More than 60 million Medicare beneficiaries are enrolled in either Traditional or Medicare Advantage (MA) plans, all of whom are 65 years and older. More than half (52%) are expected to require long-term care (LTC) at some point in their lives. This can end up costing these individuals and their families many thousands of dollars. The new long-term care benefits added to some Medicare Advantage plans in 2020 may help. The new benefits include:
- increased access to certain long-term care services – including nutrition services
- home safety modifications
- adult daycare.
This article will break down the differences between long-term care benefits offered by Traditional Medicare and those offered by Medicare Advantage plans. It will also provide an overview of new benefits available through MA plans this year. And, finally, it will offer advice for how to prepare for long-term care costs and it will explore alternative options.
Long-term care benefits through Traditional Medicare
As it stands, Medicare will only cover long-term care if a beneficiary requires skilled services or rehabilitative care under Part A. This includes
- acute hospital care
- skilled nursing care
- hospice benefits
These benefits are designed to help beneficiaries who are in the process of recovering from an illness or injury.
In order to meet LTC coverage eligibility through Medicare, a beneficiary must be an inpatient at an approved hospital for at least three days. From there, they must be admitted into a Medicare-certified nursing facility within 30 days of the inpatient visit.
Additionally, the beneficiary must require physical or occupational therapy along with a medical condition that demands skilled nursing services. However, it is important to note that coverage is limited and only available on a short-term basis.
Under Traditional Medicare, long-term care benefits carry a 100-day cap. Once this is exceeded, the beneficiary is responsible for 100% of the costs.
Long-term care benefits through Medicare Advantage
Medicare Advantage plans provide the same coverage as Traditional Medicare so they also cover skilled services or rehabilitative care for up to 100 days. However, due to legislation passed in 2018, Medicare Advantage plans include benefits for supplemental home care services for chronically ill beneficiaries as well.
Starting this year, some MA plans will now offer benefits for a variety of additional supplemental home care services to all beneficiaries. They still don’t provide coverage for assisted living expenses and benefits vary by plan and location. However, these new offerings can make a huge difference in care provided to beneficiaries by allowing them to continue living independently.
Coverage for additional services
Services we can expect to see covered by some MA plans this year include:
Adult daycare service
These centers allow regular caregivers to take a break by providing seniors with an engaging and social environment to interact with each other. In addition, they receive memory care and a variety of exercises to improve well-being. The frequency in which a beneficiary can attend will depend on their individual policy.
- In-home personal care services
These services allow beneficiaries to receive assistance with daily activities such as getting dressed, eating, using the bathroom, etc. The ability to have a home health aid assist with these activities can delay moving into a long-term care facility.
This is especially helpful for those who are not able to get to the doctor’s office easily. This allows the beneficiaries to video conference with their doctor instead of making the trip. This can provide both convenience and comfort.
Benefits for over the counter products
Beneficiaries on MA plans will begin to receive a monthly or quarterly allowance for over the counter products. This will include medications such as allergy and cold medications, daily supplements, and pain relievers.
Home Safety Modifications
If a beneficiary has fallen or has a hard time moving around but does not want to make the transition into assisted living quite yet, some MA plans will provide coverage for safety modifications including grab bars for bathrooms, wheelchair ramps, and stair rails.
Meal Delivery and Transportation
With the growing demand for transportation and meal delivery services, some Advantage plans will now cover transportation services, such as Lyft and Uber. This will help beneficiaries get to doctors’ appointments, fitness centers, or pick up prescriptions, as well as offer benefits for grocery delivery services.
Preparing for long-term care costs
One of the best ways to reduce expenses is by focusing on prevention before treatment. It is important to ensure beneficiaries are attending regular check-ups and addressing any health concerns proactively before they become a larger issue.
Medicare and Medicare Advantage plans don’t offer benefits for nursing home care or assisted living. However, there are ways to limit costs should this care become necessary. Here are two:
- Look into getting a long-term care insurance policy
- Open a savings account specifically for long-term care expenses
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Long-term care insurance
As stated in the section above, if beneficiaries are not eligible for long-term care or need additional financial help for what Medicare doesn’t cover, they can look into alternative options including long-term care insurance or Medicaid.
Long-term care insurance will cover what Medicare doesn’t. Since out-of-pocket costs can quickly add up to hundreds or thousands of dollars, this insurance plan will provide additional financial help paying for care and services. These services include nursing home care, assisted living facilities, custodial or personal care, and extended home assistance.
If long-term care insurance isn’t a viable option, look into whether the beneficiary is eligible for Medicaid. It can help pay for assisted living in some states and nursing home care nation-wide.
As the largest payer in the U.S. for long-term and nursing home care, Medicaid is a joint program between federal and state governments. It can assist with healthcare costs not covered by Medicare.
The bottom line
Long-term care can be a huge expense. However, with proper planning and leveraging these newly added benefits to Advantage plans, there is more opportunity to keep the costs manageable.
Currently, Medicare’s long-term care coverage is limited. But, it is important to know that it is also constantly changing. And, the necessity for long-term care coverage is only continuing to grow amongst the Medicare community.
It is still too early to determine what benefits may be added next year and even further down the road. Therefore, it is crucial for beneficiaries to stay up to date with the latest Medicare news whether through research or speaking to a professional.
Lindsay M Engle
Lindsay Engle, Medicare Expert, MedicareFAQ is part of the Medicare Marketing Association, the Medicare Supplement Insurance Professionals group, and the DecisionHealth – Medical Practice & Hospital Group.
By utilizing her background in SEO, content strategy, outreach, social media, website development, brand management, public relations, and marketing, Lindsay shares her expertise so beneficiaries can be better prepared for healthcare costs after retirement. She is able to provide the proper resources while educating and assisting Medicare beneficiaries as they navigate their Medicare options.
Lindsay graduated from St. Petersburg College in Florida in 2012 where she received her Associates' degree in business, management, marketing, and related support services. From there, she began her career in Marketing. Lindsay holds an SEO certification from the Tampa SEO Training Academy. She has a strong background in public relations, creating and executing marketing & digital strategic campaigns. She used her skillset to help the Medicare community and quickly became a well known expert in the Medicare space. She manages a YouTube channel & Facebook group dedicated to the Medicare community.
She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for expert columns regarding Medicare, including the MedicareFAQ website. Her articles are informative, educational, and provide the most up to date information for both beneficiaries and caregivers.
When Lindsay’s not lending her voice and expert opinion, she enjoys unwinding with a long afternoon of boating, gardening, or lounging around with her dogs and cats binge-watching the next big series. She also raises monarch butterflies!