Medicare and Health Insurance Don’t Cover Everything

Health insurance is important to all of us, and Medicare stands out as our option as we get older so we don’t have to rely on our employer to provide medical insurance. Beyond looking forward to it, many people don’t understand how Medicare works. Do you know what it will cover in your golden years? Unfortunately, Medicare and health insurance are not the silver bullet that retirees hope it will be. By the time you realize what Medicare and health insurance do not cover, it is often too late to make alternative plans ahead of time. Let’s discuss some things that are NOT covered by Medicare and typical health insurance plans.

Medicare Doesn’t Cover…

When learning about Medicare, it is like learning the ABC’s all over again. Part A, Part B, Part C and Part D all cover different aspects of healthcare. Part A and B cover a large portion of medical expenses after someone turns 65. But just because it covers a large part, doesn’t mean it covers what is important to everyone. Many new enrollees are surprised to discover that basic Medicare (Part A and B) does not cover a variety of health-care expenses that can hit retirees pretty hard in the wallet.

A big gap in Medicare coverage is long term care (LTC). Medicare provides some coverage for short term skilled nursing services but not for custodial care, such as help with performing activities of daily living like bathing, dressing and eating. Medicare covers acute medical issues. It does not cover the long term custodial care that many people need in order to stay in their home. Medicare also doesn’t cover Assisted Living or Personal Care Homes. According to the Administration for Community Living, someone turning 65 has a 70% chance of needing advanced health care services for an average of at least two years. These services are not covered by Medicare or private health insurance.

Additionally, comfort items such as a hospital phone, TV or private room aren’t covered should this be needed. 

Health Insurance Doesn’t Cover…

Since most adults are familiar with health insurance, many know that plans are medically focused- they cover the medical care that you prove to need.  

Like with Medicare, health insurance doesn’t cover private nursing or LTC. Whether we are talking about a nursing home, assisted living facility, or care at home, those expenses will likely be coming out of your own pocket. These LTC expenses quickly add up.

The Bottom Line Is…

There are always options when researching the best way to spend the latter years of your life. Planning for the future can begin at any time, especially with Providence At Home. Strategically mapping out the future provides a clear path for your way of living, especially if extra help is needed. Our team can guide, care for, and support you whenever you need it.

Is a Providence at Home Membership Similar to Long-Term Care Insurance?

As adults start to plan their future care path, there are many options to choose from. Two of the options that offer some flexibility and choice in your home are Continuing Care at Home plans like Providence At Home and long term care (LTC) insurance. The membership we offer at Providence At Home is similar to the concepts of a LTC insurance plan, but we go above and beyond on a more personal level. Let’s learn how.

What Long-Term Care Covers

According to the Administration for Community Living/The Administration on Aging, most LTC policies sold today are comprehensive. They typically allow you to use your daily benefit in a variety of settings, including in your own home, adult day service centers, hospice care, respite care, assisted living facilities, Alzheimer’s special care facilities or nursing homes. 

LTC policies in the home setting generally cover these services:

  • Skilled nursing care
  • Occupational, speech, physical, and rehabilitation therapy
  • Help with personal care, such as bathing and dressing

These services through LTC insurance become available for reimbursement when you meet stringent functional needs criteria and after your predetermined elimination period.  Once you are eligible, you are responsible for coordinating your care and paying for the services, then you submit paperwork to the LTC Insurance Claims Department to request reimbursement.

What a Providence at Home Membership Covers

On top of providing you with the best of what a LTC insurance plan can offer, Providence At Home also gives you personalized wellness and support programs. Our membership-based plan options offer you the benefits of a Continuing Care Retirement Community partnered with the independence of living in your own home. You’ll also have the support of a Personal Plan Concierge to help you live the life you want!

One of the key elements of our program is an emphasis on individualized, personal care, while being in your own home. And with being in your own home comes the daily duties of home care. This is where many members find the added value of the Providence at Home membership over a LTC insurance plan. For example, should the need arise for snow removal, your Personal Concierge will provide a trusted vendor to set up the service for you. Landscaping needs come spring? We can help with that too! Want to get out of the house? We can help with that! Then once you need services, you become eligible for them with fewer functional needs that are required by LTC insurance and the benefit is paid directly to the caregivers so you don’t have to pay and wait for reimbursement.

We Will Be There

Unlike that binder that you put away after you sign on for LTC insurance and then can’t find, Providence at Home has people focused on you to help guide you through all of the services we offer and meeting all of your needs. Our staff is ready to provide members with support and expertise, whenever it is needed. With us, it is personal. And we want to keep it that way.