What do you need to know about Medicare coverage and enrollment when it comes to long-term care? At some point in your life, you may need long-term care. Knowing that you are covered if you need long-term care, or daily care, is important.
What is Considered Long-Term Care?
Before determining how you will obtain coverage for your care, it’s important to understand the basics of long-term care. Long-term care includes activities needed to help take care of yourself daily, such as:
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Bathing
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Mobility
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Eating
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Dressing
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Using the bathroom
Are You Eligible for a Medicare Advantage Plan with Additional Benefits?
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Original Medicare and Long-Term Care
Original Medicare (Parts A and B) includes coverage for inpatient hospital care, medically necessary care, and preventative care, but not for many types of long-term care or daily in-home care, as it is considered “custodial care” and not “medical care.”
Medicare Advantage and Long-Term Care
Medicare Advantage plans, which are offered by private insurance companies, include the same coverage as Original Medicare and often provide additional benefits as well, such as dental, vision, hearing, and prescription drug coverage.
The Centers for Medicare and Medicaid Services (CMS) carefully regulate which benefits Medicare Advantage plans can offer. CMS recently expanded the permissions for benefits related to long-term care and in-home care. Carriers are still adding these new benefits to their Medicare Advantage plans, and available benefits vary based on the plans in your area.
Some benefits include:
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Home helpers/ in-home support
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Transportation
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Meal delivery
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Safety/assistive devices
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Day center visits
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Fitness membership
In Need of Long-Term Care Coverage?
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Enrollment Eligibility
Annual Enrollment Period (AEP)
Medicare Annual Enrollment Period runs each year from October 15 to December 7. What is the Annual Enrollment Period vs. Open Enrollment Period?
Initial Enrollment Period (IEP)
Your Initial Enrollment Period generally surrounds your 65th birthday but may occur if you otherwise become eligible for Medicare for the first time.
Special Enrollment Period (SEP)
You may be eligible if you experience a qualifying life event such as moving to a new zip code, losing employer coverage, or change in Medicaid status.
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