Case

Chronic Long –Term Care

Ideally I would say yes Medicare should cover chronic long-term care mainly because they already cover some healthcare cost. People with chronic conditions and long-term illnesses are too often denied Medicare coverage on the grounds that they will not improve, need “maintenance services only,” have “plateau” or are “chronic and stable”. According to an article in medicareadvocacy.org. Chronic conditions should not be a barrier to Medicare coverage, nor should any particular diagnosis, including arthritis, as coverage decisions should not be based on diagnosis, treatment norm or any other “rule of thumb”. Instead, Medicare coverage decisions should be based on an individual assessment of the person’s need for the care or services in question. The questions should be “does the individual meet the coverage criteria particular to the services in question and require skilled care”, NOT “will he/she improve. Further coverage for medically necessary services for chronic, long-term conditions should be equally available in both the traditional Medicare program and in Medicare managed care plans. The rules for determining what services a beneficiary can receive, and what Medicare will pay for, should be the same for both delivery systems.

Part I Introduction

Medicare offers home health care coverage which is helpful for those who are recovering from an illness or injury. It includes skilled nursing care and therapy visits, personal care, and medical supplies. But, home health care under Medicare is limited and is not intended to meet long term care needs. Medicare does not provide much coverage for people who need care in care facilities, such as nursing homes or assisted living facilities. Medicare covers only up to 100 days of “skilled” nursing care in a care facility. Most people in nursing homes do not receive what Medicare considers to be “skilled” nursing care. And, people in other types of care facilities, such as...