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March 2012: Paying for Long-term Care

In the March 2012 issue of School Nutrition, the article “Living Happily Ever After” by Mark Ward, Sr., PhD, explored many of the key elements of planning for long-term care. The following chart, from the National Clearinghouse for Long-Term Care Information, summarizes LTC coverage limits for Medicare and most private health insurance programs.

 Public Private
Long-Term Care ServiceMedicareMedigap InsurancePrivate Health Insurance
OverviewLimited coverage for nursing home care following a hospital stay and home health if you require a nurse or other skilled provider.Insurance purchased to cover Medicare cost sharing.Varies, but generally only covers services for a short time following a hospital stay, surgery or while recovering from an injury.
Nursing Home CarePays in full for days 1-20 if you are in a skilled nursing facility following a recent 3-day hospital stay. If your need for skilled care continues, it may pay for the difference between the total daily cost and your copayment of $137.50 per day for Days 21-100. After Day 100, it does not pay.May cover the $137.50 per day copayment if your nursing home stay meets all other Medicare requirements.Varies, but limited.
Assisted Living Facility (and similar facility options)Does not pay.Does not pay.Does not pay.
Continuing Care Retirement CommunityDoes not pay.Does not pay.Does not pay.
Adult Day ServicesNot covered.Not covered.Not covered.
Home Health and Personal CareLimited to reasonable, necessary part-time or intermittent skilled nursing care and home health aide services; some therapies if a doctor orders them and a Medicare-certified home health agency provides them.

Does not pay for ongoing personal care or only help with “activities of daily living” (also called “custodial care”), such as bathing, dressing, toilet use.
Not covered under current policies.

Some policies sold prior to 2009 offered an at-home recovery benefit that pays up to $1,600 per year for short-term at-home assistance with activities of daily living (such as bathing, dressing, toilet use) for those recovering from an illness, injury or surgery.
Varies, but limited.