Arvin D. Pfefer - Senior Advisor
 
   
 
Click on one of the links below or use the scroll bar on the right to view all of the FAQs. 2222222222  
What is long term care?
I'm healthy, I won't need long term care, or will I?
Is long term care expensive?
But doesn't my health care already cover long term care?
But won't Medicare cover long term care?
I recently read that Medicare is now covering Alzheimer's Disease. Is this true?

But won't Medicaid cover long term care?

 

What is long term care?

Long term care is the kind of care that you would need to help you perform daily activities if you had an ongoing illness or disability. It also includes the kind of care you would need if you had a severe cognitive illness like Alzheimer's disease. It is help with eating, bathing, dressing, transferring from a bed to a chair, toileting, continence, etc. This type of care isn't provided in a hospital and isn't intended to cure you. It is not acute care. It is chronic care that you might need for the rest of your life. It can be received in your own home, at a nursing home or other long term care facility.

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I'm healthy. I won't need long term care. Or, will I?

The odds are that you will need long term care at some point in your life, and you may need it sooner than you think. About 40% of people needing long term care are adults ages 18-64 (1). They may have had an accident, a stroke, be diagnosed with multiple sclerosis, etc. While we hope you never need it, everyone should have a plan for meeting their long term care needs. Many will do so through long term care insurance.

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Is long term care expensive?

Yes it can be very expensive. It can easily exhaust your savings which is one reason you might decide to buy long term care insurance.

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But doesn't my health plan already cover long term care?


No, in most cases it does not. Health plans may cover some of the skilled medical services you may need when you can't care for yourself after an illness or injury, but usually for a limited period and only as long as you are showing improvement. Health plans typically do not cover ongoing chronic care such as an extended stay in an assisted living facility or a continuing need for a home health aide to help you in and out of bed.

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But won't Medicare cover long term care?


No, in most cases it will not.  Medicare, which is primarily for persons 65 and over, generally pays limited amounts for skilled care following a hospital stay.  It does not cover much of the care which assists people with the activities of daily living over a long period of time - usually 90 days or more.  Medicare will cover the first 100 days of care in a nursing home per benefit period if: 1) you are receiving skilled care, and 2) you have a qualifying hospital stay of at least 3 days and enter the nursing home within 30 days of that hospital discharge. There are also some deductibles and co-pays (meaning you have to pay part of the cost). Medicare also covers limited home visits for skilled care and incidental homemaker services.
It's very important to realize a few things about long term care versus Medicare's coverage:

  • most long term care is not skilled care,
  • most long term care does not take place in a nursing home,
  • most nursing home stays do not immediately follow a hospital stay,
  • most people who require care in their home usually need more or different types of care than Medicare covers, and
  • most people won't start Medicare coverage until age 65.

So don't count on Medicare to cover your long term care needs.

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I recently read that Medicare is now covering Alzheimer's Disease. Is this true?

The information that you are seeing is related to the decision by the Centers for Medicare and Medicaid Services to no longer exclude persons with Alzheimer's disease from accessing Medicare-covered services due to their diagnosis alone. Medicare still only covers skilled care under certain conditions for a limited period of time. All the restrictions on receiving nursing home care or home care, including a prior hospital stay and need for skilled care, as well as required deductibles and copayments, still apply. Alzheimer's disease is a chronic illness. Persons with this illness typically require non-skilled, custodial care for long periods of time. This type of care is still not covered under Medicare, but the change in Medicare's policy has left many with the impression that it might be.

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But won't Medicaid cover long term care?

Medicaid is a state-based program supplemented by Federal funds that acts as a safety net to provide health services to the poor and impoverished. Medicaid covers long term care services and might cover you if you meet your state's poverty criteria and receive care that meets your state's guidelines. Usually this means expending all but $2,000 of your assets and savings (except for perhaps your house and your car). It also means receiving care from a limited number of state-approved caregivers (mostly institutions like nursing homes) that are willing to accept Medicaid's payments.
If you don't have much in the way of assets and income, Medicaid is probably your best bet for long term care. If you can afford long term care insurance, want to control the type and location of care that you receive, the Federal Long Term Care Insurance Program deserves your attention.

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