Which Medigap Policies Provide Coverage for Long-Term Care?
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Which Medigap Policies Provide Coverage for Long-Term Care?

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By Daniel Petkevich

Sep 16, 2022

Everything You Need to Know About Long-Term Care

As we age, daily chores we might take for granted — like cooking and bathing — can become challenging.

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If you develop age-related health issues, you might need long-term care.

Medicare and Medigap plans may only cover certain long-term care services. However, you can protect yourself by investing in a long-term care insurance plan.

Let's dive deeper into long-term care and discuss how you can get coverage.

What Is Long-Term Care?

Long-term care includes any health-related services that are needed for an extended period. It covers everything from long-term medical care to financial support to housing arrangements.

Long-term care is more than just an insurance policy.

  • It helps people who struggle to perform daily activities — like dressing, eating, walking, or using the bathroom.

  • It supports family and social needs.

  • It prevents health conditions from getting worse.

Where Can I Receive Long-Term Care?

You can receive long-term care services in the following settings:

  • Assisted Living Facilities

    • Live on your own but still receive daily assistance and medical attention.

  • Nursing Homes or Skilled Nursing Facilities

    • Receive comprehensive healthcare services and ongoing medical care.

  • Continuing Care Retirement Communities

    • Move from independent living to more individualized care (for example: meal, transportation, and/or senior center services).

  • Your Home

    • Live at home or with family members while receiving medical care and daily assistance.

Do I Need Long-Term Care Insurance Coverage?

While it's hard to predict when this coverage becomes necessary, it's good to have a backup plan.

Insurance coverage protects you if you get sick, develop severe vision problems, or encounter another sudden need for long-term medical care.

The following factors influence the need for long-term care:

  • Age — The older you are, the more likely it is that you'll need long-term care.

  • Gender — Since women typically live longer than men, they have a higher chance of needing long-term care.

  • Disability — If you have a disability or get in an accident that leaves you disabled, you'll probably need long-term care.

  • Health Condition — If you or your family have a history of chronic medical conditions or cognitive disorders, like Alzheimer's, you are more likely to require assistance.

  • Marital Status — Singles are more likely than married couples to need long-term care.

Does Medigap Cover Long-Term Care?

No. Medicare and Medigap Plans don't provide direct coverage for long-term care. However, they do cover some services that fall under the long-term care umbrella.

Let's take a look at some examples:

Skilled Nursing Facility (SNF) Care

Insurance might cover your expenses if you need skilled nursing care on a short-term basis (i.e., after an accident/medical procedure).

  • Medicare — provides full coverage for the first 20 days.

  • Medigap — covers 50% to 100% of the coinsurance (depending on your plan) for the next 80 days.

Hospice Care

Hospice makes terminally ill patients’ lives more comfortable with physical care, counseling, drugs, equipment, and other supplies.

Insurance coverage varies:

  • Medicare — covers hospice care only if your hospice provider is Medicare-approved.

    • Includes everything needed to manage terminal illness.

    • Covers services for any health problems not related to terminal illness but involves deductibles and coinsurance.

  • Medigap — covers 50% to 100% of hospice coinsurance and copayments (depending on your plan).

    • Pays for drugs, respite care, and treatments for problems unrelated to your terminal illness.

Home Health Care

Home health care provides medical care for homebound patients.

Services include:

Medicare covers 100% of these services.

It also pays for most of your durable medical equipment (DME):

  • Once you pay the Part B deductible, Medicare pays 80% of the Medicare-approved amount.

  • Your Medigap plan may cover 50% to 100% of the remaining 20%.

How Do I Get Coverage for Long-Term Care?

You can get long-term care insurance by:

  • Purchasing it directly from a private insurance company

  • Connecting to an insurance company through an agent

  • Buying it from your employer's broker at group rates

Keep these things in mind when shopping for long-term care insurance:

  1. Different insurance companies charge different prices for the same amount of coverage.

  2. Costs vary depending on your age, gender, marital status, and type of coverage.

  3. Shop around and compare policies to find one that fits your needs and budget.

Some of your long-term care choices include:

  • Home and community-based services

  • Accessory Dwelling Unit (ADU)

  • Subsidized senior housing

  • Continuing Care Retirement Communities (CCRCs)

  • Group living arrangements

  • Hospice and respite care

  • PACE (Program of All-inclusive Care for the Elderly)

Conclusion

We all experience aging differently, and it's difficult to predict when unique challenges might arise.

Age-related changes can be scary, but you are not alone. A long-term care insurance plan ensures you have assistance for as long as you need.

If you need help finding a long-term insurance provider, Fair Square Medicare is here to help! Our experts will help you decide which long-term care plan best fits your individual needs.

Call us today at 1-888-376-2028.

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