year. That’s why some people self-insure balances to Medicare and use the money they save to buy long-term care insurance.

These balances to Medicare may sound like a lot but there are really small compared to what people pay for long-term care. Eight to ten hours of home care a day can cost $5000 a month or more. Also consider that Medicare supplement premiums usually increase each January when Medicare deductibles and co-pays increase.

Phyllis Shelton is the President of LTC Consultants, a Nashville-based consulting company specializing in long-term care insurance consumer education and training since 1991. She experienced first hand the implications of long-term caregiving with her grandfather, mother and brother. Because the need is so great, she is now focused on helping consumers who don't have a local agent acquire long-term care insurance.


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28 February 2011 - 01:11 PM
I think Medicare is very hard to understand, and since I have so many years until I will need it, I hope that I can set myself up financially in case it is no longer there!

Phyllis Shelton 

03 March 2011 - 05:18 PM
Thank you for your comment. Medicare doesn't pay for long-term care at all, just to be clear, and Medicare Supplements go hand in glove with Medicare. Both pay only short-term recovery care at home or in a nursing facility - generally less than three months. However, it's so important that everyone understand that any of us could need long-term care in the next 24 hours as a result of an accident or major health event like a stroke or aneurysm. Saving to pay for it ourselves is like trying to outrun a forest fire. Long-term care insurance is a much more cost effective way to plan ahead for long-term care. Pay a little bit now to get a lot of money later if you need it, plus your premium stops when you need care.
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