Medicare covers only medically necessary nursing care

Dear Toni: In June, I’m retiring when I turn 70 and my wife, Anna, will be 68. Our retirement insurance issue is that recently we applied for a long-term care plan and were both denied due to our health issues.

I had my prostate removed due to cancer about five years ago with no current issues, and Anna has atrial fibrillation that is under control. The insurance agent said people past 60 years old have trouble finding a long-term care plan due to health issues like we have.

My brothers and I are paying an Alzheimer’s assisted living facility more than $12,000 a month for our father’s care. Are there long-term care options available for Anna and me with our health issues? Paying $12,000 a month will drain our retirement. — Paul, Tulsa, Oklahoma

Dear Paul: New short-term care plans with extended care benefits have been developed, assisting baby boomers who need extra help with unexpected health or accident issues.

The 2026 “Medicare & You” handbook, under “Paying for long-term care,” discusses how important it is to plan to maintain your independence and receive the proper care in the facility you desire.

Medicare only pays for medically necessary skilled nursing facility care or for home health care if you meet certain conditions. Skilled nursing facility care benefits last for 100 days. Days 1-20 have a $0 copay per day after you pay the Part A deductible, which is $1,736 per benefit period for 2026. Days 21-100 have a copay per day of $217 in 2026.

If you cannot qualify or do not meet Medicare’s qualifications for skilled nursing, you will pay 100 percent of the cost out of pocket.

Medicare doesn’t cover nonmedical long-term care. This is why purchasing a policy to help with a long-term need becomes essential.

Let’s discuss three options that can help protect your finances from excessive long-term care costs, especially if you have health issues that keep you from qualifying for a long-term care plan.

Short-term care: These insurance plans have a simple health questionnaire with yes/no questions, making it easier to qualify. These policies will assist in paying for a nursing home, assisted living and hospice care, with extra benefits for in-home care. Various options are available, with coverage ranging from $50 to $400 per day and benefit periods ranging from one to two years depending on plans.

Life and annuity policies: These are insurance policies with a provision allowing you to receive a certain amount of long-term care with your life or annuity policy’s face value. Health questions may keep people from qualifying.

Aid and attendance benefits: This VA program that can help veterans with long-term care issues. Find information on eligibility at VA.gov.

Toni King is an author and columnist on Medicare and health insurance issues. If you have a Medicare question, email info@tonisays.com or call 832-519-8664.