| Thu, Dec 08, 2011 @ 09:00 AM

Long-Term Care: the Basics

Posted by Medicare Made Clear

couch2Long-term care planning is a way of preparing for a time when you might require assistance with your activities of daily living. Activities of daily living include things like eating, dressing and bathing. Assisted living and skilled nursing facilities are two places you could go for help with these activities. Long-term care can include both medical and non-medical care for people with a disability or chronic illness. In certain cases, long-term care can be provided at home or in the community, as well. Since you may need long-term care at any age, it is important to plan ahead. This includes looking at how long-term care needs will fit into your Medicare coverage.

Long-Term Care Coverage and Original Medicare

Medicare Part A will pay for an unlimited number of home health care visits if you meet certain conditions. It does, however, have limits on the number of days of skilled nursing facility care it will pay for. For those who cannot leave the home, Medicare Part B covers in-home health aid services on a part-time, non-regular basis. It won’t cover the cost of help with activities of daily life. What if your long-term care needs fall outside of these restrictions?

Medicare Advantage Special Needs Plans

Medicare Advantage Special Needs plans (SNPs) are designed for Medicare recipients with special financial or care needs, like people living in long-term care facilities. In this type of SNP—often called an Institutional SNP—you get the benefit of an on-site nurse practitioner who works closely with you, your family and your physicians to better coordinate care. All SNPs include Medicare Part D prescription drug coverage, too, so that’s one less worry for you and your family. Some SNPs are designed for people who live in a long-term care facility and are “dual eligibles”: people who qualify for both Medicare and Medicaid.

Because these plans are designed for people with special needs, you do need to meet certain requirements to be eligible. The good news is, with a Special Needs Plan, you’re not limited to enrolling only during certain times of the year. This means you can enroll in an SNP whenever you are eligible—for example if you move into a long-term care facility—rather than having to wait for a specific enrollment period. Remember that SNPs are types of Medicare Advantage plans, so premiums and cost sharing—like deductibles, copays and coinsurance—can vary from plan to plan. Pay careful attention to these differences when comparing SNPs.

Medicare’s Long-Term Planning Tool

To help you get started planning for your long-term care needs, Medicare.gov provides a Long-Term Care Planning tool. This tool can help you understand what long-term care services are out there, how much you can expect long-term care to cost, and what resources might be available to help pay for your long-term care costs. This tool won’t replace financial planning or other long-term planning you might do on your own, but it’s definitely a good place to start. The tool will ask you 12 – 20 questions. Your answers will be compared to people with similar needs as yours. This can help you see the long-term care options for others like you.

For more information about plans available in your area, you can also call your State Health Insurance Assistance Program (SHIP).

While it’s impossible to anticipate all life events, with a little research and planning, you can be sure you have the coverage you need for future long-term care needs whenever they may occur.

For more information contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048. You can also contact UnitedHealthcare® Medicare Made Clear to learn more at 1-877-619-5582, TTY 711, 8 a.m. – 8 p.m. local time, seven days a week.


Your Guide to Medicare Special Needs Plans (SNPs) – Medicare.gov

CMS’ Medicare Coverage of Skilled Nursing Facility Care – Medicare.gov

Y0066_111017_160026 File & Use 10292011