Dealing with
a long-term illness can be a stressful and costly experience. In this uncertain
time, knowledge of available plans and resources is vital to making an informed
decision on how to best pay for care. Due to the increasing costs of health
care, the thought of paying for long-term care is often very stressful for
families. With expensive advances in technology and an increase in demand for
care as the Baby Boom generation ages, costs for long term care are on the rise.
Since each person or family faces different financial obstacles, it’s important
to explore the available options while keeping in mind the financial situation
particular to the family seeking care.
The
following plans and strategies can guide care-seekers toward making the best
financial decisions for themselves and their families.
About
Medicare
In general,
Medicare doesn’t pay for long-term care, including in-home care,
community-based care, and care in nursing and assisted living homes. Most
instances of long-term care are termed “custodial care,” which describes non-skilled
personal care such as help with dressing, eating, bathing, moving into or out
of a bed or chair, and using the bathroom.
Medicare
will cover the costs of medically necessary care in a skilled nursing facility
(SNF). Skilled care differs from custodial care in that it’s given for a short
period of time for people who require skilled nursing or rehabilitation staff
to manage, observe, and evaluate their care. Some examples of this type of care
are intravenous injections and physical therapy. To qualify for this coverage, it’s
necessary to receive services from a Medicare-certified SNF after a qualifying
hospital stay. A qualifying hospital stay is one in which the person receiving care
stays in the hospital for at least three days just before being transferred to
a nursing home.
Other
Resources To Pay For Care
Medicaid
Medicaid is
a joint state and Federal program for people with limited income and resources.
It will cover most of the costs associated with nursing home care provided in a
government-certified facility. Not all nursing homes accept Medicare payment,
and coverage eligibility varies by state.
Personal
Resources
About half
of all residents in nursing homes pay for their care with their own savings.
After these savings have run out, many residents become eligible for Medicaid.
Managed
Care Plans
Managed
care plans cannot pay for the costs associated with living in a nursing home
unless the nursing home has a contract with the plan. If a certain plan
approves the nursing home, it’s a good idea to find out whether the plan also
monitors the quality of care in the home.
Medicare
Supplement Insurance
This is
private insurance often referred to as “Medigap” since it pays for services
that fall between the “gaps” in Medicare coverage such as deductibles and
co-insurances. For example, some people use employer group health plans to help
cover nursing home costs. Most of these plans can help cover skilled nursing
care only when that care qualifies for Medicare coverage.
Long-Term
Care Insurance
This is a
private insurance policy in which costs and benefits vary greatly. It’s
important to do some research to compare costs and coverage between plans and
to find out whether a company has a good reputation before deciding on a plan.
Counseling
and Assistance
State
Health Insurance Assistance Programs can offer advice on finding the right plan
for specific needs. They can also answer questions about coverage, payments, or
government programs that may supplement any existing insurance.
