Elderly Parents - Understanding Medicare Gap Insurance

Elderly Parents - Understanding Medicare Gap Insurance

Medicare Gap insurance policies are a type of Medicare supplement that helps elderly parents buy extra coverage to meet individual needs. For seniors, these insurance policies are essential in order to help pay for long-term care insurance, nursing home and home health care.

Coverage plans help pay for skilled nursing care for services that Medicare covers. Every senior should have some type of long-term care insurance policy. Supplemental health insurance coverage helps to ensure that personal property and assets are available to meet the needs of long-term care. After all, Medicare payments only goes so far toward paying for long-term care benefits, and may only pay roughly 45% of such costs.

Medicare Gap Insurance

Medicare supplemental insurance policies are available with plans A though L. These policies follow federal and state laws and guidelines, and each state may offer only specific plans. Medicare Gap only covers care after Medicare services have been billed and paid for. These policies are available from independent insurance companies that will define exactly what benefits are available in such plans.

The costs for different policies will vary depending on the types of benefits as well as the state you live in, and what is covered. Individual or independent insurance companies will decide which Medicare Gap policies they wish to sell. In order to qualify for Medicare Gap policies, individuals must already have Medicare part A and part B. Remember that Medicare part B policies require a monthly premium and you will also have to pay premiums for Gap insurance policies.

To be eligible for Medicaid, individuals must have few savings or assets, and very low income. For eligibility requirements in your state, contact your State Medicaid Agency. Medicaid only pays for nursing home care that is provided in facilities certified to receive Medicaid recipients. For more information regarding Medicaid in your state, you may also contact your State Health Insurance Assistance Program.

Long-Term Care Insurance

Long-term health insurance offers benefits in a multitude of care scenarios, but plans vary widely.

Information regarding these plans can be found at the National Association of Insurance Commissioners. In addition, individuals can obtain a copy of the Guide to Health Insurance for People with Medicare by calling 1-800-MEDICARE. Long-term health care insurance policies are private policies and require monthly premiums.

Home Health Care

In order to qualify for Medicare home health coverage, various requirements need to be met. Your doctor must determine that medical care is necessary in your home and determine a plan of care. The care must be intermittent, such as temporary skilled nursing care, speech therapy, or physical therapy. In addition, you must be home bound. That doesn't mean you can't go to the beauty shop or for a walk, but that you spend a majority of your time housebound. The last requirement is that the home health agency that takes care of you must be approved by Medicare program.

However, Medicare does not cover meals, home services, personal care such as home health aides, or 24-hour care at home. Services will continue as long as they are deemed medically necessary and reasonable. However, you will be limited to the number of hours as well as days of care that are offered by such services.

Medicare Gap Insurance

Nursing Home Care

Many people erroneously believe that Medicare will cover nursing home stays indefinitely. However, Medicare only covers up to 100 days of skilled nursing care and various requirements must be met before such care will be paid for. Medicare requires that facilities be approved as Medicare approved skilled nursing facilities. Admittance to a nursing home must occur within 30 days of a hospital stay that lasted at least three days in duration. Admission to the nursing home must be related to the same condition or illness as the hospital stay required and it must be determined that you need skilled care, which means it must be a physician ordered treatment or treatment plan.

In addition, nursing home care only covers acute-care, and does not cover services for ongoing care such as bathing and dressing. On the other hand, if skilled nursing care is required to maintain current health status or in the process of the slow deterioration disease or illness, care is provided and covered by Medicare.

Medicare covers the cost of semi private rooms, rehab services, skilled nursing and meals for the first 20 days.

After 21 days, co-payments of roughly $130 a day may be covered by Medicare Gap policies, but after 100 days, the individual is responsible for all costs incurred.


Make sure that you and your elders are familiar with Medicare and Medicaid policies as well as what Medicare Gap policies cover in your state. Don't be taken by surprise, but take the time to research your options, ask questions, and understand every aspect of what is covered and what is not with Medicare Gap supplemental health insurance policies.

It is recommended that you visit these two web sites for up to date and more detailed information Medicare Website and Medicaid Website

Medicare and Medicaid Page

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