Medicare gap insurance provides senior parents with extra coverage to meet their long-term care, nursing home and home health care needs. Seniors should thus have some form of long-term care insurance policy which helps meet your long-term care needs.
These supplemental insurance policies range from plans A to L and follow specific federal and state laws, guidelines and plans. The policies only pay for billed and paid Medicare services and are available from independent insurance companies that define the benefits of these plans.
The costs for these policies vary based on the benefits and coverage offered and the state you live in. While independent insurance companies decide on the Medicare gap policies they plan to sell, to qualify for these Medicare gap policies, you need a Medicare part A and B policy. You have to pay a monthly premium for your Medicare part B policy and Medicare Gap insurance policies.
However to qualify for Medicaid, you should have few savings or assets and a very low income. Check your state’s eligibility requirements through the State Medicaid Agency as Medicaid pays for nursing home care rendered by certified facilities.
To qualify for Medicare home health coverage, your doctor determines the necessary medical care and plan of care to follow. This care should be intermittent like speech or physical therapy and wherein you spend most of your time housebound.
Moreover, the home health care agency taking care of you should be approved by Medicare program. However Medicare does not cover personal care like home health aides, 24-hour home care, meals and home services. While services continue for as long as deemed necessary, you are limited by the number of hours and days of care the services offer.
Medicare does not cover indefinite nursing home stays; it only covers about 100 days of skilled nursing care offered by Medicare approved skilled nursing facilities. To avail this coverage, you need to get admitted to a nursing home within 30 days of a 3-day hospital stay.
The nursing home admission should be related to the condition you suffered during the hospital stay and is determined based on your required skill care like a physician ordered treatment plan.
Nursing home care only provides acute-care coverage and not ongoing services like bathing and dressing. However if you require skilled nursing care, it can be provided by Medicare, which covers the cost for semi-private rooms, skilled nursing, meals and rehab services for the first 20 days. After this, co-payments of about $130 daily is covered by Medicare Gap policies; but after 100 days, you are responsible for all incurred costs.
So it’s better to ensure your elders understand the Medicare and Medicaid policies and its coverage. Do the right research, ask questions where required and understand the coverage offered by Medicare Gap Supplemental health insurance policies before you get yourself a policy.