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Do Medicare and/or Tricare for Life (TFL) cover Long Term Care (LTC)?
Generally speaking, Medicare and Tricare for Life (TFL) do not pay for the chronic, ongoing assistance with daily living tasks that are most often associated with “long-term care.” The most common form of long-term care is personal care, which normally refers to those services that assist with the “activities of daily living” like bathing, dressing, eating, toileting or mobility issues or the costs of the long-term care facilities. Long-term care can also include community services such as meals, adult day care, and transportation services. Medicare and TFL coverage does include things like inpatient care at a hospital, skilled nursing facility (SNF), or hospice as well as services like lab tests, surgery, doctor visits, and home health care. In addition, they cover things like doctor and other health care providers' services, outpatient care, durable medical equipment, home health care, and some preventive services. While TRICARE doesn't cover long term care, you can discuss exceptions or partial exceptions to the "no coverage" guidance with your regional contractor.
To determine whether or not LTC insurance makes sense for you, you need to assess various aspects of your personal situation - what is your financial situation, what is your family medical history in this area, how much risk are you willing to assume regarding the probability you and/or your wife will need LTC, if you do need LTC is that something your children can/will help with, etc. In addition, you need to understand what your particular Medicare plan (original Medicare or Medicare Advantage Plan), and Tricare for Life, will and won’t cover related to LTC costs.
In general, we suggest you write up a list of questions you have on this subject and then talk to both your Medicare provider (whether it is “original” Medicare, or you use a Medicare Advantage plan) and Tricare to get a good understanding of what they will and won’t cover. Based on that you can make a preliminary decision on whether you want to then do some research on various LTC providers/plans and determine if one makes sense for you.
If you do decide to look into purchasing LTC insurance, there are of course many commercial companies that offer such insurance. Just one example is the Federal Long Term Care Insurance Program (FLTCIP), which is available only to federal employees and their families, which includes military retirees. The underwriter of this program is John Hancock, and the program provides both pre-packaged and customizable policies. You can find more information on this particular program at the link below. Keep in mind, there are many other companies and plans you can choose from and, like anything else, you need to do your due diligence. Not surprisingly, you will find a wide variety of plan prices depending on the coverage you want.
Below are some links to just a few website articles that talk about this, from both Tricare and Medicare.
https://tricare.mil/CoveredServices/IsItCovered/LongTermCare
https://www.medicare.gov/coverage/skilled-nursing-facility-snf-care
https://www.medicare.gov/what-medicare-covers/what-part-a-covers/how-can-i-pay-for-nursing-home-care
What are the Basics of Medicare?
Original Medicare (https://www.medicare.gov/) is our country’s federal health insurance program for people age 65 or older. People younger than age 65 with certain disabilities, permanent kidney failure, or amyotrophic lateral sclerosis (Lou Gehrig’s disease), can also qualify for Medicare. The program helps with the cost of health care, but it doesn’t cover all medical expenses or the cost of most long-term care. Generally speaking, Medicare reimbursement under Part B is 80% of allowable charges for a covered service after you meet your Part B deductible. For this reason, some people purchase additional coverage (Medigap policies), to help with the ~20% Medicare won’t cover.
Medicare Part A is free and covers hospital costs. Medicare Part B covers doctors' fees and outpatient services and has a monthly premium. Each year you should check for new rules for prescription drug coverage, changes for new enrollees in Medigap supplemental insurance plans, new benefits available in all-inclusive Medicare Advantage plans, etc. In addition, the federal government has a Plan Finder tool to help beneficiaries find their best coverage options. Medicare Part D (Medicare prescription drug coverage) helps cover the cost of prescription drugs.
Although the Centers for Medicare & Medicaid Services (CMS) is the agency in charge of the Medicare program, Social Security(https://www.ssa.gov/) processes your application for Original Medicare (Part A and Part B). Social Security enrolls you in Original Medicare (Part A and Part B). Medicare Part A (hospital insurance) helps pay for inpatient care in a hospital or limited time at a skilled nursing facility (following a hospital stay). Part A also pays for some home health care and hospice care. Medicare Part B (medical insurance) helps pay for services from doctors and other health care providers, outpatient care, home health care, durable medical equipment, and some preventive services.
Other parts of Medicare are run by private insurance companies that follow rules set by Medicare. Supplemental (Medigap) policies (https://www.medicare.gov/supplements-other-insurance/how-to-compare-medigap-policies) help pay Medicare out-of-pocket copayment, coinsurance, and deductible expenses.
Medicare Advantage Plans (sometimes known as Medicare Part C) are a type of Medicare health plan offered by private companies (Kaiser, Blue Cross, United Healthcare, Humana, etc) that contract with Medicare to provide all your Part A and Part B benefits. Most Medicare Advantage Plans also offer prescription drug coverage (Part D). By law, Medicare Advantage Plans must cover all of the services that Original Medicare covers. Many Medicare Advantage Plans also provide coverage for things that aren't covered by Original Medicare, like vision, hearing, dental, and wellness programs (like gym memberships). Some of these plans may also offer services like transportation to doctor visits, over-the-counter drugs, adult day-care services, and other health-related services that promote your health and wellness. It should be noted there are many Medicare Advantage commercial providers that offer what are often called “0 Premium” plans. In essence, this means the Medicare Advantage plan premium is the exact same amount as your Medicare Part B premium. In this situation, the customer has the option to choose Original Medicare or a Medicare Advantage plan for the exact same cost - the cost of the Medicare Part B premium. Why would anyone want a “0 premium” Medicare Advantage plan instead of Original Medicare? One reason is because the Medicare Advantage plan may offer additional benefits not provided by Original Medicare (gym memberships, other health care services, etc). As with anything, the customer needs to do their research to determine what is the best plan for them (what insurance does your doctor take, is the plan good anywhere in the US, what are the co-pays, etc). You should just be aware there are options to using Original Medicare.
Since military retirees enrolled in Medicare are automatically covered by Tricare for Life (TFL) (https://www.tricare.mil/ ), normally Medicare (or a Medicare Advantage Plan) becomes the military retiree’s primary health insurance at age 65 and Tricare For Life (TFL) becomes the secondary insurance. Since TFL costs the retiree nothing this is a great deal for them. In essence, TFL is the retirees “Medigap”, or Medicare supplement, plan that covers the ~20% of bills Medicare doesn’t cover. So, a military retiree with Medicare and TFL does not need to purchase a Medigap, or Medicare supplement, plan.
A health insurance broker can provide you with information regarding various Medicare Advantage carriers/plans. Just be aware these brokers generally focus on plans offered by insurers with whom they have a contractual arrangement (think Kaiser, Humana, Blue Cross, United Healthcare, etc). You can do a Google search to locate a health broker in CO. Another alternative is the counselors working in the federally funded State Health Insurance Assistance Program (SHIP). These counselors provide free advice with no conflicts of interest whereas brokers typically earn commissions from policies they sell. For example, a broker would get no commission if you select Original Medicare vs a Medicare Advantage plan. You can get additional info on SHIP and counselors in your area at the following link: https://www.shiptacenter.org/ click on the “SHIP Locator” icon.
You can sign up for Original Medicare (Part A and Part B) through Social Security’s online Medicare application. Visit Medicare’s website, https://www.medicare.gov/ , to get more information about Original Medicare, Medicare Advantage, or Part D coverage; or to download a copy of the publication Medicare & You (Publication No. CMS-10050). You can also call the Medicare toll-free number at 1-800-633-4227.
Note: Retirees should sign up for Medicare Parts A & B within 3 months of turning 65 to avoid late penalty fees.
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