Long-Term Care Insurance

What Medicare actually covers

Medicare covers skilled care, briefly, and only after a qualifying hospital stay.

• Skilled nursing facility — up to 100 days per benefit period following a qualifying inpatient hospital stay, with full coverage for the first 20 days and daily coinsurance after that.
• Home health — intermittent skilled nursing or therapy when you're homebound and a doctor certifies the need.
• Hospice — comfort care for a terminal diagnosis.

What it does not cover is custodial care — the help most people actually need, for years rather than weeks. See Medicare.gov's cost pages and the Medicare & You handbook.

Medigap doesn't fill this gap either

A common and expensive misunderstanding: Medigap pays your share of Medicare-covered services. Because Medicare doesn't cover custodial long-term care at all, there's no share for Medigap to pay. A Plan G policy does nothing for a five-year stay in assisted living.

Medicare Advantage plans increasingly offer limited supplemental benefits like in-home support, but they are not long-term care coverage either.

The three realistic ways to pay for it

Route	How it works	The catch
Self-funding	Pay from savings and income	Care is expensive and open-ended; it can consume an estate
Long-term care insurance	Traditional or hybrid life/LTC policy pays a daily or monthly benefit	Premiums rise with age; health underwriting; must qualify while healthy
Medicaid	Pays for nursing facility care once assets and income are within limits	Requires spending down; a five-year look-back applies to transfers

New Mexicans apply for Medicaid through the New Mexico Health Care Authority. State aging services and long-term care resources are at the NM Aging & Long-Term Services Department.

Traditional vs hybrid policies

Traditional long-term care insurance pays only if you need care — lower premium, but nothing back if you never claim, and carriers have historically raised rates on in-force policies.

Hybrid policies combine life insurance or an annuity with a long-term care benefit: if you never need care, there's a death benefit instead. Premiums are higher and often paid over a fixed period, but the "use it or lose it" objection disappears and the pricing is generally more stable.

When to buy, and who qualifies

Underwriting is genuine — cognitive impairment or significant mobility limitation will usually mean a decline. That makes timing the whole game: most people buy in their mid-50s to mid-60s, because waiting means both a higher premium and a real chance of being uninsurable.

If you're already past the point where coverage is available, the planning conversation shifts to asset protection, Medicaid rules, and family logistics — which is a different but equally worthwhile discussion.

How we approach it

We start with what you'd want to happen, not with a product: where you'd want to receive care, who would coordinate it, and what assets you want protected. Then we look at whether insurance, self-funding, or Medicaid planning fits — and we say so if insurance isn't the right answer for you.

Not sure which of these fits you? A free 15-minute call with a licensed local advisor sorts it out — no pressure, and no cost to you. We do not offer every plan available in your area. For a complete list of every plan in your county, use Medicare Plan Compare or call 1-800-MEDICARE.