Long-Term Care: What insurance covers it?

By: Lupe Bruneman, HCMBA
Ph: (786) 322.8633


Para leer en Español

As people age, the need for long-term care (LTC) can become a grim reality. The need for these services usually occurs after either an acute health issue, such as a stroke or over time as a result of a slowly accelerating illness, such as Alzheimer’s or dementia.  Long-term care is a very misunderstood form of medical and non-medical support and services.  These services are provided to individuals who cannot perform activities of daily living (ADL’s) such as bathing, dressing, and eating on their own.

For individuals over the age of 65, who for the most part are covered by Medicare, access to these much needed benefits is becoming increasingly important, and yet long-term care services are NOT available through Medicare.  Only short-term home health care is covered by Medicare, but services have to be related to a specific and acute clinical situation, such as recovery after a bone fracture, and in that case, services would have a starting and end date once the health concern has been resolved. Services related to helping individuals perform activities related to daily living either at home or in an assisted living facilities or nursing homes are NOT covered by Medicare.  So, what insurance covers these services?

If you are considered low-income according to financial guidelines, Medicaid can help cover Long Term care. Medicaid is a state-funded insurance program that provides health care coverage for low-income individuals and families. Medicaid covers a variety of long-term care services, including home health care, nursing home care, and hospice care. Some states also offer additional long term care services such as adult day care and home and community-based services.

Additionally, many private insurance companies offer long-term care insurance policies in different forms such as riders to life insurance. These policies are typically privately paid and usually have to be purchased at a younger age since they are underwritten by age and health issues, thus making the policies very expensive the older they are put in place.

It is important for individuals to understand their options and to explore all available resources when seeking long-term care services, but most importantly, planning should be done way before someone turns 65.  By this age, your only options are to pay for services out of pocket, and this could cost over $5,000 a month and increasing by the day.  Don’t put off planning for these ever-important services!


Leave a Reply

Your email address will not be published. Required fields are marked *

Send this to a friend