While we were working and paying into the federal Medicare insurance program for decades, it was under the assumption that it would cover all our medical expenses in retirement. But now that we seniors have reached the age of our reward, it seems one of the most confusing and daunting tasks we face is understanding what Medicare pays for, and what it does not.
Here is a quick, but far from exhaustive, primer on Medicare insurance:
- Medicare Part A covers inpatient hospitalizations, skilled nursing visits, hospice, and/or rehabilitation care for a maximum benefit of 100 lifetime days.
- Medicare Part B covers physician office visits and outpatient care.
- Medicare Part C is a combination of Part A & B plus some additional benefits such as dental, hearing, wellness checks, and drug costs. This additional coverage can be purchased through an insurance company that has been approved by Medicare, such as Aetna, Humana, and others.
- MEDIGAP policies supplement Medicare and will pay the difference between what traditional Medicare covers and the actual cost of services, such as co-pays and deductibles.
What kinds of care require private pay or non-Medicare insurance?
Medicare covers health care for short-term, acute (sudden) illnesses such as a stroke, heart attack, injury, or surgery. It also covers dialysis.
The more important question though, when one is planning for financial security, is to understand what Medicare will not pay for, such as:
- Routine eye exams and optician visits
- Hearing aids
- Medical care while traveling overseas
- Routine podiatry care
- Dental care (Pay attention to this expense; it takes many seniors by surprise.)
- Cosmetic surgery
- Care related to a chronic (long-lasting) or multiple chronic conditions such as diabetes, congestive heart failure, Parkinson’s disease, or vascular disease.
- Nursing home care, assisted living facilities, or home health care services*
* It is important to understand and plan for one of these three options, because personal care probably, even eventually, will become a need at some stage in life, particularly over age 85.
What coverage does long-term care insurance provide?
Long-term care insurance will partially or fully cover the expense of any of the three personal care options above. The amount insurance will pay depends on the cost of one’s policy, the selected “period of elimination” (how many initial months you choose to pay out-of-pocket before insurance kicks in), and the duration and amount of the lifetime benefit.
Study after study show that seniors overwhelmingly desire to “age in place” in the comfort and familiarity of their own home. About 90 percent of Americans shared this preference before the COVID-19 pandemic, and even more do now. Still, for some, if around-the-clock skilled nursing care is needed, there is no substitute for a skilled nursing facility.
An assisted living community can be a wonderful option for people who are social and in relatively good medical condition, or for those who may not have the necessary social supports and relationships nearby to support a decision to stay at home. When needed, additional one-on-one nursing or personal care services can be provided by a home health care agency such as BAYADA while living in an assisted living community.
Please contact your local BAYADA office or (888) 876-0111 for more information on paying for short- or long-term care in your own home. A BAYADA insurance specialist can help explain your personal coverage and help facilitate billing if you choose to receive home health care services.
BAYADA, Hourly Essex County: 973-857-5035
BAYADA, Live In Essex County: 908-379-7780