Combining Coverage Medicare and Long Term Care

Combine Medicare, Medigap, and long term care insurance for best coverage

"Medicare was designed to cover strictly basic medical needs," notes Martin Weiss, chairman of Weiss Ratings, an independent provider of insurance ratings and analyses. "However, most elderly needing long term health care have significant personal needs that go far beyond pure medical coverage."

Weiss Ratings recommends that you combine insurance coverages for skilled nursing care, home health care, and community-based care. Here's what the company suggests:

Skilled nursing care

• Medicare will cover 100 percent of the first 20 days of skilled nursing care provided that you have spent three consecutive days in the hospital for the same condition, that care is administered in a certified facility, and that care is given within 30 days of your hospital stay. From the 21st to the 100th day, Medicare pays all expenses, except for a daily co-insurance fee.
• Medigap insurance will pick up your co-insurance fee for the 21st to 100th days.
• Private long term care insurance is needed for any nursing care that extends beyond 100 days. A doctor must determine that such care is medically necessary, or it must be shown that you can no longer perform everyday activities, such as bathing, eating, and dressing.

  Recommendation: Maximize the benefits of your Medigap policy first and then purchase a long term care policy to cover nursing care needs beyond 100 days and nursing care that is unrelated to a hospital stay.

Home health coverage

• Medicare covers your home health care expenses only if you need intermittent skilled nursing care, physical therapy, or speech therapy, and if you are confined to your home and under a doctor's care.
• Medigap policies augment your coverage by paying a $40 per visit at-home recovery benefit after your illness or injury � but only if a doctor orders that follow-up care.
• Long term care policies are needed for nonmedical care, such as custodial or personal care; nonpersonal services, such as light housekeeping, meal preparation, and laundry; and home modification, such as adding hand rails or wheelchair ramps.

  Recommendation: After taking full advantage of your Medicare and Medigap benefits, if you want to stay at home as long as possible, you should buy a comprehensive long term care policy that includes coverage for home health care.

Community-based care

• Medicare and Medigap offer no coverage for community-based care.
• Long term care insurance covers facilities such as adult day care centers, continuing-care retirement communities, and assisted-living facilities.

  Recommendation: Purchase a long term care policy, and if you can afford it, buy coverage for as many different types of care facilities as possible in order to maximize your future options.

Last updated May 13, 1999

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