Share This
Print
E-mail
Health Insurance and Paying for Long Term Care
| Definition |
Qualifications |
Costs |
| Pros & Cons |
Benefit Types & Limits |
How to Apply |
| Overview of Health Insurance | ||
Private or traditional health insurance refers to a senior’s primary health insurance offered by a private company or through a retired employee’s pension plan. Traditional health insurance does not refer to Medicare or Medigap coverage. Note that while Medigap is a private health insurance plan, it is not considered a primary plan, but a supplemental plan. Also note that long term care insurance is not considered a primary health insurance.
It is important to recognize that every health insurance plan provides different benefits but generally speaking, private pay, union, COBRA and pension-based health insurance plans follow very closely Medicare’s stance on long term care for seniors.
Most health insurers, like Medicare, will pay for short term skilled nursing care costs only. Home care is also limited to medically necessary, skilled care for short periods of time. Custodial or personal care is almost never covered at home, in adult day care or in assisted living.
Most Americans get health insurance from their employers and lose that coverage when they retire. Therefore most seniors receive their health insurance from Medicare. Private health insurance, because of limited senior enrollees and limited services covered plays a very small role in long term care for American seniors.
Be Aware That:
Most health insurance plans do not pay for long term care for seniors.
Health Insurance is Also Known As:
-Managed Care Plans
-HMOs
-Health Maintenance Organization
-PPOs
-Preferred Provider Organization
-HMOs
-Health Maintenance Organization
-PPOs
-Preferred Provider Organization
Every health insurance policy has its own eligibility requirements.
Age Requirements
Age is almost always a factor that is considered both for eligibility reasons and when determining premium amounts in purchasing private health insurance.
Disabilities / Health Requirements
Some private health insurance plan will exclude seniors based on their pre-existing conditions or will accept the senior but exclude certain services.
Family Status
A senior’s marital or family status is not a factor in private health insurance plans eligibility.
Financial Status Requirements
Most private health insurance companies do not consider an individual’s financial status when making an eligibility decision.
Veteran Status Requirements
Most private health insurance companies do not consider an individual’s veteran status when making an eligibility decision.
Geographic Requirements
Usually private health insurance companies don’t consider geographic location when making an eligibility decision.
Types of Benefit Payout
Payments made by private health insurance companies are most frequently made directly to the medical provider. Seniors do not receive any payout directly.
Restrictions on How Payout Can be Used
Health insurance benefits are restricted to direct payments to medical providers. Seniors receive checks from the insurance company only as reimbursement.
Benefits Amounts & Limits
Private health insurance companies typically restrict coverage to 100 days in a skilled nursing facility and they’ll pay only a percentage of those costs. Some of the more generous plans offer limited in-home skilled nursing. Both of these are only if the senior is recovering from illness or injury, not for long term care.
Time to Receive Benefits
Private health insurance usually begins the first day of the month following enrollment.
This Source Can Help For
Private health insurance companies help the elderly only with short term skilled nursing or recovery periods.
While every insurance company and policy is different, many people find private pay and COBRA policies to be very expensive. Premiums in excess of $200 / month are common and for seniors they can be much higher.
Health insurance can be purchased from any number of websites. This website offers an easy-to-use tool to compare health insurance costs and benefits.
