How Does Long-Term Care Insurance Differ From Health Benefits Available to Medicare Enrollees? |
| To understand how long-term care insurance differs from Medicare, it is important to understand what each covers. To help you understand long-term care insurance, please refer also the the Long-Term Care Insurance Checklist . Medicare Medicare is a federal program which provides partial payments for medical services for persons 65 and older. Medicare is divided into 2 parts:
Most American citizens over the age of 65 are eligible for Part A which pays for hospital care. Those desiring Part B coverage for doctor bills and other medical expense must pay a monthly premium (which is deducted from their social security checks). Neither Part A nor Part B pays for the entire cost of medical services. Either you or other supplementary insurance pays for deductibles and copayments. A deductible is an initial dollar amount which you pay before the Medicare starts paying. A copayment is your share of expenses for covered services above the deductible.
| Medicare is not designed to cover long-term care and, therefore, provides little nursing home coverage. Medicare provides limited skilled nursing home care. However, because of various Medicare restrictions, the average user of Medicare nursing home benefits receives only 27 days of covered care per year. You must need daily skilled nursing or skilled rehabilitation therapies to improve your condition. Medicare does not pay for intermediate or custodial care. What is Medicare Supplement Insurance? Medicare supplement insurance (which may also be called 'Medigap' insurance) pays for some or all of Medicare's deductibles and copayments. Some policies may also pay for some services not covered by Medicare. Medicare pays only for services determined to be medically necessary and only up to the 'allowable charges' approved by Medicare. Most Medicare supplements follow the same guidelines and pay nothing for services that Medicare finds unnecessary; nor do they make payments above the amount authorized by Medicare. In general, Medicare supplement policies do not cover the type of skilled, intermediate and custodial care included in long-term care insurance policies. How to compare long-term care insurance policies How do you decide what to buy? |
