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Medicare and Long Term Care

Medicare and long term care insurance offer very different benefits.

Medicare

Medicare is health insurance for:

  • People age 65 or older
  • People under age 65 with certain disabilities
  • People of any age with End-Stage Renal Disease

Medicare covers medically necessary care only. It focuses on medical acute care such as doctor visits, medicine, and hospital stays.

In addition, Medicare coverage focuses on short-term services for conditions that are expected to improve. This may include physical therapy services to help a patient regain physical function after a fall or stroke.

Unfortunately, Medicare’s skilled nursing facility (SNF) benefit does not cover most nursing home care. Medicare will pay the cost of some skilled care in an approved nursing home or in your own home, but only in specific situations.

The SNF benefit applies only if a medical professional determines you need daily skilled care after you’ve been in the hospital for at least three days. This care can only be received in a Medicare-Certified skilled nursing facility.

Medicare may cover up to 100 days of skilled nursing home care per benefit period when these conditions are met. After 20 days, beneficiaries must pay a coinsurance fee (for example: 20%).

Please Note: Medicare does not cover the cost of care in assisted living facilities. This coverage is not designed to pay for your long term care needs.

Long Term Care Insurance

Long term care insurance pays for care in your home, assisted living facility, community-based care center, nursing home, and more. This includes assistance with daily activities such as eating, bathing, dressing, transferring, toileting, and continence.

Policies begin coverage when an individual is unable to perform two out of six of these activities of daily living (ADLs) or is cognitively impaired (such as Dementia and Alzheimer’s).

Learn more about the differences of Medicare and long term care and how you can protect your family and your assets by planning now.

Use our quote calculator to discover how much long term care coverage costs for you and your spouse (if applicable).