Why Medicare Matters to People Who Need Long-Term Care

Medicare was enacted to provide health insurance to the elderly (and later, the disabled) population. Not only was it not intended to pay for long-term care (LTC); its statute explicitly excluded coverage for custodial care—the assistance with basic activities of daily living (ADLs) (such as bathing, dressing, and eating) that constitute LTC. Although the Federal-State Medicaid program, unlike Medicare, does finance LTC, its protection does not prevent financial catastrophe resulting from LTC needs. Rather, it supports service only after people have become impoverished. Given the limitations of public programs and of private insurance, today, as in 1966, people face the prospect of financial catastrophe when they need extensive LTC services. Although Medicare was not designed as, and has not become, an LTC program, it matters enormously to people who need such care. First and foremost, Medicare's functionally impaired beneficiaries depend on Medicare to finance the substantial medical care they require. Second, beneficiaries are affected by Medicare policies regarding its postacute benefits, home health, and skilled nursing facility (SNF) care. Although SNF care remains overwhelmingly related to acute rather than