How do retiree health benefits work when you move out-of-state?

1 answer | Last updated: Dec 03, 2016
Agroche/nj asked...

My mother is a retiree of the NJ State government.  Her package includes NJ Blue Cross/Blue Shield of NJ, a very good additional health care plan.  NJBC/BS NJ does have ALF in NJ.  My mother is now in FL, where her benefits are Totally In Effect.  How do I apply these benefits of this insurance towards her ALF care?


Expert Answers

Barbara Steinberg is the CEO and founder of BLS Eldercare Financial Solutions, which specializes in helping families pay for long-term care for their loved ones. A registered financial gerontologist, she speaks regularly on the topic of paying for long-term care and is a financial expert for Caring.com.

As you stated, Blue Cross/Blue Shield is a supplemental health care plan to Medicare. It is sometimes called Medigap insurance because it fills in the gaps left by Medicare Parts A and B, e.g. deductibles, copays, etc. However, neither Medicare nor Medigap pay for long term care in an ALF -- Assisted Living Facility. They strictly pay for medical expenses involving skilled care, i.e. nursing or therapy under a doctor's orders.

Even though your mother's health care plan covers her medical needs anywhere in the country, she will have to find other means to pay for assisted living. The only insurance that covers assisted living is long term care insurance. Most newer policies cover assisted living and home care. However, many older policies are restricted to nursing home coverage only. If your mother has a long term care policy, check with her agent or the issuer to determine what her benefits cover.