Currently Medicare Part A (hospital care) covers the full cost of skilled nursing facility care for 20 days following a qualifying inpatient hospital stay of 3 days. For days 21 thru 100 the patient pays $176/day coinsurance. After 100 days the patient pays all costs. No other form of long term care is paid for by Medicare except hospice care. To qualify for hospice care a doctor must certify that the patient is terminally ill with a life expectancy of 6 months of less. The patient must agree to accept palliative (comfort) care in lieu of medical treatment for the illness.

According to Senator Sanders’ campaign website:

“Medicare coverage will be expanded and improved to include: include dental, hearing, vision, and home- and community-based long-term care”

Senator Sanders’ proposed Medicare-for-all bill S.1129 page Title II, Section 201, Comprehensive Benefits (a)(13) references 42 CFR Section 441.530 which excludes skilled nursing facilities.

Home and community based long-term care is typically funded by Medicaid that varies by state. In 2018 Medicaid reimbursement rates to skilled nursing facilities were less than half of Medicare reimbursement rates. Since most skilled nursing facilities are profit motivated, there is a vast difference in the quality of care provided to Medicaid funded patients vs Medicare funded patients.

“I’d ask you to think of the last few health issues you or a friend/family member have had, from unpleasant to life threatening — or medications you currently take. And then, imagine you or that person didn’t have the ability to afford treatment and just had to live (or not!) with the problem.”

The median cost of a skilled nursing care facility varies by state from $4,258 to $23,451 per month. Some Americans have considered moving to Mexico where assisted living and nursing care is much cheaper. Senator Sanders’ Medicare-for-all fails to address the cost impact of long-term care.