Why Medicare is not intended as a long-term care coverage plan.
With all of the concerns and details that arise during the aging process, it’s easy to be confused about the difference between Medicare and long-term care. The confusion likely stems from the services that Medicare Part A, hospital insurance, will cover. Two of those are inpatient care in a skilled nursing facility (SNF) and home health care, common settings for long-term care.
The fact is that 70% of people over 65 will need some type of long-term care during their lifetimes. To clarify, long-term care means services and support for your personal care needs. Most long-term care is not medical.
And let’s be very clear: Medicare does not pay for long-term care expenses. Neither will Medicare health insurance or employer health insurance, for that matter.
If a person moves into a nursing home because he or she needs long-term care or a homecare agency sends an aide to the home to help a patient with bathing, why doesn’t Medicare pay? The simple answer: Medicare pays for care that is skilled, meaning that it requires the skills of a registered nurse, physical therapist, occupational therapist or speech-language pathologist.
What’s more, deductibles, coinsurance and copays still need to be paid, even for services that Medicare covers.
In addition, if the average non-medical person can provide the care without additional training, the care is not categorized as skilled and Medicare will not pay for it. With a program like Envisage, on the other hand, our team helps to coordinate services and support on your behalf so you won’t become a burden to family. And that’s a key benefit that’s included with your membership.
So, with all of this in mind, how can you start planning for long-term care?
Here are some beginning steps:
- Learn about long-term care, the different options, and what’s available in your community.
- Work with a trusted financial advisor to develop a plan to cover the costs. Consider these two scary statistics:
- Fewer than 35% of Boomers have a plan for how they will receive care in retirement.
- Almost 80% have no money set aside specifically for their long-term care needs.
- Determine who can play a role in your plan. Do not expect your family to be your sole source of support. Explore community resources and caregiving options like the Envisage membership program.
- Incorporate your wishes into the plan. Do you have an up-to-date will, advance health-care directive and durable power of attorney for health care? Include in your plan important financial information and your long-term care wishes.
- Share the plan with family members, health-care providers, and anyone else who needs to know.
Older adults who believe that Medicare will pay for long-term care – or that this care involves long-term care insurance or living in a nursing home – may be woefully unprepared for the future. It’s never too late to put together a long-term care plan and to develop your personal strategy for handling decisions in the future.