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Doesn't Health Insurance Pay for Long-Term Care? What About Medicare and Supplements? Medicaid?

Quick Answer

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 extended care. Medicaid is the medical welfare program, and you must have little or no income and assets to qualify.
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Detailed Answer

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

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

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.

 

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Get Accurate Quotes

Work With A Trusted Specialist

  • Has substantial experience in Long-Term Care Insurance
  • Strong understanding of underwriting, policy design, and claims experience
  • Represents all or most of all the leading insurance companies
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