Question of the month

Does my health insurance policy cover long term elder care?

Insurance May Cover Short Term Care

Long term treatment needs to be contrasted with short-term, rehabilitation care which are commonly covered by medical insurance coverage's including medicare and advantage medicare plans. Long-term care is helping with showering, grooming, aiding around your home, providing supervision to individuals who require protective supervision and also guidance. Those solutions are called custodial care or personal care and are not covered by medicare.  

Custodial Care and Long-Term Care

Health insurance coverage's like standard Medicare or advantage Medicare plans like Humana Gold, Caremore do not pay for custodial care services or long-term care services in retirement home, or at home care agencies, or assisted living facilities, or in residential care settings or in senior adult daycare.  We also need to distinguish In-home custodial care which also is not covered by medicare.  Examples of custodial care might include offering medicines or helping with medications is an intermediary solution and also is not covered by advantage medicare  

Making sense of Insurance and Assisted Living Settings

Retirement homes offering long-term care are usually NOT paid for by traditional Medicare or Advantage Medicare alternatives. The fact is that Medicare as well as various other Advantage care choices only cover a limited amount of days for short-term rehab. Generally, traditional Medicare pays for up to 21 days in full and then with co pays for the remaining days around a total of 100 days of rehabilitation care after a 3 days hospital stay. As soon as the rehabilitation goal has been attained or the person has plateaued or they get to that ONE HUNDRED days Medicare does not pay and the price of any type of extra days in the retirement home are private pay. The out of pocket prices for a retirement home can be anywhere between two to four hundred dollars a day. Several are shocked to discover that several Advantage Medicare insurances only pay for approximately 20 days instead of the ONE HUNDRED days conventional Medicare covers.   Only after a person has actually exhausted all their nest egg and also funds will certainly they end up being qualified for Government Assistance like Medicaid. Only when an individual has Medicaid, which is very different from Medicare, does Medicaid pay for custodial care in a nursing home. In addition, there is a new fad in a number of Skilled Nursing Facilities for SNF to decline lower paying for disabled elderly on Medicaid for better paying Medicare rehabilitation residents. This fad is placing a genuine pressure on the health care system to find risk-free and trustworthy Long Term Care to our neediest elders at an affordable price. One more typical false impression is that medical insurance pays for custodial care while in your house. While many seniors require that care in addition to the licensed skilled RN which insurance does pay for, the custodial day to day help is not paid for generally. In order to be eligible for skilled RN services in the house under Medicare you have to have licensed requirement for a RN or PT to provide professional activity like dressing care, administer shots or IV or require rehabilitation from a PT or OT. Occasionally home healthcare companies use / give away as a value added of a certified nurse aide to help in bathing and also dressing one or two times a week but at no time was that paid for directly by Medicare.  Some Home Health Care Providers have offered that as an included benefit.  Most often the client or family is called upon to offer the custodial service or work with/ pay a firm or service to do that. The RN does just the skilled component of the service.   Since LTC is mostly out of pocket it is crucial for individuals to budget their funds and also not to exhaust all financial savings on costly short term Personal Care Agency or other in-home services leaving themselves with only state funded Medicaid choices in the future. While all of us want to stay at home it is always wise to recognize the budget and exactly how over spending could leave you with a reduced number of options than a more well balanced spending plan.

Answer by:

on Jul 18,2017

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