FEDweek

What FEHB and Medicare Don’t Cover

Many active and retired federal employees apparently think that their Federal Employees Health Benefits coverage, Medicare or some combination of the two will pay for long-term care type costs and they therefore don’t seriously consider buying long-term care insurance.

However, there is a difference between health insurance, which FEHB and Medicare provide, and long-term care, which the Federal Long Term Care Insurance Program and private carriers provide. Long-term care is primarily assistance with daily living, not medical care, and the benefits for such care under either FEHB or Medicare are extremely limited, covering only short defined periods and only certain specified types of care in some situations. (Medicaid—which is a separate program from Medicare–covers long-term care, but only for those who meet their state’s poverty guidelines, and it also has restrictions on covered services and where they can be received.)

FEHB does not cover long-term care needs, as explained in the "not covered" blocks in sections 5(a) and 5(c) of an FEHB brochure. Health plans don’t cover custodial care, a stay in an assisted living facility, or a continuing need for a home health aide to help you with other activities of daily living. Limited stays in skilled nursing facilities can be covered in some circumstances.

Medicare only covers skilled nursing home care (the highest level of nursing care) after a hospitalization for those who are blind, age 65 or older or fully disabled. It also has a 100-day limit.