A Start to Understanding Medicare

Medicare is a national program that provides health insurance for Americans aged 65 and older who have worked and paid into the system. Many people think that if they have Medicare along with Supplemental insurance or a Medicare Advantage plan they do not have to worry about coverage for their health care needs as they age. Others, including me, who read the Medicare booklet that is sent out yearly to all enrollees, think that the 100 days of in-patient skilled care Medicare provides in each benefit period seems like a lot. Who would need more than that? Well, two families that I know are coping with exactly that situation—and their stories reveal both the benefits of limitations of the program.

I have one friend whose 90 year-old widowed mother had lived on her own for many years. A fall led to a nursing home stay for rehabilitation. Mom used up her Medicare-covered days for skilled care but did not made enough progress to live on her own. No one in the family, including Mom, had ever considered this possibility and as a consequence there was major panic over what to do next. Eventually Mom decided to stay at the nursing home and pay privately because there is no family member who is able to assist her at home.

The other situation is different because Dad is married, so there is someone to care for him at home. The problem here is that Dad’s wife is not strong enough to care for him herself. He often needs two people to assist him when he gets in or out of bed or needs to be bathed. Dad also has a daughter and a son, both of whom live and work in other states. However, this family decided to bring Dad home. His daughter plans to come and stay with her Dad and stepmom as much as possible—and they will also hire a private caregiver. The son will come as often as he can and do as much as possible. Although Dad used up his Medicare in-patient skilled care days he will qualify for Medicare covered skilled services at home. Dad requires care for wound that is not healing, physical therapy and an aide who can assist with bathing. His doctor has ordered these services. He will also be able to get a hospital bed, a wheelchair and other assistive equipment. .

These are two of many examples of what people end up doing when the unthinkable happens—they have used up their Medicare benefit for skilled care in the nursing home without recovering enough to be live independently. Often, it is only at this point that people learn that Medicare does not cover long-term care.

In my September 1st post, I wrote about a dinner conversation where a guest made the suggestion that we should all decide on and write down a plan outlining how we want to be cared for when we can no longer care for ourselves—and do this long before we need to make these choices. We should discuss our ideas with family members, our spouse and children, so that they are clear about our wishes. With that we should figure out how we will arrange and pay for the care we want knowing that Medicare does not provide long-term care.

My next post will offer ideas of what to consider when we make a plan for long-term care–long before it’s actually needed. After all, any of us could end up being the one who requires a high level of care after we have used up our Medicare covered days of in-patient skilled care. With a plan in place, at least we would reduce the stress and anguish of what to do next.

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