Long-term care and Medicare Advantage

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While Medicare hasn’t always covered long-term care, that’s beginning to change. Well, sort of.

The Centers for Medicare and Medicaid Services are letting Medicare Advantage insurers expand into long-term care services.

Medicaid  typically offers long-term care coverage for those who qualify. Medicaid coverage includes assisted living, nursing home and in-home care. However, to be eligible for Medicaid, your income cannot exceed a certain amount. See the  differences between Medicare and Medicaid. 

That level of long-term care coverage isn’t available in Medicare. However, Medicare Advantage has expanded supplemental benefits that cover some long-term and at-home care.

Key Takeaways

Medicare Advantage may be a good option for those who want to get supplemental benefits like some long-term and at-home care.
Medicare Advantage may cover more than just hospital visits and basic checkups. It may include stays in a skilled nursing facility, hospice and respite care and eligible home health services.

The word “long-term care” can be somewhat misleading. Sometimes the care isn’t really “long term.” Insurance Information Institute (III) said the term pertains to actions called “activities of daily living” (ADLs):

Eating
Bathing
Dressing
Toileting
Transferring
Maintaining continence

“In general, if you can’t do two or more of these activities, or if you have a cognitive impairment, you are said to need ‘long-term care,'” III said. “Long-term care isn’t a very helpful name for this type of situation because, for one thing, it might not last for a long time. Some people who need ADL services might need them only for a few months or less.”

This care could be provided in a nursing home, but that’s not required. It can also be at an assisted living facility, adult day care center or home.

Does Medicare cover long-term care?

The short answer is no. Not in the technical sense of the term.

III said it’s vital to understand the difference between help with ADLs, which is referred to as “custodial care,” and “skilled care.” Skilled care is help with medical, rehabilitation services, nursing, testing or taking medication. This distinction is important because Medicare and most private health insurance pay only for skilled care — not custodial care.

Medicare Advantage covers specialized care, such as stays in a skilled nursing facility, hospice and respite care and eligible home health services. Some Medicare Advantage plans now cover certain long-term care and at-home care services. These services may include home-delivered meals and grab bars for home bathrooms.

“Medicare Advantage plans now have the flexibility to offer new supplemental benefits like in-home care support, but long-term care coverage is different,” explained Cathryn Donaldson, director, Communications & Public Affairs, America’s Health Insurance Plans (AHIP).

Long-term care alternatives

We’ve reviewed how Medicare Advantage is adding supplemental benefits to help with aspects of long-term care, but how can you get actual long-term care coverage?

Medicaid is often how people get long-term care protection. However, you have to qualify in your state. Enrollment differs from state. Most states expanded Medicaid to allow people to enroll who are 138% of the federal poverty level.

Source:

Medicare.gov. “Long-term care.” Accessed August 2022.

Disclaimer:

Insure.com is not affiliated with or endorsed by the government or Federal Medicare program. Plans are insured or covered by a Medicare Advantage organization with a Medicare contract and/or a Medicare approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY 1-877-486-2048), 24 hours a day/7 days a week, to get information on all of your options. Not all plans offer all of these benefits. Benefits and availability may vary by carrier and location. Limitations and exclusions may apply. Every year, Medicare evaluates plans based on a 5-star rating system. Part B Premium give-back is not available with all plans. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.

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Long-term care options in Medicare Advantage

Does Medicare cover long-term care?

Long-term care alternatives

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