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Understanding Where Medicare Falls Short on Long Term Care

Far too many Americans are surprised to find themselves at a financial shortfall for their long term care needs due to confusion over what their Medicare benefits do and don’t cover. However, long term care insurance can help financial professionals provide their clients security and peace of mind.

One problem clients may have is differentiating between long term care and medical care.As financial professionals are all too aware, Medicare is only intended to provide coverage for medically necessary care, such as doctor visits and hospital stays. While some coverage for short-term services is available, clients will still likely have to pay a deductible, coinsurance or copayments.

Yet each and every year, individuals head into their golden years believing that Medicare will provide them with a safety net against the expenses associated with long term care. It’s up to professionals to educate their clients on how such a mistake can cost them.

More Americans seeking out long term care insurance

According to data from the American Association for Long-Term Care Insurance, 8.1 million Americans are protected under some form of LTC coverage. In fact, during 2012 alone, the AALTCI stated that 322,000 new Americans obtained LTC insurance, while $6.6 billion in claims was paid out. Also during this period, more than 264,000 people received some type of long term care benefit.

In short, more people are waking up to the necessity for LTC insurance. However, those who don’t take the initiative may find themselves contending with exorbitant costs or a lack of needed care.

Addressing the benefits of LTC

One problem clients may have is differentiating between LTC and medical care. In their minds, the two are one and the same. However, long term care is assistance with day-to-day tasks, not medical emergencies. This type of care includes help with bathing, dressing, eating, toileting and other daily undertakings that may become more difficult to accomplish as a person ages.

Medicare can be a huge help when it comes to paying for a hospital stay or buying prescription drugs, but individuals can rely on LTC insurance to help with the expense of help with things like housework, taking medication, managing money and more.

Many clients likely associate long term care with nursing facilities, but this type of care can be provided by nurses and home health aides inside the home as well.

When does Medicare help?
While LTC insurance is the only way to afford the full range of custodial services long term care provides, there are certain instances where Medicare can help.

For instance, Medicare will help pay for a limited stay in a skilled nursing facility if a person has had a recent hospital stay of at least three days, is admitted to a Medicare-certified nursing facility within 30 days of this hospital stay and requires skilled care. However, Medicare will only pay for some of the costs, and only for up to 100 days, according to the U.S. Department of Health and Human Services.

Some nursing care services in the home are also covered by Medicare, but only as long as they are deemed medically necessary by a doctor who reorders them every 60 days.

Carrying the costs

Unfortunately, the long term care limitations associated with Medicare lead to many people being forced to dip into their retirement savings or even take out a reverse mortgage in order to afford help with daily tasks as they age.

However, with comprehensive LTC insurance, individuals can rest easy knowing they’ll receive the care and attention they deserve without having to go into debt or rely on the funds of loved ones.

This is just one area where financial professionals can provide their clients with not just a product, but a life-changing service. The key is making sure clients understand why such a service is necessary.


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