Healthcare Educators


LTC Benefits Now Available in Some Texas Medicare Advantage Plans

by | Oct 24, 2018

Long-term care is a major expense that many seniors will need to cover but few have planned for. According to the U.S. Department of Health and Human Services, a person turning 65 today has a 70 percent chance of needing long-term care services at some point. Care can cost thousands of dollars each month, and many people are surprised to learn that their Medicare plan won’t cover it. This is changing, though, as new rules allow Medicare Advantage plans to offer long-term care services.

What is Long-Term Care?

The term “long-term care” is used to refer to a number of services that are not considered medical in nature but instead tied to daily activities like eating and dressing. Care can be provided in a facility, such as a nursing home, assisted living facility or adult day health care center. It can also be provided at home.

Although some at-home care is provided by unpaid friends or family members, this requires a great deal of time and energy, and caregiver burnout is a serious issue. Paid services, on the other hand, tend to be very pricy. Home health aides can cost $20.50 an hour, and a day at an adult day heath care center can cost $68.

How Does CMS Cover It?

Medicaid covers long-term care, but in order to qualify, individuals must meet their state’s eligibility requirements. This means that their income and assets must be below a set threshold.

Medicare has traditionally covered only medically necessary care, which can include skilled nursing care but does not generally cover long-term care services.

Under new rules, however, Medicare Advantage plans will be allowed to offer certain long-term care services.

What Are the New Rules?

Major changes for Medicare Advantage were announced earlier this year.

“For the first time ever, Medicare Advantage beneficiaries can access significant new flexibility for additional benefits that can help them live healthier, more independent lives,” said CMS Administrator Seema Verma.

Medicare Advantage plans will be able to provide new offerings that include the following:

  • Adult day care services
  • Respite care for caregivers
  • In-home assistance with daily activities

What Will Be Available in 2019?

According to a press release issued from CMS in September, 270 Medicare Advantage plans are taking advantage of the new rules to provide additional benefits. It’s estimated that 1.5 million enrollees will have access to these benefits.

The press release also shows that enrollment in Medicare Advantage is expected to increase to 22.6 million as Medicare Advantage premiums decrease and plan options increase.

Ask your Medicare Insurance agent for details. Or if you don’t have an agent, contact PTT for assistance or attend one of our agents’ upcoming seminars.