4 Long-Term Care Insurance Myths Keeping Retirees Confused About Their Options
The cost of long-term care has gone through the roof! Today, the average cost in a nursing home nationwide is $111,325 for a semi-private room or $127,750 for a private room (Genworth). Medicare famously does not pay for long-term care, so unless you have a plan, you’ll be paying 100% out-of-pocket for long-term needs. Unfortunately, retirees are often unsure of their options. This is especially due to the many myths surrounding long-term care insurance. Let’s discuss a few of the myths that are keeping America confused!
Myth #1: A government program will help take care of long-term care needs when the time comes.
It is not easy to qualify financially for a government program for long-term care needs. Medicare, Medicaid, and certain VA programs may help to pay for some illness needs in certain circumstances. But each program has specific rules and qualifications for that program. It is important to note that government programs are generally qualified based on financial resources. The more assets one has, the less likely to qualify.
Sadly, more than 400 Baby Boomers said they thought Medicare would pay for their long-term care needs in a 2019 study. I’m here to tell you that traditional Medicare doesn’t pay for long-term care, such as nursing care. Unfortunately, it also doesn’t cover assisted living or adult day care programs. However, it does cover certain types of care, such as:
- Skilled nursing care. Medicare Part A covers skilled nursing facility care for a limited time if you:
- Have Part A and have days left in your benefit period to use.
- Have a qualifying inpatient hospital stay.
- Enter the SNF within a short time (generally 30 days) of leaving the hospital.
- Your doctor or other health care provider has decided that you need daily skilled care.
- You get these skilled services in a Medicare-certified SNF.
- You need skilled nursing care or therapy to improve or maintain your current condition, or to prevent or delay it from getting worse.
- Home health care. Those who are homebound by illness or injury may receive home health care if their doctor says they need short-term skilled care.
- Hospice. Medicare covers hospice care under certain conditions. If you aren’t being treated for your terminal illness and your doctor certifies that you won’t live longer than live months, then you can receive hospice care coverage from Medicare.
Related: I Have Cancer and I’m on Medicaid – Should I Apply for Social Security Disability?
Myth #2: You don’t need long-term care insurance because you have a health policy that takes care of medical.
Medical insurance plans, such as group or individual health insurance, Medicare supplement, or Medicare Advantage plans, only take care of your medical needs. Long-term care includes:
- Taking care of one’s activities of daily living, such as bathing, dressing, or walking
- Skilled nursing
- Speech, physical, and occupational therapies
- Home health aide services
- Adult day care
- Respite care
- Hospice care
- Memory care
Health insurance typically doesn’t cover these things, or any aspect of long-term care. “While some of these services are covered by Medicare for specific situations and short durations and Medicaid for those who qualify, traditional health insurance plans do not offer this type of non-medical coverage,” says Dr. Char Hu, Ph.D., co-founder and CEO of The Helper Bees, an InsurTech company. “When, how, and the amount of coverage also varies between health insurance and long-term care insurance.”
Related: Long Term Care Insurance Basics
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Myth #3: Long-term care plans are only for nursing home care.
Long-term care plans let you design how you wish to receive your help for daily care, whether at home, in an assisted living facility, or a skilled nursing facility. Without a long-term care plan, most needs are provided at home by unskilled family members. Long-term care benefits can provide caregiver training, care coordination, respite care, and even hospice care in end-of-life situations.
Myth #4: My family will take care of me.
An individual often doesn’t realize the emotional and financial burden that taking care of an ill family member can create on the whole family, whether it is the wife or husband taking care of their spouse or the family member who takes care of their elderly parents. According to statistics, family caregivers spend an average of 23.7 hours per week providing unpaid care. And while some family members might be able to act in a caregiving role, others might be too busy with their own responsibilities and families to lend a helping hand. Additionally, you could develop complex health issues, such as dementia or a chronic illness, that will require round-the-clock skilled care. Therefore, don’t just blindly assume that your family will be able to step in and care for you. Make sure that you have a long-term care plan in place—one that doesn’t rely on Medicare, your family members, and anyone else!
Toni Says: Take your time and explore what your, your spouse’s, or your elderly parents’ long-term care options are. But, don’t wait too long! Waiting too long may keep one from qualifying due to health issues.
Takeaway
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Originally published March 25, 2025
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