There is a common misconception that health insurance, including Medicare and Medicare Supplements (Medigap), pay for long-term health care services. Most people are relatively ignorant about the topic until a loved one needs long-term health care services.
The answer is these traditional health insurance programs will not pay for most long-term care services and supports. Health insurance, including Medicare and supplements, will pay for a limited amount of skilled long-term care services.
Most Long-Term Health Care is Custodial Care
However, most long-term health care is custodial in nature. Custodial care is help with your activities of daily living or supervision due to a cognitive decline. Health insurance, including Medicare and supplements, will not pay for custodial care.
They will pay for a limited number of days of skilled care. An example of skilled care is the rehab you may require following a surgery or a stroke.
For example, Medicare pays 100% of the first 20 days of skilled care. Most people have a Medicare supplement which will pay the remaining 80 days of skilled care. Fater that, you are 100% out-of-pocket.
Medicare and a supplement will pay a limited amount of in-home medical services that are prescribed by a doctor and only on a part-time basis. The care recipient must also be “confined,” which means they cannot leave their home without assistance. This coverage is certainly not long-term health care.
Medicare will not pay for anyone who needs to go into a nursing home indefinitely because they are disabled or can no longer take care of themselves. Medicare also does not cover assisted living or memory care facilities.
Remember - Medicare also does not cover custodial care, such as assistance with bathing, dressing, and eating.
Medicare Advantage plans will sometimes cover some costs related to long-term care, and Medicare Advantage may pay for respite care, meal delivery, and medical and non-medical transportation. In addition, medical-related adult day care may be covered. None of this is considered long-term care.
Medicaid is the medical welfare program, and it will pay for all types of long-term health care services if you have little or no income and assets. While some states are expanding Medicaid to include some in-home care, many people end up in a Medicaid nursing home for their care. The care recipient must use a Medicaid-approved provider.
You are Responsible for Most Long-Term Health Care
All this means is that without some type of Long-Term Care Insurance, you will have to pay for most, if not all, of your future extended care. Your family may need to become caregivers, a role that is physically and emotionally demanding.
Unless you have lived through a long-term health care event with a family member, you may not be aware that your health insurance or Medicare will not pay for long-term care services and supports. Medicaid is the medical welfare program, and you must have little or no income and assets to qualify.
A qualified and experienced Long-Term Care Insurance specialist can explain exactly what your current insurance covers and show you how Long-Term Care Insurance can pay for your choice of quality care, including in-home care.