Which Medigap Policies Provide Coverage for Long-Term Care?

By Daniel Petkevich

Sep 16, 2022

Copy Link

Everything You Need to Know About Long-Term Care

What Is Long-Term Care?

• 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?

• 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?

• 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?

Skilled Nursing Facility (SNF) Care

• 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

• 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

• Physical therapy

• Occupational therapy

• Speech-language pathology services

• Medical social services
• Part-time or intermittent home health aide care
• Injectable

  drugs for women with osteoporosis

• Medical supplies for use at home

• 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?

• 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

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.

• 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