Why do I need long term care insurance when Medicare will pick up what exceeds my income?


Sadly, for long term care, this is not the case.

Medicare will only cover expenses related to short-term recovery - even from an injury or an illness. However, there is no provision in Medicare for long term care that has no definite length. Nor will it provide for fees for adult daycare or assisted living facilities.

Here are the fees that Medicare can cover:

  • Home health care. This covers for therapists and nurses who go to your home to provide care. The benefits will go for only up to 35 hours a week and is for short term care only.
  • Nursing home or any other skilled nursing facility care. The payments will only be until 100 days.
  • Hospice care. This is for those who have a terminal illness or is expected to live not longer than half a year.

Please note that these payments are only for medically necessary care. Long term care, which usually includes non-skilled care (i.e. providing assistance for daily living such as going to the toilet, bathing, and eating), is not payable under Medicare.

Since Medicare will not provide for long term care, you need to buy coverage through an individual or group long term care insurance policy. The policy will provide a specified benefit amount for every day/week/month that you are enrolled in a long term care facility. And this is regardless of what level your income is. As long as you meet the qualifications during the claim (and every policy has different qualifications), then you will receive benefits based on what kind of facility you avail of.

Another option to Medicare would be Medicaid. This can cover some of the long-term costs you incur. However, there are some requirements for you to be eligible for Medicaid cover.

For one, you have to prove that you have very limited assets and income. The cut-off level of income will vary from state to state.

Also, depending on the state you are living in, you could avail of the Programs of All-inclusive Care for the Elderly. This program is also managed by Medicaid and is for the benefit of seniors or the very sick who may need help with medical costs.

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