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What is Medicare Long Term Care?

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  • Written By: Jason C. Chavis
  • Edited By: Bronwyn Harris
  • Last Modified Date: 30 November 2016
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Medicare long term care is a service designed to offer care to people with chronic illness or disability by medical or non-medical professionals skilled in the profession. It is designed to help meet both medical and personal needs. Often, daily activities such as getting dressed, taking a bath, or even using a bathroom can be a challenge for certain people. Medicare long term care comes in the form of community-based treatment at home, assisted living facilities or nursing homes. According to the U.S. Department of Health and Human Services, 40 percent of people over the age of 65 will need long term care during their lifetime, with 10 percent receiving more than five years of assistance.

Medicare generally does not pay for long term care. The system is designed to only offer necessary medical treatment either in a nursing facility or the home, rather than day-to-day assistance. However, certain situations allow for Medicare to cover this type of care. Only on rare occasions, though, is this process used to make Medicare pay for long term care.

According to the basic Medicare system, the plan is divided into four different sections, each with a letter identifying its purpose. Medicare Part A covers hospital stays and residency in a long term skilled nursing facility up to 100 days; 20 days covered in full and 80 with a co-payment. A person then needs to have a 60 day break before another 100 days in a nursing facility will be approved.

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Some forms of Medicare Part C, the Medicare Advantage Plan, offer long term care. This usually comes in the form of skilled professionals able to assist with living patterns and monitoring of a person's health, such as diabetes care. With these Medicare long term care plans, however, some of the cost is deferred to the recipient.

The only exceptions to these rules occur when Medicare long term care is deemed necessary. The first step to this process is having a diagnosis by a medical practitioner or physician. This diagnosis is then sent to the Medicare administration. Approval can take many weeks to months and generally does not occur in time for the individual to avoid out-of-pocket costs. Usually, people in need of long term care must pay a portion of the costs, at least up front, using either savings or social security payments.

Some organizations will work directly with Medicare to provide long term care as well. If a person uses these agencies, the individual generally does not have to deal with the Medicare administration and simply waits for approval. These organizations are full-service companies, providing both care and administrative duties. However, some of these groups take advantage of the system and the patients themselves in an effort to make a large profit, so care must always be taken when choosing a private company.

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