Healthcare Needs that Health Insurance Does Not Cover

Healthcare Needs that Health Insurance Does Not Cover

Just What Healthcare Needs Does Health Insurance Not Cover?

After many hospital stays, people learn the hard way that, indeed, health insurance does not cover all things healthcare-related.

When a serious medical need arises there are often multiple stages that one goes through on the path to recovery. A stroke victim may stay in a hospital for several days, but will be released to either the care of a family member or to a skilled care facility.

Special needs? There is an indefinite period of time after a stroke that a stroke victim will need assistance to get through many “taken for granted” daily activities. The hospital stay is typically paid by health insurance. However, the assistance with daily activities is not part of a health insurance policy. Therefore, planning for AFTER the hospital stay can be just as important as buying a health policy.

Examples of situations where health insurance does not cover all things healthcare-related.

    • Physical Rehab (how much does your health plan allow?)   Most health insurance plans have a LIMIT on how much they will pay for physical rehab. Some will pay for 10 days and some for 20 days. How many days will YOURS pay for? I have not encountered ANYONE who could answer this question. However, I have found MANY who were shocked at the answer.
    • Acute Care – medical care aimed at treating physical problems directly in an attempt to permanently cure or control them. This type of care is typically covered under a health policy.

      Examples of Acute vs Chronic

      What kind of conditions may signal a need for short-term care

    • Skilled Nursing Care – This is another example of where health insurance does not cover all things healthcare-related is patients with post-hospital needs.
      What about those who require ongoing medical observation or even nursing care? What about rehab services for the injuries, or serious illnesses. Some health insurance policies offer limited care in a skilled nursing facility, typically 20-60 days. In fact, I’ve seen a high number of health plans that either do not cover this at all or offered limited benefits.  (see chart below) This begs the question:  Do you know what you want included in a health plan?
    • Long term care – Insurance coverage for this is called LONG-TERM-CARE insurance. The goal of LTC is not to cure an illness, but to allow an individual to attain and maintain an optimal level of functioning day-by-day. Meet their medical, personal, and social needs is important. For example, something could happen that limits a person’s ability to carry out daily basic self-care tasks, and, as a result, someone will be facing LTC expenses. (Without some sort of a plan of protection, the average annual cost for care  is between $30,000 and $70,000 annually.)
Conditions that health insurance may not full cover

See the limitations of some health insurance limiting coverage

Using these examples of situations where healthcare needs are not fully covered, Short-term Care plans are used to alleviate or offset the costs of these types of care.

A Few Short-Term Care Facts?

(click to see AALTCI.org)

  • Minimum Applicant Age: 40 or 50.
  • Maximum Applicant Age 85 – 89.
  • Typical Benefit Amount $100, $150 or $200 per-day.
  • Can a policy pay for Home Care? YES! 
  • Can a policy pay for Assisted Living? YES! 
  • Can a policy pay for Nursing Home Care? YES!
  • Typical premium at age 65 — $105 monthly .
  • Typical premium at age 70 — $141 monthly option.
Request a quote for a SHORT-TERM CARE plan

Compare plans and see if they fit your needs

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