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Medicare Guidelines for Long-Term Care

Long-term care services are administered in nursing homes, assisted living facilities and in-home environments. Some services may require skilled medical care whereas others provide assistance in carrying out activities of daily living. Medicare---a federally-administered health care program---sets guidelines for what types of long-term care services are covered under the program.

  1. Long-Term Care

    • Medicare exists as a federally-administered health insurance program that provides for the medical needs of senior citizens and the disabled. The program is paid for out of payroll deductions made throughout a person's time in the work force so anyone who has worked in the workforce has contributed to their Medicare coverage. And while Medicare provides for hospital and doctor's costs, certain services required within a long-term care setting are not covered under Medicare guidelines. In actuality, Medicare is not designed to provide for long-term conditions, but rather temporary care needs, such as recovery from surgical procedures or acute conditions such as heart attacks or strokes.

    Types of Care

    • Medicare health insurance coverage is divided into Parts A and B, which cover hospital and medical costs. Medicare guidelines for long-term care coverage corresponds with the benefits listed under Parts A and B, or medically-necessary services. Many of the services provided under long-term care are not considered medically necessary. These services fall under the category of custodial care and include essential daily-living activities, such as bathing, dressing and cooking. Under Medicare, services related to custodial care needs are not covered.

    Nursing Home Care

    • Medicare coverage guidelines for nursing home stays require an existing need for skilled nursing care in order for Medicare benefits to apply. Nursing home stays must be preceded by a hospital stay of at least three days in duration. Medicare benefits cover the first 20 days of nursing home care at full cost. After the first 20 days, recipients have a $141.50 per day copay requirement for up to 100 days, according to the ElderLaw Answers reference site. People who purchase Medicare supplement plans from private insurance companies may receive additional coverage for the 80-day copay period depending on the type of supplement plan purchased.

    Home Health Care Coverage

    • Home health care services are often used in the place of nursing home care for people who've undergone major surgery or experienced episodes of heart failure. Medicare coverage guidelines require any home health care services be administered according to a "plan of care" drawn up by a physician. A plan of care must include a need for skilled nursing services on a frequent basis for a designated period of time. Medicare guidelines also cover home health aide services provided they're included in the plan of care.

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