Medicare Expansion Ignores Long-Term Care Needs

Last week, Medicare entered into an agreement to settle a lawsuit brought by a Vermont-based woman named Glenda Jimmo in conjunction with the Center for Medicare Advocacy and other plaintiffs, according to Forbes.com. As part of the settlement, Medicare has agreed to expand skilled nursing cares and rehabilitation benefits for some individuals with chronic disease. But what this settlement does not include is an expansion of long-term care benefits.

No long-term care benefits

Medicare has never provided coverage for long-term care, which can be a common misconception. Medicare covers only skilled nursing care, which includes physical and occupational therapy as well as complex nursing care, such as IV therapies or wound care. And Medicare only provides coverage for skilled care for a short duration, after which it becomes the patient’s responsibility to continue paying for care out-of-pocket. Only if another qualifying hospital stay occurs can an extension of skilled nursing benefits occur.

Medicare settlement won't expand long-term care benefits

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Long-term care, on the other hand, is also known as custodial care. Medicaid will cover long-term care in some cases, but not all.

Clarifying vague language on maintenance therapy

This settlement won’t change the duration of coverage for skilled nursing care, which has a maximum of 100 days. It will, however, clarify vague language. Providers have been reluctant to continue providing skilled care to patients who were not continuously improving as a result of that care, fearing that payment would be denied. But now, patients are eligible to receive skilled care even if that care doesn’t cause improvement but allows the patient to maintain her current health status.

Skilled nursing care must be deemed necessary by a medical professional or based on an individual assessment, but doctors will no longer have to certify that patients will improve as a result.

Forbes.com points out that these changes could actually end up saving the Medicare program money in the long run. Ongoing therapies can help patients maintain their current health status, preventing more frequent hospitalizations.

While a judge must enter the ruling for it to become official, Medicare will already begin to implement these changes. Still, it could take months for the changes to be in full effect.

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2 Responses to “Medicare Expansion Ignores Long-Term Care Needs”

  1. Ed Young says:

    Appreciate the update. I discuss these details in my educational workshops. To be clear, there is no effect on the cost of Medicare due to this change?
    Thanks.
    Ed

  2. LTCI Leads says:

    This lawsuit is a perfect example of the ignorance of people regarding Medicare and long term care. They assume and insist that it provides comprehensive coverage including custodial care. It only covers skilled nursing care, which is not enough for most Americans. Although they have agreed to expand their coverage, it’s still limited to skilled care. What people should do is explore their other options since federal programs aren’t enough to help them foot their long term care expenses by considering buying a private insurance. LTC insurance is expensive in nature but there are ways to keep the premiums low and yet they will still greatly benefit from their coverage. People should learn to do things on their own through research, by asking around and by asking the help of ltc specialists. Filing a lawsuit to Medicare is not the answer. I believe that it’s the responsibility of the person to take charge of his life and ensure his future.

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