Health Insurance
Most forms of health insurance (e.g., PPO, indemnity, HMO) typically cover long
term care only if it is considered medically necessary. Insurance carriers’ policies
generally mirror Medicare rules. As with Medicare, skilled nursing facility coverage
is limited to 100 days. Any home care is limited to rehabilitative care considered
medically necessary. Custodial or personal care is never covered.
Like Medicare, health insurance generally covers long term care up to 100 days after
a recent hospital stay, doctor-prescribed home care as part of a rehabilitative
program, and hospice in the case of terminal illness. While health insurance coverage
is critical, be aware of what parts of long term care or custodial care are truly
covered by investigating the policy closely. The Evidence of Coverage document is
a good place to start in looking into this.
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Advantages |
Disadvantages
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Insurance partially covers some skilled nursing facility care, up to 100 days after
a hospital stay. This does provide some coverage if you experience a major medical
event.
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You must be working for the company in order to receive benefits. Coverage may not
be available after you retire. |
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Insurance will cover some skilled nursing care, therapy, and home health aide services
that are ordered by a physician.
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You are responsible for any copays, coinsurance or deductibles as specified in the
evidence of coverage.
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Your company may cover some or most of the cost of premiums for this coverage.
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Health insurance does not cover personal or custodial care provided at home or in
the community. You may need help around the home before a major medical event occurs.
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You must receive care from a provider accepted by your insurance carrier. Care provided
in assisted living and continuing care facilities is not covered.
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