Margie Barrie, a veteran long-term care insurance (LTCI) agent, marketer and educator, has been writing articles about long-term care (LTC) planning and related issues for years.
Here she looks at how Medicare coverage can help with some types of LTC expenses, or LTC-like expenses, in some situations.
Question: As part of my client presentation, I discuss Medicare and how you can’t depend on it to pay for long-term care expenses. My explanation includes that you must be getting better every day in order for Medicare to pay a nursing home bill. Is that still correct or have the rules changed?
Answer: The rules have changed! And I must admit it was rather embarrassing how I learned about it. I was meeting with Donna Blizman, a health agent who specializes in Medicare supplements and a past president of the Sarasota National Association of Health Underwriters (NAHU) chapter, to provide her with a LTC policy. When I went through my customary Medicare explanation, she informed me that it was no longer correct.
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As Donna explained it, using the words that you no longer get benefits “after you have plateaued” or “are not getting better” is no longer accurate. Medicare has changed its criteria.
Now, in order for Medicare to pay, skilled care must be necessary to treat your medical condition, but, if you aren’t getting better, it doesn’t matter. You may have plateaued, but skilled nursing facility (SNF) care might be required to keep you from getting worse. If so, then you can still qualify for Medicare benefits in the nursing home.
For more details, I asked colleagues at America’s Health Insurance Plans (AHIP) about the explanation they are using in their LTCI professional designation course, for the Long-Term Care Professional (LTCP) program.