Long-Term Care Coverage by Health Insurance Plans, Medicare, or Medigap
Part 4, Chapter 14: Specialized Situations: Coverage for Long-Term Care Page 2
Continued from Previous Page
Health Insurance Plans, Medicare, Medigap
Traditional health insurance policies generally provide only limited coverage for home-based long-term care. Under certain conditions, Medicare may provide limited coverage for some types of home health care, including skilled nursing services, management of medications, physical therapy, and other related services. However, Medicare rules require that a doctor certify that there is a medical need for skilled home care. In addition, the care must generally be provided by a Medicare-certified agency, and the Medicare beneficiary must be considered home-bound.
Medicare may provide coverage for durable medical equipment, as well, and for treatment in a skilled nursing facility following a period of hospitalization. Medicare may also provide coverage for home-based hospice care for beneficiaries who are terminally ill. However, Medicare does not generally provide coverage for nursing home placements that primarily involve personal care.
Several of the standardized Medigap policies may also offer coverage for specific types of home health care for Medicare beneficiaries. (See Chapter 10 for additional information on Medigap policies.) Such coverage, though, is limited, and is generally available only if the individual has first met the Medicare requirements for home health care.
Continued on Next Page
