Long Term Care Insurance Coverage through Government-Funded Plans
A long-term care insurance coverage covers the costs of long term care services like, nursing home expenses, adult day care costs or home health aide charges. The reason you need a separate long-term care insurance is because your regular health insurance does not cover the costs of long term care services.
There are many private insurance companies who offer long term care insurance coverage through various plans. Long term care is mostly needed by elderly people who are suffering from some old-age related issues.Another reason to buy long term care insurance is the fact that there is very little long-term care insurance coverage from government-funded health insurance plans. People have the assumption that Medicare covers these costs,but it is not so.
Medicare and Medigap for Long-Term Care Insurance Coverage
Before going on to the long-term care insurance coverage provided by these two federally-funded plans, we should get a clear idea about Medicare and Medigap first.
Medicare is the health insurance plan which is funded by the federal-government and is meant for people 65 years or older.Implemented in 1965, it is now managed by the Centers for Medicare and Medicaid Services. This program also includes people who are legally blind, those who are suffering from end-stage renal failure, those who have some disability which makes them eligible to get disability benefit.
Parts of Medicare
The Medicare program has four parts – Part A, Part B, Part C and Part D. Part A and Part B together make what is known as Original Medicare.
Medicare Part A -Hospital Insurance
This part of the Medicare program covers the inpatient hospitalization costs and some nursing home stay or home health care costs followed by the hospital stay and some hospice care. Those who have at least forty quarters of social security credits do not have to pay any premiums for Medicare Part A.
Part B – Outpatient Costs Insurance
This part covers the costs of doctor visits, outpatient hospitalization expenses, certain therapies, lab tests and some preventive care. Anyone who is eligible for Part A can buy Part B for which a monthly premium is required.
Medicare Part C – Medicare Advantage
This part has to be bought from private insurance companies and provides the benefits of both Part A and Part B along with some additional benefits.You can buy these plans if you have both Medicare Part A and Part B.
Medicare Part D – Prescription Drug Coverage
This part covers the costs for prescription drugs and has to be bought from private insurance companies. Some Medicare Advantage plans offer prescription drugs benefits also.
These are special plans which supplement the Original Medicare plans – cover the out-of-pocket expenses, provide some extra benefits etc. These have to be bought from private insurance companies and can be used with Medicare Part A and Part B only. There are ten standardized Medigap plans from which you can choose any one.
Long-Term Care Coverage from Medicare and Medigap
Though Medicare covers many health benefits for seniors, the long-term care insurance coverage is very limited. Medicare covers some skilled nursing home care only after the eligibility criteria are met. These are –
- In order to get skilled nursing care coverage, the person should have a hospital stay prior to the stay in the nursing home.
- The skilled nursing home care has to be taken within thirty days of the prior hospitalization
- The skilled nursing care has to be approved by a doctor
- The skilled nursing care can be taken from only those facilities which are approved by Medicare
Skilled Nursing Home Coverage through Medicare
Medicare will only provide skilled nursing home care costs only when the above conditions are fulfilled. However, even after a person meets the conditions, full coverage is not allowed under Medicare. The coverage varies with the number of days of stay. For the first twenty days of stay, Medicare pays the full cost, from the twenty-first day through the hundredth day, the patient has to pay a daily co-pay, which is $167.50 in 2018. The rest of the amount is paid by Medicare. After the hundredth day, Medicare does not provide any coverage. If you have Medicare Advantage or Medigap, the co-pay amount (21st day -100th day) could be covered by them to some extent.
Home Health Coverage through Medicare
Medicare covers some amount of home health care coverage only under restricted conditions.The necessity of the skilled care at home has to be approved by a physician. The home health care can be taken from only an agency which is approved by Medicare. Skilled care at home is covered only for patients who are confined at home. Medicare may allow some medical social services, medical equipment or supplies if the patient qualifies. Custodial care in any form is not covered by Medicare.
Long-Term Care Coverage through Medigap
Medigap covers the co-pays that you are supposed to pay for stay at a skilled nursing home following a hospital stay. After the hundredth day, Medicare does not offer any coverage so Medigap coverage is not there. There is also no coverage for custodial care under any of the Medigap plans.
Where long-term care insurance coverage is concerned, both Medicare and Medigap offer almost negligible coverage. So, it is all the more important to have a proper long-term care insurance policy from a private insurance company.
More Useful Links:
What is Long Term Care