Insurance Coverage for Elder Care

Private Health Insurance coverage for long term care varies by insurance provider. Subacute Rehab or skilled Homecare is often only available after a hospital stay for an injury, surgery or serious illness. Assisted Living Facilities and Adult Day Care are usually not covered. Check with your insurance company to find out what is covered.

Long Term Care Insurance is a special insurance policy sold to cover long term care in a variety of settings. Not everyone qualifies. Before buying Long Term Care Insurance ask:

  • Will you need a medical evaluation first?
  • Does the cost will go up over time?
  • Is there a coverage term limit or is it for your lifetime?
  • Can the insurance company pay the provider directly or do you need to send proof of payment to get reimbursed?
  • If the insurance company provides reimbursement -are they able to direct deposit the money into your account? (This is important if getting to a bank to cash a check becomes too difficult.)

Medicare provides short-term coverage for a Subacute Rehab or skilled Homecare after a 3-day hospital admission. Medicare does NOT pay for everything forever.

Medicaid provides coverage for long term care if you are eligible.

Medicare and Medicaid coverage & eligibility are often confused.

Medicare=we CARE for our Elders over 65 & people who are disabled

Medicaid=we AID our poor

¬†PACE-“Program of All-inclusive Care for the Elderly” is a program for people who qualify for Medicare and/or Medicaid. PACE provides care and services in the home, the community, and in a PACE center. In order to be covered by PACE you must

Agree to have PACE provide ALL of your medical care.

  • You must be age 55 or older
  • You must need nursing home level of care & be able to live safely in the community with PACE support services
  • You must live in a PACE service area. Find a list of your state’s website for PACE here.

Why Should I Care?

Long Term Care services can be expensive.

It is important that you be familiar with what your insurance covers

BEFORE you get the bill.