Insurance and Care Costs: What's Covered and What's Not
Understanding what insurance covers for senior care can save thousands. Learn about Medicare, Medicaid, and private insurance coverage.
Navigating insurance coverage for senior care is confusing. Understanding what's covered—and what's not—helps you plan and avoid surprises.
Medicare Coverage
What Medicare Covers
- Hospital stays (Part A)
- Doctor visits and outpatient care (Part B)
- Short-term skilled nursing facility care (up to 100 days)
- Home health care (limited)
- Hospice care
- Prescription drugs (Part D)
What Medicare Doesn't Cover
- Long-term custodial care: Assistance with daily activities
- Assisted living: Room and board costs
- Most dental, vision, hearing: Routine care not covered
- Extended nursing home stays: Beyond 100 days
Medicaid Coverage
Medicaid may cover long-term care for those who qualify:
- Nursing home care
- Home and community-based services
- Personal care services
Qualifying for Medicaid
- Income and asset limits vary by state
- Look-back periods for asset transfers (typically 5 years)
- Spouses have some asset protections
- Consult an elder law attorney for planning
Long-Term Care Insurance
Private policies may cover:
- Nursing home care
- Assisted living
- Home health care
- Adult day services
Filling the Gaps
Consider Medicare Supplement (Medigap) policies to reduce out-of-pocket costs for covered services.