Medicare Long-Term Care Benefits

If you have a chronic illness or disability, you may need long-term care in the form of medical and non-medical services. You may receive long-term care services at home, in community programs, in assisted living or in a nursing home. Medicare offers limited long-term care benefits, paying only for medically necessary skilled nursing facility or home health care if you meet certain conditions.

Skilled Nursing Care Eligibility

• Medicare Part A pays for skilled nursing care under the following conditions: If you spend at least three Medicare-covered days in a hospital and then go to a skilled nursing facility, Medicare covers eligible expenses in full for the first 20 days in the skilled nursing facility during that benefit period. For days 21 through 100, your daily co-pay contribution in 2011 will be $141.50. You pay all costs after day 100. Medicare defines a benefit period as starting on the day you go to a hospital or skilled nursing facility and ending when you haven't received any hospital or skilled nursing care for 60 days in a row. If you go into a hospital or nursing facility after the end of a benefit period, a new benefit period begins.

Skilled Nursing Care Benefits

• Medicare covers the following services in a skilled nursing facility: semi-private room, meals, skilled nursing care, physical therapy, occupational therapy, speech-language pathology services, medical social services, medications, dietary counseling, medical supplies and equipment used in the facility, and ambulance service to the nearest provider of needed services not available at the nursing facility.

Qualifying for Home Health Care

• Medicare covers some home health care services if you meet all of the following four conditions: your doctor decides you need medical care at home and makes a home-care plan; you need intermittent skilled nursing care, physical therapy, speech-language therapy or occupational therapy; a Medicare-certified home health agency must provide the care; you must be homebound or normally unable to leave home without help.

Covered Home Health Care Services

• If you meet all four of these eligibility requirements, Medicare will cover part-time or intermittent skilled nursing care and part-time or intermittent home health aide services. Medicare defines part-time or intermittent care as care that you receive on fewer than seven days a week or less than eight hours a day over a period of 21 days or less, with occasional exceptions. Medicare will also cover physical therapy, speech-language therapy and occupational therapy for as long as your doctor says you need it; medical social services to help you with social and emotional concerns related to your illness; some medical supplies, such as wound dressings; and durable medical equipment, such as a wheelchair or walker. Although Medicare generally does not cover prescription drugs or biologicals such as vaccines, cultures and other preparations made from living organisms and their products, Medicare will cover Food and Drug Administration-approved injectable osteoporosis drugs under some circumstances.

Custodial Care

• Medicare doesn't pay for non-skilled custodial care. The most common type of long-term care, non-custodial care provides help with the activities of daily living, such as dressing, bathing and using the bathroom.