Who pays for long term care

Key to understanding who pays for Long Term Care is realizing the difference between Skilled Care and Unskilled Care (also called custodial care).

Skilled Care is trying to cure and thus make us better; it is the care we get from someone with a medical license (doctor, nurse, x-ray tech, respiratory and occupational therapists etc.)

Unskilled Care is not trying to cure us but rather just helps us live each day. It is basically providing help with the Activities of Daily Living, something that we cannot live without

Health Insurance

Health insurance does not cover long term care.

Health insurance pays to cure us (skilled care) with care provided by someone with a license: physicians, nurses, physical therapists, respiratory therapists, x-ray technicians and pharmacists. Since most long term care is unskilled care or custodial care, health insurance does not cover it. The “exclusions” section in your health insurance policy contains the actual wording showing the policy does not cover long term care. Here are examples of actual wording from health insurance policies excluding long term care:

  • “Exclusions: Custodial care”
  • “Medical care not covered: Custodial Care or Rest Cures.”
  • “Exclusions: Custodial care, except for covered hospice care.”