There is a common misconception that the Federal Employees Health Benefits program covers long-term care needs. In fact, long-term care is primarily not medical care and the benefits for such care under FEHB (or Medicare) are limited, covering only short periods and only certain types of care in some situations.
FEHB 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. Specifics are in sections 5(a) and 5(c) of FEHB plan brochures.
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.
Long-term care is available on the private market as well as through the Federal Long Term Care Insurance Program. In general, people eligible to enroll in the FEHB are eligible to apply for coverage under the FLTCIP (domestic partners who meet certain requirements are eligible under the FLTCIP but not under FEHB). However, the FLTCIP is not part of the FEHB program but rather is an entirely separate, unrelated program. You do not need to be enrolled in FEHB in order to participate in the FLTCIP.
There is no self-and-family or self plus one option for the FLTCIP. In the FLTCIP program, you apply for your own coverage and any of your eligible family members apply for their own individual coverage separately. Any of your eligible family members could apply for coverage even if you don’t. Also, unlike the FEHB, the FLTCIP doesn’t cover minor children but eligible adult (age 18 or over) “children” could apply for coverage.
Under FEHB you have to be enrolled for the five years immediately before (or from a first opportunity to enroll) in order to have the coverage in retirement. Also under FEHB, if you leave government service before retirement eligibility, you can continue coverage only temporarily or must convert to a private contract.
Those restrictions do not apply under FLTCIP. There is no requirement for enrollment before retirement in order to carry the coverage in retirement. FLTCIP coverage is fully portable—if you quit your job or retire, you still have the long term care insurance coverage, as long as you continue to pay the premiums.
Read more about the Federal Long Term Care Insurance Program (FLTCIP) at ask.FEDweek.com