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What does my existing insurance cover?

Health insurance plans and Medicare do not pay for extended long-term care needs. They limit coverage to post-hospital, short-term care while you recuperate.

Your employer-based health insurance policy might have a section on nursing home or home health care. As you read the details, you will realize the limited conditions and rules for paying for care in those settings.


The Medicare booklet Medicare and You provides details on your choices and coverage under Medicare. Medicare and most health insurance plans, including Medicare supplement insurance (Medigap) policies do not pay for this type of care. Medicare only pays for medically necessary skilled nursing facility care or home health care if you meet certain conditions for limited periods of time.

Your private health insurance or health plan will follow similar rules and is likely to clearly state in the Exclusions page that custodial care (another word for long-term care) is not covered.

While many people think that disability insurance covers long-term care situations, most do not.  Many employers offer disability insurance. But people may also buy on their own. Both short-term and long-term disability insurance products have strict limits on when they pay benefits:

  • Your disability must be the result of an accident or injury at the workplace. Most long-term care needs are the result of a gradual decline in function due to the frailties of aging.

  • Disability insurance provides partial income replacement if you are unable to work due to a disability, but it does not pay for care.

  • Disability benefits, if you are eligible for them, end when you reach age 65, while most long-term care needs emerge or continue well after that age.

As a part of this insurance review, find out if your employer offers any other benefits, including life or long-term care insurance.

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