What Is “Long Term Care”?

Medicare is a Federal Government healthcare program designed primarily for seniors 65 and over, although other Americans (disabled persons for example) can qualify under certain rules.  Mostly people qualify through payroll deductions over a period of time.  Medicare is not “free” and is not comprehensive care as there are costs borne by the beneficiary that, if left uncovered that can be a financial burden.  There are four parts to Medicare labelled A, B, C and D.

How Does Long Term Care Coverage Work?

Original Medicare, also known as “Fee For Service” Medicare consists of two parts – Part A and Part B.  In Original Medicare the Federal Government is the primary insurer managed through CMS (the Center for Medicare and Medicaid Services) a division of HHS (Health and Human Services.  Learn more about Parts A and B.

Traditional

Important Points

  • Plans have a monthly premium that increases with age
  • Premiums are higher for tobacco users
  • Acceptance is not guaranteed after initial period
  • Access to care is not limited by a network
  • There is a deductible
  • Part A & B coverage only
  • “Gap” coverage for valid Medicare claims can’t be denied
  • Must get separate Part D for Rx coverage
  • Enrollment is open year round 

Asset Based

Important Points

  • Plans have a monthly premium that increases with age
  • Premiums are higher for tobacco users
  • Acceptance is not guaranteed after initial period
  • Access to care is not limited by a network
  • There is a deductible
  • Part A & B coverage only
  • “Gap” coverage for valid Medicare claims can’t be denied
  • Must get separate Part D for Rx coverage
  • Enrollment is open year round 

Prepaid Home

Important Points

  • Plans have a monthly premium that increases with age
  • Premiums are higher for tobacco users
  • Acceptance is not guaranteed after initial period
  • Access to care is not limited by a network
  • There is a deductible
  • Part A & B coverage only
  • “Gap” coverage for valid Medicare claims can’t be denied
  • Must get separate Part D for Rx coverage
  • Enrollment is open year round 

What Type Is Right For Me?

There are two ways to accomplish this.  The first is to get Medicare Supplement insurance (aka Medigap).  Medigap is secondary coverage provided by a private insurer where your primary coverage is Original Medicare.  The second way is to get Part C or Medicare Advantage (aka MA or MAPD). 

With Medicare Advantage you allow a private insurer that operates under Medicare rules to manage your Medicare coverage.  See the images below for more and refer to our blog for our “Good, Bad and Ugly” series on each option.