Medicare does not cover long-term care after 100 days
This article is 1st in a Series on Long Term Care.
As life expectancy continues to climb, more Americans are facing a question that few are prepared to answer: “What happens when I need long-term care?” Long-term care (LTC) is no longer an issue for the distant future—it’s an urgent reality. More than half of all individuals will require some form of long-term care in their lifetime. Yet, many are caught off guard, unsure of where to turn or how to prepare.
A Feb 2000 report prepared by the U.S. Senate Special Committee on Aging described long-term care as “. . . differing from other types of health care in that the goal of long-term care is not to cure an illness, but to allow an individual to attain and maintain an optimal level of functioning.”
Long-term care pertains to the organization, financing, and delivery of sustained medical and human services to people in need. With an aging population and an increasing number of retirees, the demand for long-term care services is expected to skyrocket in the coming years.
More Than Nursing Homes: The Many Faces of Long-Term Care
For many, long-term care conjures images of nursing homes. But in reality, it takes many different forms, tailored to the needs of individuals with varying levels of dependency. Care can be provided:
- At home, allowing individuals to remain in familiar surroundings.
- In community settings, offering social interaction and essential services.
- In assisted living facilities, balancing independence with on-site support.
- In skilled nursing facilities, providing around-the-clock medical care.
While nursing homes are essential for those requiring intensive care, the majority of Americans prefer aging in place, receiving care at home for as long as possible. The challenge? Ensuring that care is accessible and affordable.
Medical vs. Non-Medical Care: What’s the Difference?
Long-term care isn’t just about medical treatment—it’s about supporting daily life. Medical long-term care focuses on managing chronic conditions such as heart disease and Alzheimer’s. This can include rehabilitation after an injury, medication management, or ongoing treatments for degenerative conditions.
But a significant portion of LTC is non-medical care, often referred to as custodial care. Many individuals don’t require intensive medical attention but need help with daily tasks—bathing, dressing, preparing meals, or simply moving around safely. It’s these fundamental services that often determine whether a person can remain at home or if they require a higher level of care.
Medical Long-Term Care
In absolute medical terms, long-term care is chronic care with the aim of management, control of symptoms, and maintenance of function. Chronic care differs from acute care, which is medical care aimed at treating physical problems directly in an attempt to permanently cure or control them.
From a medical perspective, long-term medical care includes treatment for or application of the following:
- falls, fractures, and injuries
- pulmonary and cardiovascular disorders
- psychiatric disorders
- kidney and liver malfunction
- prescription drug treatment
- lab work
- surgeries
- similar medical issues
Medical LTC might include medical support services for people with degenerative conditions such as Parkinson’s disease or stroke; those with prolonged illnesses such as cancer or heart disease; or people with cognitive disorders like Alzheimer’s disease.
Nonmedical Long-Term Care
Long-term care also has a nonmedical scope. Many individuals requiring long-term care are not, in fact, ill. Long-term care on the non-medical front is more like custodial care. Its purpose is to assist people with support services for daily tasks such as bathing, grooming, eating, dressing, and similar activities. Other, less personal long-term custodial care needs may involve tasks such as preparing meals, running errands, and performing household chores. Custodial care may be provided by people without special professional skills or training. Custodial care is intended to maintain and support an existing level of well-being and to preserve health and prevent its further decline. Its primary focus is on helping with activities of daily living (ADLs) and instrumental activities of daily living (IADLs).
Activities of Daily Living (ADLs)
These ordinary activities are called activities of daily living or ADLs. ADLs are the basics of self-care. The extent to which one is able or unable to perform ADLs is considered one of the most reliable ways to assess the need for long-term care services.
The following are considered fundamental self-care ADLs:
- bathing
- maintaining continence
- eating
- toileting
- dressing
- transferring (getting out of a bed or chair)
Private insurance policies and Medicaid rely on ADL measures as triggers for benefits. An insurance policy or Medicaid guidelines will specify the number of ADLs for which assistance is required—typically two out of six—for LTC benefits or payments to begin. All insurance policies must list the ADLs that trigger benefits. Cognitive impairment also triggers long-term care, often involving loss of functional or physical abilities.
Instrumental Activities of Daily Living (IADLs)
The following tasks are typically considered IADLs:
- using the telephone
- traveling
- shopping
- preparing meals
- housework
- taking medicine
- managing money
A person’s level of IADL abilities is used as a measurement of functionality. Unlike activities of daily living, which represent the fundamentals of self-care, IADLs are not considered necessary for basic functioning, and do not trigger Long Term Care benefits on most insurance policies.
Despite its importance, long-term care remains one of the most expensive and overlooked aspects of aging. Home care, assisted living, and skilled nursing facilities come with hefty price tags, often leaving families struggling to cover costs. Medicare does not cover long-term care after 100 days, leaving Medicaid and private insurance as the primary options.
The Time to Plan Is Now
Long-term care is not just a personal issue—it’s a societal challenge. Whether for yourself, a parent, or a loved one, having a plan in place can make all the difference. Understanding care options, exploring financial resources, and starting the conversation early can help ensure a future with dignity and security. After all, aging is inevitable. But facing it unprepared doesn’t have to be.
Mary Hiatt is a Retirement & Insurance Advisor and President of Mary the Medicare Lady (A non-government entity.) She is Certified in Long Term Care Programs, Policies, & Partnerships and Annuities. She offers Educational Workshops on Medicare, Long Term Care and more at no charge. Not connected with or endorsed by the U.S. government or the federal Medicare program. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. See www.hiattagency.com or contact licensed independent agent mary@hiattagency.com or call or text 402 672 9449 for more information.