Where does Medicare End - Activities of Daily Living (ADL's)

Category: Elder Law

A common question with seniors when there is a medical crisis is "Where does Medicare end?" There is always great confusion around what Medicare covers and what is does not.

I think that the most useful distinction to understand is that Medicare is a health insurance program NOT a long term care program. As a health insurance program, Medicare focuses on making you well. As a general rule, if you are stabilized and no longer improving from a medical perspective, Medicare will not cover the cost of your care.

Another way to look at it is that Medicare is not designed to pay the costs of Activities of Daily Living, or ADL's. These are the providence of long term care insurance. Activities of Daily Living are generally considered to be mobility (e.g., transfer from bed to chair), dressing, bathing, self-feeding and toileting. If you require help with these, but are no longer medically ill, Medicare will not cover the costs.

It is also useful to consider who Medicare pays. Medicare is designed to pay doctors, nurses, physicians assistance, therapists, hospitals and sub-acute care or rehabilitation facilities. All of these are dealing with your health. Medicare will not pay a nursing home, which is geared towards providing for your ADL's when you can no longer provide for the same in your home.