Medicare doesn’t pay for long term care, but you could be forgiven for thinking that it does

From Capitol Hill Watch

More than three dozen House members on Aug. 2 sent a letter to the Social Security Administration asking the agency to clarify that Medicare does not cover long-term care, CQ HealthBeat reports. The bipartisan letter urges SSA Commissioner Michael Astrue to include in Social Security statements sent annually to 143 million U.S. residents the sentence: “Medicare generally does not pay for long-term care.”

The statement currently says that Medicare provides some coverage for “nursing care,” which the lawmakers wrote “creates an unnecessary risk that individuals will assume Medicare covers an extended stay in a nursing home, when in fact it does not.” While Medicare covers care delivered in skilled nursing facilities for beneficiaries who require longer-term medical treatment, it does not pay for custodial care, such as assistance with eating, bathing and other daily living activities. A December 2006 AARP survey found that 59% of adults ages 45 and older overestimated Medicare coverage for long-term care (CQ HealthBeat, 8/9).

Why the confusion? Medicare is a non-means tested program for the elderly and disabled. Medicaid is a means tested program –in other words it is health care coverage for the poor. That sounds simple. But then there are “dual eligibles” who qualify for both programs. They sucked up 40% of Medicaid spending as of 2003. Of that, 66% was for long term care spending. So almost 30% of Medicaid spending goes to Medicare-eligible patients for long-term care. Medicare patients can achieve Medicaid eligibility by running out of money (or in the past by giving it away).
I can understand the philosophy behind dual-eligibility, but it tends to obscure the fact that the US spends even more on the old and less on the young than is generally acknowledged. Personally I’d rather see the federal government spend more on the poor and less on the old and add a means test to Medicare while we’re at it.

August 14, 2007

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