Toni:
Recently in your Medicare column, you discussed home healthcare for the elderly. I would like to know about Long Term Care. I always thought Medicare covered long term care but now I am finding out I was totally wrong.
My mother has suffered a severe stroke. Her rehab facility is saying Medicare is not paying for her care. I’ve been informed that beginning next week either to receive care from this facility, it will have to be private pay or I will have to take her home. I need some help trying to understand this frustrating government system. What is the difference in rehab/skilled care and long term care? I thought they were both the same!!…Sue…Dallas, TX
Hi there!! Sue:
It is very frustrating to understand the rules of Medicare when a loved one has a severe illness and requires both medical and custodial care. I will try and explain what long term care is in as simple terms as I can.
People are living longer today and want to control the quality of care, especially when they may need some extra help when their health begins to change.
On page 127-130 of the 2014 Medicare & You handbook, it discusses Long Term Care and a few ways to pay for it. Medicare only pays for medically-necessary skilled nursing facility care or home health care if you meet certain conditions.
Skilled nursing has 100 days of benefit with days 1-20 having $0 co pays per day and days 21-100 with a $152.00 co pay per day for 2014. If you cannot qualify or do not meet Medicare’s qualification for skilled nursing, you will pay 100% of the cost out of your pocket. This is where Long Term Care comes in!
Long Term Care includes medical and non-medical care for people who have a chronic illness or disability. They may need help with activities of daily living known as ADLs such as bathing, dressing, eating, transferring, continence (ability to use the bathroom) or cognitive impairment.
At least 70% of people over 65 will need long term care services at some point. Long term care can be provided at home, in a adult day care, an assisted living facility, personal care home or in a nursing home.
Long term care can be very costly, when you begin to seek the care. The average annual cost ranges from $40,000 per year for a 1 bedroom assisted living facility to $65,000 per year for an average nursing home.
There are many different ways to pay for long term care:
1) Many purchase a long term care policy. The younger you are when you purchase a long term care policy, the lower the premiums will be. Many wait too long to try and qualify for their policy and because of health issues they may not meet the underwriting requirements. My advice is look into Long Term Care while you are younger and in relatively good health. Make sure that your policy covers care at home and also facility care.
2) Use your personal resources such as savings, IRA, 401K etc. Many life policies have a provision if you need long term care; you can receive a certain amount of your life policy’s face amount.
3) Check to see if you can qualify for Medicaid. Many have to “spend down” to qualify. See page 110-111 of the 2014 Medicare & You handbook for more information on Medicaid and Long Term Care.
4) Aid and Attendance benefits with the VA can help Veterans with Long Term Care issues. There is over $20 Billion dollars available for long term care pension money just waiting for Veterans to apply for their Aid and Attendance benefits. You need to have a Long Term Care issue to qualify.
Long term care can be very complex. Seek the advice of an Eldercare attorney who can help with long term care issues and planning.
Toni King, author of the new Medicare Survival Guide®, which is a simple guide that puts Medicare in “people” terms, is on sale at www.tonisays.com Email questions to www.tonisays.com/ask-toni or call 832/519-TONI (8664).
