How Does Long-Term Care and Medicare Work?

How Does Long-Term Care and Medicare Work?

Unfortunately, many of those who are on Medicare find themselves needing more than what their Medicare coverage offers, including care for their daily living. You’ve heard of Long Term Care, but what exactly is it and how does it help those who are on Medicare coverage?

Long-term care is a range of services and support for your personal care needs — it’s not medical care,  but helps with basic personal tasks of everyday life. You may have heard it referred to as “activities of daily living” or “custodial care”. It’s provided by non-licensed caregivers and is separate and not covered by your Medicare policy.

How do I know if I need Long-Term Care?

The need for long-term care comes into play when the aging process takes effect and one loses the ability to perform the activities of daily living, which includes the ability to eat independently, dress, walk or transfer from one position to another, bathe, and toilet, and maintain bowel and bladder continence. Arthritis and Alzheimer’s disease or other dementias top the list of medical conditions contributing to a need for long-term care.

Long term care is provided in a variety of settings like:

  • An adult day-care center
  • A nursing home
  • An assisted living facility or residential care community
  • The home (most common) provided by a family member or friend

The confusion between long-term care and what Medicare covers

This confusion likely stems from the services that Medicare Part A (hospital insurance) covers. Two of those are inpatient care in a skilled nursing facility and home health care, which are common settings for long-term care. Medicare pays for care that is skilled, meaning that it requires the skills of a registered nurse, physical therapist, occupational therapist, or speech-language pathologist. 

I need long-term care. What do I do?

Well, first things first — you call us! We are happy to help you go over any questions you may have about your healthcare needs and recommend the the best course of action for you. For long-term care, however, it’s important to note (again) that Medicare does not pay for long-term care. There are a few options on how to purchase long-term care coverage, but we’re going to focus on Medicare Advantage plans. Policies have changed recently and are now allowing Medicare Advantage plans to cover supplemental healthcare benefits for “daily maintenance”, including ADL assistance, transportation to medical appointments, meals after hospitalization and more. 

If your healthcare needs have recently changed and you think long-term care might be an option for you, or you simply want to prepare for your future, call us today and speak with one of our expert agents! We can help you through each step of the process, ensure that your policy is specific to your needs, and provide excellent customer service. 

For more information or to speak directly with a Medicare Specialist, please email Michelle Tunis at or call (561) 665-7752.

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