Don't Trust Your Long Term Care to Medicare

By Larry Mitchell
For many people, making the decision whether or not to purchase long term care insurance can be a tough one.

They are very costly, there is no guarantee you'll ever need it, and if you do, surely Medicare or Medicaid will come to the rescue. Right? Not necessarily. There are so many variables in both the Medicare and Medicaid systems that it's not safe to assume that any of your care will be covered. Even if it is, there are limits on how long and sometimes how much care you can actually receive if paid for by the government.

Long Term Care Insurance

With private long term care insurance, on the other hand, your benefits and covered services are spelled out long before you need them.

Medicare is a federal program that provides services primarily for those over the age of 65 and some younger people with disabilities. Medicaid, on the other hand, is a joint state and federal program that provides care to people who meet certain income eligibility requirements. It's generally reserved for low and limited income people.

Many people mistakenly believe that once they reach 65, Medicare will be available to them if they need certain types of care. This is somewhat accurate, because Medicare was designed to provide medical services to senior citizens. But if you need long term care, there are restrictions on how long you can receive services, as well as what types of services you can receive, unlike private long term care insurance, which will likely provide more services for a longer period of time.

Do you want to spend your remaining years in a sub-par long term care facility because of limits on what Medicare will pay for?

If you need long term care, Medicare doesn't cover assisted living care. If an injury or illness results in a sudden need nursing home care, Medicare will only provide services if you were in the hospital for at least three days immediately prior to admission. Then, it will cover skilled nursing facility care for up to 20 days; after 20 days, a co-pay applies which is currently $105 a day. It will cover a semiprivate room, skilled nursing care (though not private duty nursing care) and equipment, supplies and medicine provided by the nursing home. These are significantly less benefits than practically any private long term care insurance policy.

If you're on Medicare and you need in-home care, it will cover all in-home medical services, and home health-aide and skilled nursing care for no more than 8 hours a day and 28 hours a week. It covers 80% of the cost of things like walkers and medical beds.

These specific details will be spelled out in any long term care insurance policy you purchase, so there will be no surprises and no stress about what services you can and can't get when you need long-term care.

If you think Medicaid might be a good answer for long-term care if needed, remember that coverage through Medicaid is income-based and includes any assets. Sometimes you will be required to deplete your assets before you qualify for Medicaid services. Because Medicaid is a joint state and federal program, income and other eligibility requirements depend on the state.

If you do qualify for Medicaid, it will cover many of the expenses associate with long-term care, but generally there is no choice in which facility you can stay and you have little control over your care.

Experts say purchasing a long term care insurance policy is useful and beneficial for several reasons, specifically the shortcomings of both Medicare and Medicaid. Because you are working with private insurance, you have more choices with regard to your care and most of your care benefits are spelled out when you purchase the policy. When you purchase a long term care policy, there are many choices you can make with regard to your care so when you need it, there are no surprises about what kind of care you will receive.