Most forms of insurance, such as the private health insurance or HMO you may have on your own or through your employer, follow the same general rules as Medicare. Medicare is a Federal program that provides hospital and medical expense benefits for people over age 65, or those meeting specific disability standards. Benefits for nursing home and home health services are limited.
In order to understand when and if Medicare or your other insurance will cover a stay in a long term care facility, you first have to understand the purpose of your stay. Most insurances will not cover “custodial care” alone. Custodial care is when the patient simply needs help dressing, eating or showering for example. Long Term care is frequently covered by insurance or Medicare if the recipient requires services similar to or extended from a hospital stay. including medical and non-medical care for people with a chronic illness or disability.
For purposes of Medicaid eligibility and payment, long-term care services are those provided to an individual who requires a level of care equivalent to that received in a nursing facility. However, it must be understood that Medicaid can only be approved if the person needing the care meets restrictive financial guidelines.
Most health insurance brokers will be able to help you determine if a separate or additional policy may be recommended that is geared specifically to cover long term care needs that are usually not covered by health insurance, medicare or medicaid. Long term care insurance can help people avoid the need to downspend their assets in order to qualify for Medicaid. Medicaid will provide coverage for assistance with daily living to those that meet restrictive financial thresholds.
Our admissions team can help you understand what your insurance will (and won’t) cover. Give us a call to schedule an appointment!