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Medicare

Medicare is the federal government’s health insurance program for the disabled and those 65 years and older. Many Americans believe Medicare will pay their long-term care bills, but in fact it pays for a small percentage of all nursing home costs. At present, may cover skilled care in a nursing home for the first 20 days (and a portion of the cost for the next 80 days) if admission follows a three day hospital stay. The biggest gaps in Medicare’s long-term coverage are:

  • No coverage for custodial care, either at home or in a nursing home

  • No coverage in a nursing home without prior hospitalization

  • No coverage for nursing home care after 100 days

  • Coverage only in a Medicare-approved facility

To apply for Medicare or obtain information about the program, contact your local office of the Social Security Administration. For a free copy of The Medicare Handbook, write to:

CMS, Office of Public Affairs

200 Independence Avenue SW

Washington, D.C. 20201

or call the Medicare Hotline at 1-800-772-1213. Medicare supplement insurance (often called Medigap) is private insurance that supplements Medicare benefits and may cover co-payments and dedubtibles for medical and hospital expenses. Medigap policies generally do not provide converage for long-term care.

Instead of purchasing a Medigap policy, some people enroll in a Medicare HMO to supplement their Medicare benefits. Such plans may provide more preventative services and charge lower co-payments. However, you are generally restricted to participating providers (physicians, hospitals, nursing homes, etc…). Again, such plans generally do not provide coverage for long-term care. Short-term nursing home care by Medicare and you Medicare HMO is usually available only in participating facilities.