Medicare

Health insurance, including Medicare and Medicare Supplements (MediGap) will only pay a limited amount of skilled long-term care and only for 100 days (this includes the days paid for by a Medicare Supplement).

Medicare Part A (Hospital Insurance) covers skilled nursing care provided in a skilled nursing facility (SNF) under certain conditions for a limited time.

Medicare-covered services include, but aren't limited to:

  • Semi-private room (a room you share with other patients)
  • Meals
  • Skilled nursing care
  • Physical and occupational therapy*
  • Speech-language pathology services*
  • Medical social services
  • Medications
  • Medical supplies and equipment used in the facility
  • Ambulance transportation (when other transportation endangers health) to the nearest supplier of needed services that aren’t available at the SNF
  • Dietary counseling

*Medicare covers these services if they're needed to meet your health goal.

Most long-term care is custodial in nature (this means help with activities of daily living or supervision due to cognitive issues). Custodial care is NOT covered by any health insurance or any Medicare type of policy. Only affordable long-term care insurance will provide the resources to safeguard your savings and ease the burden extended care places on your loved ones.

Medicare Coverage Breakdown Chart

Medicare Supplement Policies are Standardized

Every Medicare Supplement policy (also known as a Medigap policy) must follow federal and state laws, according to the Centers for Medicare & Medicaid Services (CMS). By law, these policies must clearly be identified as "Medicare Supplement Insurance." On a Long-Term Care Insurance policy, they are clearly identified as NOT being "Medicare Supplement Insurance."

The insurance companies that offer these supplements can only offer a "standardized" policy that is identified by letters in most states.

All policies offer the same primary benefits, but some offer added benefits, allowing you to choose which one satisfies your needs. In Massachusetts, Minnesota, and Wisconsin, Medigap policies are patterned differently.

While state laws might affect which plans an insurance company may offer, each insurance company determines which supplement policies they wish to sell. Insurance companies which market supplement policies do not have to offer every plan, but they must offer Plan A if they sell any Medigap policy. Also, companies must provide Plan C or Plan F.

Since January 1, 2020, Medicare Supplement policies sold to new people are no longer allowed to cover the Part B deductible. With the new regulation, Plan C and F are no longer available to purchase. If you already have either an existing supplement Plan C or F, you can continue with that plan.

Compare Medicare Supplement Plans Side-by-Side

CMS publishes a chart that shows the basic information about the different benefits Medicare Supplement policies cover.

Yes = plan covers 100% of this benefit

No = policy does not cover that benefit

% = plan covers that percentage of this benefit

N/A = not applicable

Keep in mind any supplement policy covers the coinsurance amount only after you've paid the deductible (unless the policy also pays the deductible).

Supplement BenefitsMedicare Supplement Plans
 ABCDF*G*KLMN
Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used upYesYesYesYesYesYesYesYesYesYes
Part B coinsurance or copaymentYesYesYesYesYesYes50%75%YesYes***
Blood (first 3 pints)YesYesYesYesYesYes50%75%YesYes
Part A hospice care coinsurance or copaymentYesYesYesYesYesYes50%75%YesYes
Skilled nursing facility care coinsuranceNoNoYesYesYesYes50%75%YesYes
Part A deductibleNoYesYesYesYesYes50%75%50%Yes
Part B deductibleNoNoYesNoYesNoNoNoNoNo
Part B excess chargeNoNoNoNoYesYesNoNoNoNo
Foreign travel exchange (up to plan limits)NoNo80%80%80%80%NoNo80%80%
Out-of-pocket limit in 2020**N/AN/AN/AN/AN/AN/A$5,880 $2,940 N/AN/A

* Plans F and G also offer a high-deductible plan in some states. With this option, you must pay for Medicare-covered costs (coinsurance, copayments, and deductibles) up to the deductible amount before your policy pays anything.

** For Plans K and L, after you meet your out-of-pocket yearly limit and your yearly Part B deductible ($198 in 2020), the Medigap plan pays 100% of covered services for the rest of the calendar year.

*** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don't result in inpatient admission.

Remember, Medicare and Medicare supplements will only pay a limited amount of skilled long-term care services and will never pay for custodial long-term care.

If You Live in Massachusetts Click Here

If You Live in Minnesota Click Here

If You Live in Wisconsin Click Here

McCann Insurance Services, Inc. can enroll you for your Medicare Supplement with several top insurance companies to choose from. You can enroll six months before your 65th birthday. Click here if you wish information on Medicare Supplements.

Part D Drug Coverage Under Medicare

You can also select your drug coverage under Part D. Do not confuse this "Part D" with the Medicare Supplement "D". You often do not have the same insurance company for your Part D Drug plan as you do for your Medicare Supplement since each drug plan covers generics and name brands, based on certain manufacturers, differently.

Click here for more information on the Part D Drug Coverage under Medicare.

Medicaid

Medicaid is a joint federal and state program that helps with medical costs for some people with limited income and resources. Medicaid also offers benefits for long-term care in the event you either have little or no resources or exhaust your savings when you must pay for long-term care costs out-of-pocket. Often, this care is only in a Medicaid nursing home although some states will provide some homecare from Medicaid approved providers. 

Many people wish to avoid spending down their hard-earned savings and investments because of a long-term care event. Many states also participate in the federal/state long-term care partnership program which provides additional asset protection. See your state spend down requirements and participation in the partnership program by clicking here: LTC Information By State.

Who Pays For Long Term Care

The bottom line: Unless you have affordable long-term care insurance you will have to pay for long-term care out-of-pocket draining your 401(k), IRA 403(b) and other assets and perhaps forcing yourself into a spend-down Medicaid situation.

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