Follow
Share
This question has been closed for answers. Ask a New Question.
Medicare and additional PPO insurance (which is usually a type of Medicare Supplemental Insurance that covers the percentage of services or costs that Medicare does not pay) are generally for hospitalizations and for rehabilitation therapy (physical, occupational, &/or speech therapy) in a skilled nursing home.  Medicare only pays up to 100 days of Rehabilitation Therapy--but often pays from 30 to 60 days because you either refuse to participate in therapy for at least 3 days or are not progressing (improving) in your ability to perform therapy or activities of daily living-- walking, dressing self, transfers, etc. 

THEN if you continue to stay at the nursing home facility, you either have to "private pay" or apply for Medicaid to pay for your stay at the nursing home.

You have to pay privately for your first 3-6+ months in the nursing home (for any costs that Medicare does not cover) while you are trying to meet the LTC insurance deductible requirements.  Once Long Term Care Insurance starts to pay for your stay at the nursing home because you have met the number of deductible days of that policy; they only pay $40, $80 or $____ dollars/PER DAY for each day that you stay at a nursing home.  You are responsible for paying for any nursing home costs or expenses that the LTC insurance monthly payment(s) does not cover.  

Also, LTC insurance PAYS AFTER the current month has been completed AND the nursing home has sent the LTC insurance company a list of charges/expenses for the current month.  THUS you have to pay the nursing home for the current month.  After the LTC insurance pays you the $40, $80, $___/DAY, you are responsible for paying the nursing home the money that you receive from the LTC insurance (just like you would if you receive Medicaid).  If you use the money that you receive from the LTC insurance for something other than your room and board and medications at the nursing home, then you could be charged with defrauding the insurance company.  Thus you need to keep accurate records as to how much money you receive from the LTC insurance company and when you pay that money to the nursing home.  

If you are going to "private pay" for your stay at the nursing home because you have too much money (and are unable to spend down to the $2,000 Medicaid requirement) or you own some rental property or farm land or property that you do not want to sell in order to qualify for Medicaid; then it might be a good idea to purchase Long Term Care Insurance to help pay a percentage ($40, $80, $_____?Per Day) of your nursing home bill.
Helpful Answer (1)
Report

I recommend finding a Medicare knowledgeable insurance broker and having them explain exactly what each insurance covers. Each has it's very own role.

If you have Medicare, a supplemental insurance and buy long term care you will not have over lapping coverage. They are 3 different types of coverage and depending on the circumstances all of them are beneficial to the holder.

Let me know what you find out.
Helpful Answer (0)
Report

Yes, you need long term care insurance even with you having medicare plus additional insurance. Medicare does not pay for long term care. Medicaid does pay for long term care for the poor.
Helpful Answer (0)
Report

Do you mean Long term care insurance. Since Medicare or any health insurance does not pay for longterm nursing care than you may want to consider a policy.
Helpful Answer (1)
Report

I’m not sure, but if you should go into a facility, I don’t believe Medicare or Medigap if that’s what you mean by PPO Insurance, will pay long term. I think Medicare only pays for a certain number of days and then you’d be self-pay. Medicaid pays for long term care, but that’s another story.
Helpful Answer (0)
Report

This question has been closed for answers. Ask a New Question.
Ask a Question
Subscribe to
Our Newsletter