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Is Long Term Care Covered By Medicare or Health Insurance?

Medicare: Medicare does NOT pay for most long term care services. Individuals should not rely on Medicare to meet their long term care service needs. Medicare does not pay for custodial care when that is the only kind of care needed. Skilled nursing facility care is covered by Medicare but only on a very limited basis.

If you need skilled health care in your home for the treatment of an illness or injury, Medicare may pay for some part-time or intermittent home health services furnished by a home health agency. Visit www.medicare.gov and www.cms.gov for more information on what is/is not covered by Medicare.

Medicare Supplement Insurance Plans: These plans are designed to fill in some of the gaps in Medicare coverage, but they do NOT cover most long term care services.

Private health insurance: that you might already have covers mainly acute conditions and probably does NOT cover long term care.

Medicaid: In order to qualify for Medicaid coverage, you must meet certain income and asset tests. Because of the high cost of nursing home care, more than half of those who enter nursing homes privately paying for their care deplete their assets to the level required to qualify for Medicaid in less than a year.

In New York State in 2012, if only one spouse needs nursing home care, the married couple is allowed to keep a home, a car and assets up to $113,640. A single person who requires such care may have resources up to $14,250 and still qualify for Medicaid.

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