Dear Remi,

Unfortunately, Medicare usually does not cover long-term care (LTC) services.

LTC refers to a range of services and supports that help you perform everyday activities. LTC can be provided in your home, a nursing home, an assisted living facility, or other setting, and may include medical care, therapy, 24-hour care, personal care, and custodial care (homemaker services).

Just because something is not covered by Medicare, though, doesn’t mean it isn’t needed. There are other ways you can receive this help. Let’s discuss a few:

• Medicaid is a state and federal program that provides health coverage if you have a limited income. Medicaid is the country’s largest payer of LTC services and will pay for nursing home care. Medicaid benefits also coordinate with Medicare. While Medicaid can vary from state to state, all states should have a Medicaid program that covers long-term care for those who need care at home and those who need long-term care in a nursing home. Call your local Medicaid office to learn if meet the eligibility criteria in your state.
• An Area Agency on Aging (AAA) may be able to provide counseling and connect you with low-cost services in your area.
• Local senior centers may have programs that can deliver meals, provide transportation and shopping assistance, and offer case management. To find senior centers in your area, call your local AAA or use the Eldercare Locator tool.
• Faith-based organizations and charities may offer services, financial assistance, and/or referrals to other organizations in your area.
• Geriatric care managers are health and human services professionals who work privately with you and your family to create a plan of care that meets your needs.

While Medicare does not cover long-term care, it does cover home health care. Under the home health benefit, Medicare pays in full for an aide if you require skilled care (skilled nursing or therapy services). A home health aide provides personal care services, including help with bathing, toileting, and dressing. However, Medicare will not pay for an aide if you only require personal care and do not need skilled care.

In other words, if your spouse needs skilled nursing care or therapy services in addition to personal care, Medicare may cover the cost of an aide. If you are unsure what kind of care your spouse needs, start by speaking with his health care provider.

I hope this helps with your and your spouse’s situation. You can also contact your State Health Insurance Assistance Program (SHIP) for more counseling.

-Marci