Medicare supplements and long term care

Won’t my Medicare supplement pay for my care?

Yes – if the care is recovery based.

No – if the care is long term care.

Medicare supplements simply pay the amount of the bill that Medicare approves but won’t pay.
Did you just think “what?” with a pinch of the brow? Yeah…us to the first time we heard all that.

Here is what it is saying…

Medicare has maximum amounts they will pay for any medical service. Say, for instance, you get an X-ray of your foot. Maybe the doc charges $250 for that. But Medicare will say, “Nope. In your geographic area the standard and usual fee for that is $100.” And if the Doc wants to work Medicare cases, s/he will have to write off the other $150 and only bill $100 for x-ray. Now, Medicare still won’t PAY all $100. Medicare only pays 80% of the approved charge – and only then after you have met your deductible for the year. So let’s say you have met your deductible. Now Medicare pays $80 of the approved $100 fee for the x-ray.

Who pays the other $20?
You do.

Unless you have a supplement. If you own a supplement, then the supplement will pay the remaining $20 on the bill.

In my example, it seems a little like chump change. I mean, most people could manage paying $20. But multiply the numbers in my example by 100 or 1000 and suddenly we are talking a lot more money!

Case in point…we had a daughter of a woman contact us not to long ago. Her Mom had decided not to get a Medicare supplement and just pay the 20% out of pocket as she was in such great health. Wouldn’t you know it, she had a stroke. Had a hospital stay and then a rehab stay for just over a month. The 3 day hospital stay was over $20,000 and then the rehab stay was another $9000. So there was an approved bill of $29,000 for her care. Medicare paid 80% of that and she had to pay the rest. It came to just under $6000. But that wasn’t even the ugliest part. She had to have long term care after that as she never did regain speech and full balance. Medicare pays none of that. Nor does your Medicare supplement! If Medicare won’t approve it to begin with, your Medicare supplement is not going to kick in either!

So she ended up paying another $7,000/month for her stay in a nursing home.

The real skinny is this: your Medicare supplement will pay for the care that Medicare APPROVES but doesn’t pay. As of this writing, the maximum number of days Medicare will approve in a rehab is 100. The average is much lower than that. So you should not plan on a Medicare supplement paying any of your long term care though it ought to pay some of your recovery care.