How Does Long-Term Care and Medicare Work?

How Does Long-Term Care and Medicare Work?

Unfortunately, many of those who are on Medicare or Medical social services 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, or skilled nursing care, but helps with basic personal tasks of everyday life. You may have heard long term care referred to as “activities of daily living” or “custodial care”. Long term care or custodial care provided by non-licensed caregivers and is separate and not covered by your Medicare policy.

Long Term Care and Medicare Advantage Explained

Long term care insurance and Medicare Advantage are two types of insurance that can help cover the costs of medical care and assistance with daily living activities. Long term care insurance is a type of insurance that is specifically designed to cover the costs of long term care, such as nursing home care or in-home care. Medicare Advantage, on the other hand, is a type of Medicare plan that provides additional coverage beyond what is offered by traditional Medicare, such as coverage for prescription drugs and certain medical procedures. While both types of insurance can provide important benefits, it is important to carefully consider your individual needs and budget when choosing which type of coverage to purchase.

How do I know if I need Long Term Care or skilled nursing facility with Medicare Advantage?

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. You’ll see long term care in places like a nursing home, custodial care, and personal care services, but not in a skilled nursing facility. Long term care insurance provides variety of settings like an assisted living facility and nursing home, but not skilled nursing facility. 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 insurance is provided in a variety of settings like:

  • An adult day health care center
  • A nursing home
  • An assisted living facility or residential care community
  • Long term care in the home (most common) provided by a family member or friend

The confusion between health coverage for long term care and Medicare Advantage likely stems from the medical services that Medicare Part A (hospital insurance) covers or what Medicare pay. Two of those Medicare coverage are skilled nursing facility — inpatient care in a skilled nursing facility and home health care, or a nursing home, which are common settings for long term care. Medicare pays medical services for skilled nursing facility. Skilled nursing or skilled nursing facility care is 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 insurance for my medical care. Should I purchase Long term care or Medicare Advantage plans? 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 skilled. nursing facilities or long term care or your healthcare needs (whether it be a medicare advantage plan, long term care, custodial care, or care from skilled nursing facilities) 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, chronic illness, in home care servicestransportation to medical appointments, meals after hospitalization and more. 

If your healthcare needs have recently changed and you think long-term care or skilled nursing 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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