Long Term Care Coverage for Less

You may have never considered the idea that you, or someone you love, will need long term care. Your current Medicare or Medicaid coverage may pay for some or all of your current medical expenses, but long-term care doesn’t actually qualify as a “medical expense.”

What is long-term care?

Long-term care consists of all the services and support you may need on a day to day basis, apart from doctor or hospital visits. Sometimes categorized as Activities of Daily Living (ADLs) or Instrumental Activities of Daily Living (IADLs), covered long-term care services can range from help bathing, eating, dressing, and using the bathroom, to having a care provider help you get around your living space, do light housework, manage your medications, care for pets, and even help manage your money.  

Receiving supplemental care by a in-home hired professional or specialized care facility (like a nursing home or assisted living facility) between medical doctors visits is often crucial to recovery from a serious injury, coping with a disability, or living with a chronic health condition. Planning ahead is the best way you can protect your family, both emotionally and financially, if a situation arises that you need long-term care. You can do this by building an advance care plan, organizing all of your legal documents, discussing your wishes with your loved ones, and appointing a family member to be your health care decision maker in the event that you can’t speak for yourself.  If you can afford it, you may also want to consider purchasing additional long-term care insurance from a private insurance company. 

Under certain circumstances, Medicare or Medicaid might cover a portion of your long-term care costs. But, both plans have varying rules and regulations regarding benefits and out-of-pocket cost. According to the U.S. Department of Health & Human Services, the following is the breakdown of long-term care covered by Medicare & Medicaid. 

Medicaid:

  • Does pay for the largest share of long-term care services, but to qualify, your income must be below a certain level and you must meet minimum state eligibility requirements (requirements are based on the amount of assistance you need with ADLs)
  • Other federal programs such as the Older Americans Act and the Department of Veterans Affairs pay for long-term care services, but only for specific populations and in certain circumstances.

Medicare:

  • Medicare only pays for long-term care if you require skilled services or rehabilitative care: 
  • May cover up to 100 days in a nursing facility , but the average Medicare covered stay is much shorter (22 days).
  • May cover care at home if you are also receiving skilled home health or other skilled in-home services. Generally, long-term care services are covered only for a short period of time.
  • Medicare does not pay for non-skilled assistance with ADLs, which make up the majority of long-term care services. Read the fine print before you hire someone.
  • You are personally responsible for paying for any & all long-term care services you receive that aren’t covered by a public or private insurance program. 

To learn more about what’s covered, what’s not, and explore all your long-term care options, click here

Ready to request that Medicaid or Medicare pay for some your long-term care costs? Complete and submit this printable Medicare/Medicaid Long Term Care Facility Application (CMS-671).  PDFfiller‘s platform make it simple and fast to type your information into the CMS-167 form (or any other document you like), add check marks and your signature as needed, then save it, send it via email, eFax it to the applicable department, or print it and send it by snail mail. Don’t worry: your security is our priority. Every single form, signature, and piece of personal information you input is securely protected within your account.