Long-term care refers to a range of services and support provided to individuals who have chronic illnesses, disabilities, or other conditions that prevent them from performing daily activities independently. Health insurance, including private health plans and Medicare, generally does not cover long-term care in the way that many people expect. While there are some exceptions and overlap in coverage for certain types of services, long-term care (LTC) often requires additional coverage or resources.
Here’s how different types of health insurance address long-term care:
- Medicare:
Medicare, the federal health insurance program for those aged 65 and older or with certain disabilities, does not cover long-term care. However, it does cover:- Skilled nursing care: If you require a specific, short-term stay in a skilled nursing facility (for rehabilitation or post-hospital recovery), Medicare may cover up to 100 days. But this is only for skilled care, not for general custodial care, which is typically needed for long-term assistance with daily activities.
- Home health care: Medicare will cover certain home health care services like physical therapy or nursing care, but only if you’re homebound and under a physician’s plan of care.
- Medicaid: Medicaid, a joint federal and state program for low-income individuals, is one of the few insurance programs that does cover long-term care. It covers services in nursing homes, assisted living, and home care, but eligibility is based on income and assets. Medicaid generally only kicks in after individuals have spent down their savings and resources to a level below a certain threshold, which varies by state.
- Private Health Insurance: Most private health insurance plans (including employer-sponsored or individual health insurance) do not cover long-term care. These plans typically cover short-term medical care, hospitalization, and doctor visits but not extended custodial or personal care. Some private insurance plans may offer coverage for certain aspects of care (e.g., home health care or hospice care) but only under specific conditions.
- Long-Term Care Insurance: This is a specialized insurance policy designed to cover the cost of long-term care services. It can help pay for services in nursing homes, assisted living facilities, and home care. Long-term care insurance is purchased separately and is not included in traditional health insurance plans. However, it is important to note that long-term care insurance policies are often expensive and may not be available to everyone, especially as individuals age.
Key Takeaways:
- Medicare does not cover long-term care, except for short-term skilled services.
- Medicaid may cover long-term care if you qualify based on income and assets.
- Private health insurance does not cover long-term care, except for limited services.
- Long-term care insurance is specifically designed to cover these services, but it is separate from regular health insurance.
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