If You Think Medicare Covers All Aging Needs Think again.
Medicare is Medical Care. It covers physician care, hospital care, post-acute care (care after a hospital stay), such as a skilled nursing facility or home health care for rehabilitation. In all cases, however, there are limits.
1) Hospice is covered and it now appears doctors will be paid for end of life discussions.
2) Medicare Advantage plans may cover a few more things than traditional Medicare supplemental plans, such as fitness classes and limited eyeglass and dental care. These plans do not cover long term care whether at home or in a facility.
3) Part D covers pharmaceutical costs up to a point. With the Affordable Care Act the “donut hole” will be closing, but still cancer drugs and other specialty medications can cost up to $100,000. You are still responsible for co-pays up to your deductible amount. In Medicare you are generally responsible for 20% of the cost.
4) Medicare covers certain “assistive” devices, including walkers and some types of wheelchairs, but there are many restrictions about what is available. High co-insurance means you also must pay for a substantial portion yourself.
Medicare does not cover long-term care! It did not cover most of the costs associated with my mother’s care as noted in my previous blog. Nor does it cover non-medical care needed by people with dementia or long-term disabilities.
Overall, long-term care insurance coverage is inadequate. It is expensive and typically covers around three or slightly more years of care and not always at full cost. If you need long term care, and have means, you must spend them (called ‘spend down’). If you don’t have means, there is Medicaid for low-income seniors and there are a few programs available in some communities that help.
“Most people don’t realize what they will face, but there are some positive steps people can take to prevent what can often can be an emotional and personal disaster for the person and the family,” explains Denise Klein, Executive Director, Wider Horizons, in Seattle, WA(http://widerhorizonsvillage.org/), former Executive Director of Senior Services in Seattle for 10 years. She has worked in the fields of aging, health, and long-term care for more than 40 years.