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, it 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 Ave. SW, Washington, DC 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 deductibles for medical and hospital expenses. Medigap policies generally do not provide coverage for long-term care.

 

Medicare managed care. Instead of purchasing a Medigap policy, some people enroll in a Medicare HMO to supplement their Medicare benefits. Such plans may provide more preventive 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 covered by Medicare and your Medicare HMO is usually available only in participating facilities.