As discussed in Part 1 of this series, the U.S. Department of Health and Human Services estimates that at least 70% of people over age 65 will need long-term care services at some point in their lives – and over 40% will need care in a nursing home for some period of time. In Pennsylvania, the cost for nursing care is nearly $8,000 per month. Nursing care generally is paid either out of one’s private assets, Medicare and private health insurance, long-term care insurance, or Medicaid/Medical Assistance. Medicare and private health insurance will be the focus of this Part 2. According to current statistics, approximately 20% of nursing care throughout the country is paid by Medicare. However, as will be explained below, that statistic is somewhat misleading in that Medicare coverage for nursing care is quite limited.

Many individuals mistakenly use the terms “Medicare” and “Medicaid” interchangeably, but they are entirely different programs. Medicare is a health insurance program generally for people age 65 and above. People under 65 with certain types of disabilities also can qualify for Medicare. Medicare generally has four “parts,” but the most common parts are Part A (hospital insurance) and Part B (medical insurance). For most individuals 65 or older, if they receive or are eligible to receive Social Security benefits, they are entitled to Medicare Part A completely free of charge (and others may be able to “buy-in” to Part A). Anyone who is eligible for free Part A also may enroll in Medicare Part B by paying a monthly premium (currently $96.40 or $110.50 for most individuals).