Coverage for long-term care can vary depending on how you receive your Medicare and/or supplemental benefits. The type of long-term care you receive also impacts how your Medicare benefits apply to the cost of those services. Supplemental insurance may help reduce some of the out-of-pocket expenses associated with long-term care.

Understanding Long-Term Care

The National Institute of Aging defines long-term care as a set of coordinated services designed to meet a person’s needs with personal care and health. These services can be provided in a variety of settings:

  • Assisted Living Facility. This type of long-term care integrates independent living arrangements with services that cover the spectrum between daily living and basic healthcare needs.
  • Nursing Home or Skilled Nursing Facility. Long-term care residents who need the services of a team of healthcare professionals often choose a nursing home or skilled nursing facility for its healthcare services that go beyond the basics.
  • Continuing Care Retirement Communities. These long-term care communities allow residents to transition from independent living arrangements to more personalized healthcare services like those found in a nursing home as their needs increase, all within the same facility.
  • Home Health Care. When possible, some long-term care recipients prefer to receive services while living in their home or with family members. Home health care provides them with skilled nursing assistance and may also include help with other daily living activities, such as cooking, housecleaning and transportation.

Personal preferences and the circumstances of a person’s needs will be factors in choosing which setting for services works best for them. The recommendations of healthcare professionals and family members can also play an important role in making this decision.

Determining When Long-Term Care is Necessary

Some people may never require long-term care services, but it’s important to consider which options are best in case you do find yourself in a situation where long-term care is appropriate. Sudden and severe illnesses or unexpected accidents can create an immediate need for long-term care, and it can help you secure the services you need if you have a plan in place.

Mobility and vision issues can increase the risk of dangerous falls and limit your ability to drive or get around your own home to complete tasks. If you struggle to maintain your health needs or personal care requirements, long-term care can help you regain a sense of wellbeing and help you prevent any medical conditions from worsening. It can also help you stay connected to your community and keep up with the daily activities you enjoy.

Discuss your choices with your healthcare team and any members of your family who may be involved in helping you transition to long-term care services.

Medigap Coverage for Long-Term Care

Neither Original Medicare nor any of the Medicare Supplement plans known as Medigap provide full coverage for long-term care. The coverage that is available focuses on any qualifying medical services received as part of long-term care services.

Temporary stays in skilled nursing facilities, which are often also long-term care nursing homes, can be covered by both Original Medicare and Medigap supplemental insurance. Patients who have had surgeries that require longer rehabilitation periods often use skilled nursing facilities to aid in their recovery. Medicare’s rules regarding when skilled nursing facility services are covered can depend on the type of surgery and how long a patient stayed in the hospital prior to their transition.

Some Medigap plans can help extend the period of coverage for skilled nursing facility stays. Medigap plans may also reduce out-of-pocket costs for hospice services not fully covered by Medicare Part A. Supplemental insurance plans are provided by private insurers, and while all Medigap insurers must offer the same benefits for each Medigap plan they carry, not all insurers carry every Medigap plan. You should check with a representative in order to determine which Medigap plan is the most comprehensive one for your needs.

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