Long Term Care – Does Health Insurance Policy Cover it?

Long term care as in nursing home care  is not really covered by traditional medical insurance policies. Medicare benefits only cover short term or basic care. If a plan member needs to spend many months, or even years, in a nursing home, they will quickly exhaust  their Medicare benefits. Supplements or Medicare Advantage plans usually mirror the benefits of the original plan expanding in some areas but still not covering long-term nursing home care. This is important to understand because many people believe that their Medicare benefits will take care of this expense. They find out too late that this is not the case.

Medicaid can save the day for these individuals but usually only after they exhaust all or most of their own savings and funds. This federal and state program for low income Americans may cover long term care expenses. Qualification rules vary by state, and sometimes by individual circumstances. But it is probably  true and safe  to say that most people will have to spend most of their savings in order to qualify.

Long Term Care – Does Health Insurance Policy Cover it?

The cost of full-tune nursing home care could easily wipe out savings fairly quickly. Other types of care, like assisted living and home health care, may be somewhat cheaper. But they can still cost thousands of dollars a month. The average cost of nursing home care, full time is approximately $8000 per month.

There are some provisions in the Affordable Care Act (ACA) to expand Medicaid benefits, so this may help more low income, disabled senior citizens get the kind of nursing care they need.  At the moment, most Medicaid long term care funds go to full time nursing homes. Some provisions in the ACA expand home and community based health care services, so this may help some seniors get better nursing care at home.

Many states are attempting to reform nursing care on their own. Several US states have implemented long term care insurance partnerships. If residents purchase qualified long term care insurance  policies, the states will modify Medicaid qualification rules. This will help these people qualify for Medicaid without spending all of their money if their plan benefits run out.

You can see that the ACA does not seem to directly affect nursing care at the moment. Some programs may help expand services for some people. However, there are government incentives for people to purchase a policy to help them pay for nursing care in the future. Some of these incentives may be at the national or state level.

The issue of long-term nursing home care for the elderly, it’s expense, and how it’s covered is an issue for new medical billing and coding students to think about and consider. It’s important to think about and form educated opinions regarding the issues that affect your career field. If you would like to learn more about this issue, you can Google “Funding Long-term Care.”


By: Dawn Moreno, PhD, CBCS, CMAA, MTC. Lives in the beautiful Southwest United States and has been an instructor for medical coding/billing for the past 7 years.  Interested in quality medical billing training?

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