Because of old age, mental or physical illness, or injury, some people find themselves in need of help with eating, bathing, dressing, toileting or continence, and/or transferring (e.g., getting out of a chair or out of bed). These six actions are called Activities of Daily

Living–sometimes referred to as ADLs. In general, if you can’t do two or more of these activities, or if you have a cognitive impairment, you are said to need “long-term care.”

Long-term care isn’t a very helpful name for this type of situation because, for one thing, it might not last for a long time. Some people who need ADL services might need them only for a few months or less.

Many people think that long-term care is provided exclusively in a nursing home. It can be, but it can also be provided in an adult day care center, an assisted living facility, or at home.

Assistance with ADLs, called “custodial care,” may be provided in the same place as (and therefore is sometimes confused with) “skilled care.” Skilled care means medical, nursing, or rehabilitative services, including help taking medicine, undergoing testing (e.g. blood pressure), or other similar services. This distinction is important because generally Medicare and most private health insurance pays only for skilled care–not custodial care.

What is Medicare?

Medicare is a fee-for-service health care program for seniors, in which the government pays health care providers directly for services that fall under Parts A and B of Medicare benefits (see below). However, if you are looking for more coverage than Original Medicare, you can purchase one of our Medicare Advantage Plans to receive all your Part A and Part B benefits.¹

Medicare is divided into four categories. This allows you to customize your personal coverage when shopping for a comprehensive policy.

• Part A (hospital insurance): Covers hospital care, emergency services, nursing home care, home health services and hospice.
• Part B (medical insurance): Covers medically necessary services and supplies used for diagnosing and treating medical conditions, and preventative services for illness prevention and/or early detection. Examples include ambulance services, mental health care, outpatient procedures and clinical research.
• Part C: Combines Parts A and B and often part D as well.
• Part D: Offers prescription drug coverage.

What Medicare options are available?

Original Medicare offers coverage for services and supplies that are considered to be medically necessary, such as doctor visits, lab tests and wheelchairs. There are several alternative plans you can choose from for additional coverage, and each plan must offer at least the same coverage as Original Medicare. There are two Medicare plans that we can assist you with.

1. A Medicare Advantage Plan, also known as Part C, combines Part A and Part B as a replacement to Medicare for more comprehensive health care coverage. This plan can be customized with additional coverage, such as a prescription drug program (Part D), vision and dental.
2. A Medicare Supplemental Plan, also known as Medigap, has a higher premium but supplements the coverage gaps and deductibles that Part A and Part B leave behind.

Why do you need Medicare?

Seniors are in the most need of health care, but once retired monthly premiums can become hard to maintain. Enrolling in the Medicare program allows you to get the care you need for a minimal charge.

Contact us today to learn more about coverage options. We are happy to work with you to determine which Medicare options works best for you.