How Not To Tear Your Family Apart

The Medicare and Medicare Basics33

Medicare covers medically necessary acute care, such as doctor visits, prescription drugs, and hospital stays. Except for specific circumstances, Medicare does not pay for most long-term care services or personal care, such as help with bathing or for supervision, which is considered custodial care.34 Medicare does not provide long-term care coverage or custodial care unless medical care is needed.

Medigap plans are intended to fill the “gaps” in Medicare insurance. However, even the most comprehensive Medigap plans do not cover long-term care needs. These policies currently do not pay for assisted living, Alzheimer’s disease, custodial care, personal care, or adult day care.35

Medicare Advantage plans generally cover specialized care, such as stays in a skilled nursing facility, hospice, respite care, and eligible home health services. Some Medicare Advantage plans now cover certain long-term care and at-home care services.36

Recent Changes

Medicare provides benefit payments for three broad categories of treatment: hospital (emergencies and surgeries), medical (doctors and treatments), and pharmaceutical (medicines). Unlike Medicaid, Medicare is an entitlement program, meaning that everyone who reaches age sixty-five and is entitled to receive social security benefits also receives Medicare. Medicare also covers people of any age who are permanently disabled or who have end-stage renal disease. Medicare is financed by multiple tax-funded trust funds, trust fund interest, beneficiary premiums, and additional money approved by Congress.