Medicare and Long-Term Care? What is it and What’s covered?
The high cost of long-term care is what most folks are concerned about. When discussing this with clients, the one thing we ask is “What’s your Plan?” Many people take this as what long- term care policy do you have in place when I mean nothing of the sort. I asked “what’s your plan?” Your plan can be that you are going to have a relative come to your home and take care of you and there will be some sort of financial compensation. Or maybe it’s an adult child or someone else who loves you dearly that’s going to take care of you. The point is, you have a plan that doesn’t necessarily involve having an insurance policy.
Many folks are concerned about their quality of life if they should become disabled or have a long-term health issue. What we need is to review what’s covered under your current Medicare coverage first.
Medicare is “medical coverage” not “long-term care” coverage. What does that mean? As long as you are in the hospital or a Skilled Nursing Facility recovering from an accident or rehabilitation from surgery, you will be covered by your Medicare coverage as long as you spent three days in the hospital first. This can be through Medicare with a Medigap (Medicare Supplement) policy or a Medicare Advantage plan. The key to this coverage is that you are improving or being rehabilitated and showing improvement from an illness, accident, or surgery. This type of Skilled Nursing coverage is usually good for 1-100 days per event. Your co-pay, if any, will differ depending on which Medicare plan you have.
An example would be a Medicare Medigap Plan F would have no co-pay for Skilled Nursing during the first 100 days, where a Medicare Advantage Plan may have no co-pay for the first 10-20 days but co-pays after day 21 to 100. Remember these are just examples of coverage. Your coverage and co-pays are outlined in your Summer of Benefits with your policy.
If you are suffering from a cognitive or physical limitation that shows no improvement and just need daily ongoing “custodial care”, this is when you need “long-term care”. This is not covered by Medicare and Medigap or Medicare Advantage.
Long-term care situations can be anything from mental or physical conditions which are judged on 2 of the 6 ADLs (Activities of Daily Living), or cognitively impaired. In other words, you can’t perform daily functions without assistance. This can also include a variety of illnesses where you require constant medical supervision such as stroke, or some other debilitating condition.
We suggest you do your research before any of this happens. Discuss your concerns with a Retirement Planner you trust. Hint, Hint, we know someone who can help and their name starts with a “D”!! J