Filling The Gaps In Medicare Coverage With Long-Term Care Insurance

With Annual Election Period (AEP) under way, many Americans will be meeting with agents all over the country and inquiring about their specific Medicare needs.

Angie Hughes

LTCi Marketing Manager
800.541.6705

portion of your clients’ long-term care needs, but only after a 3-day hospital stay, and so long as the client is not deemed chronically ill, and only if the doctor says they are in need of those services. The list of chronic illnesses your client might develop isn’t short. If they’re deemed to suffer from one of these health issues Medicare stops their coverage ^pg.52.

With Annual Election Period (AEP) under way, many Americans will be meeting with agents all over the country and inquiring about their specific Medicare needs.

During AEP, millions sit down to discuss all the alphabet soup of Parts A, B, C, D, E. As an agent, it is important for you to be aware of the ‘rest of the coverage’.There are gaps in Medicare – many gaps – so being knowledgeable on available coverage is a must. Medicare does not cover all the areas of a person’s health and there are some major facets your clients should be aware of, namely their long-term care needs. A long-term care event can leave a client open to financial insecurity. Technically, Medicare will cover a portion of your clients’ long-term care needs, but only after a 3-day hospital stay, and so long as the client is not deemed chronically ill, and only if the doctor says they are in need of those services. The list of chronic illnesses your client might develop isn’t short. If they’re deemed to suffer from one of these health issues Medicare stops their coverage ^pg.52.

Medicare and most health insurance, including Medicare Supplement Insurance (Medigap), don’t pay for long-term care, sometimes called “custodial care”.

People might be eligible for this care through Medicaid, provided specific criteria are met, or your client can choose to buy private long-term care insurance.

Now, I feel it important to point out that an agent cannot broach extended care planning while selling a prescription drug plan or a Medicare Advantage plan unless the beneficiary brings it up first. However, I’d like you to remember that AEP is only for PDP and MA/PD, not Medicare Supplements.

For those interested in cross-selling, the easiest conversational transition in the Medicare market is short-term care and long-term care. It is the ‘rest of the coverage’. It’s typically what’s necessary when Medicare no longer pays for your clients’ care if they become custodial. If that day comes it’s already too late to talk about getting. If you understand Medicare, then you understand how Medicare pays for home care: medically necessary, part-time, or intermittent skilled nursing care.

I want agents discussing the possibility of a long-term care event before clients are at the point of requiring skilled care either at home, an assisted living facility, or a nursing home.

What if the family just needs some help? Currently, I’m involved in three different claims with three different women. All three families believe there are severe cognitive issues and brought. “Severe” is not a condition that would trigger payments to stop, however, all three ladies require assistance with at least three activities of daily living, which is a trigger. One of these ladies lives at home with her spouse who simply cannot take the responsibilities any longer. This is the point when extended care has become a requirement for daily life.

I understand selling long-term care insurance isn’t fun or glamorous, but it’s 2020! I’ll ask you, if it were your mom or your dad struggling with daily activities, wouldn’t you be willing to find help? Exactly. Similarly, you should have a discussion about extended care planning with your clients. It makes a difference, even when we can’t picture getting older and being unable to take care of ourselves.

November is LTC Awareness Month and I will be presenting a webinar each week discussing the specifics of long-term care insurance, ways to approach selling it, and how to overcome common obstacles in the discussion surrounding long-term care events. Please join me and let’s make a plan to help your clients before assistance is a requirement for them.