Toni:
My husband, 67 years old, suffered a severe stroke this January and his skilled/ rehab facility is saying Medicare will not pay for his care anymore. I’ve been informed that beginning next week either to receive care from this facility, it will have to be private pay of about $4000 or I will have to take him home.
He is over 6 feet tall and weighs 275 lbs. I cannot lift him and have a full time job which I cannot quit, since I am the only one working. There is no family close by…what can I do! I thought Medicare paid for your care when you are sick. I need some help trying to understand this confusing system. What is the difference in rehab/skilled care and long term care? I thought they were both the same!!…Elizabeth from Katy, TX
Elizabeth:
Situations like yours are the reasons I do the “Confused about Medicare” workshops and wrote the Medicare Survival Guide because your health can change drastically in the blink of an eye and you must be prepared when life throws you a curve!
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 the difference of rehab/skilled nursing and long term care is in as simple terms as I can.
Medicare only pays for medically-necessary rehab/skilled nursing facility care, if you meet certain medical conditions and criteria. Rehab/skilled nursing has only100 days of benefit with days 1-20 being a $0 co pay per day and days 21-100 with a $148.00 co pay per day. If you cannot qualify or do not meet Medicare’s qualification for rehab/skilled nursing, you will pay 100% of the cost out of your pocket as you are experiencing right now. Your husband either has met the maximum day amount or does not meet the medical qualifications for improving his health condition for rehab/skilled nursing. This is where Long Term Care and purchasing a Long Term Care policy becomes so important.
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 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 an adult day care, an assisted living facility, personal care home or in a nursing home. Long term care can be costly with the average cost ranging from $40,000 a year for a 1 bedroom assisted living facility to $65,000 a year for an average nursing home room.
There are many different ways to help pay for long term care.
1) Purchase a long term care policy. The younger you are, the lower the premiums will be. My advice is look into Long Term Care policy 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 pages 100-102 of the 2013 Medicare & You handbook for more information on Medicaid and Long Term Care.
4) Aid and Attendant benefits with the VA can help Veterans with Long Term Care issues.
5) Reverse mortgage is another option. Talk to your banker about that option.
**Seek the advice of an Eldercare attorney who can help with long term care issues and planning.
Toni King, author of the Medicare Survival Guide which is on sale at www.tonisays.com. Toni is an advocate/consultant for those “Confused about Medicare”. Email questions to toni@tonisays.com or call 832/519-TONI (8664).
