Ask Jaleh: How To Pay For Elder Care.


Video Summary

Paying for elder care. If you are looking for care for yourself or a loved one, you must understand how you're going to pay for it. Many people have a misperception that Medicare, social security or Medicaid will pay for their long-term care needs. Medicaid does cover nursing facility care for the impoverished and Medicare may cover some of the costs of nursing center care for those who require short-term rehabilitation. But both require individuals to meet certain physical and medical standards. Generally speaking neither covers the entire cost of long-term home health care and assisted living care.


Personal resources. Most personal care home residents and roughly 20 percent of nursing center residents pay for costs out of their own savings and assets. Frequently when people enter a nursing center for extended long-term care, they first pay for their care out of their own assets and then expend their resources and apply for Medicaid. This can be prevented by properly planning for long-term care in advance. There are many estate planning tools that will enable one to utilize their resources for their own benefit prior to expending their resources in order to exhaust them to meet the income and asset standards required for Medicaid coverage.


Private insurance. For the most part unfortunately private medical insurance does not cover the cost of personal care or nursing center care except in very specific circumstances. Long-term care insurance. Long-term care insurance can be purchased to provide some payment for nursing center care and home healthcare as well as assisted living care. Some Medicare supplementary insurance policies which are often referred to as Medigap insurance also may provide some limited payment. Many health maintenance organizations, also known as HMOs and other coordinated care plans participate in the Medicare and Medicaid programs. These healthcare plans often cover certain benefits in addition to those required by Medicare and Medicaid and are experienced in coordinating a member's healthcare.


Some HMOs may also offer more medical or supportive services. Others may not require a hospital stay before approving a nursing facility admission. Medicare. Medicare is a federal health insurance program for people age 65 and older as well as certain people with disabilities younger than 65. Historically Medicare was never intended to provide the kind of extensive support required by today's elderly population. Medicare pays for acute, episodic and rehabilitative care as well as some preventative care. It does not provide a comprehensive long-term care component and generally does not cover personal home care costs but may pay for some short-term services, for example physical and other therapies. But it is also contracted through a home healthcare agency and provided to the resident at their home.


Medicare covers only those nursing center services rendered to help someone recover from acute illness or injury. Medicare is administered by the Federal Medicaid Services and is divided into two parts:  hospital insurance which is commonly referred to as Part A and medical insurance which is commonly referred to as Part B. Eligibility for Medicare. Nursing center coverage falls under Part A of Medicare and is very, very limited. If certain conditions are met, Medicare only pays for the first 20 days of care in a skilled nursing center. For the 21st through the 100th day the patient must share or co-pay for the cost of care by paying a daily co-insurance rate which does change yearly. This is typically what a Medigap policy will cover.


Medicaid. Medicaid is a joint federal state government program designed to provide healthcare assistance to low income people with limited assets and it has become the major player for services for care in skilled nursing centers across the country. Eligibility. Medicaid will pay for nursing center care for those individuals who meet a state determined poverty level and certain health-related criteria, provided the nursing center is certified and meets a stringent set of government standards.


The Florida Medicaid Program. In Florida the Agency for Healthcare Administration, also commonly referred to as AHCA, is responsible for Medicaid and has implemented the statewide Medicaid Managed Care Program. Long-term care insurance. Long-term care insurance can protect personal assets and inheritance for the family, provide greater choice in the selection of long-term care settings such as home care, nursing care, etcetera and generally provide for financial security. Because cost for long-term care policies can vary widely, even for similar policies, shopping and price comparison is very important.


Long-term care insurance policy premiums are set based upon several factors such as age, health, length of deductible period, the amount paid and the duration of the benefits. Higher daily benefit and optional features such as inflation protection and non-forfeiture benefits do increase the premium. According to the Health Insurance Association of America, the annual premium for a low option policy for a person at age 50 is about $850 annually. For a person at age 65, that same policy costs about $1,800 and a person at age 79 about $5,500. You should consult with your local insurance or financial advisor on the current costs in your area. Counseling services may also help you select a policy which is most appropriate to your specific needs.


People purchase long-term care insurance for several reasons. If you are deciding whether and when to buy long-term care insurance, you should consider the following questions. Will you income cover long-term care expenses along with other ongoing expenses?  If you purchase such insurance, can you pay for the deductible period and coinsurance?  Can you pay the premiums now?  Can you pay it if the premiums rise?  Will you be able to pay the premium if your spouse dies?  Will you be able to pay for upgrading benefits to meet inflation?  Would you become eligible for Medicaid if you have large medical bills or entered a nursing home where your average yearly cost could run up to almost $30,000?


According to the Centers for Medicare and Medicaid Services, before signing a long-term care insurance policy, you should also ask if you have a period during which to cancel the policy and receive a refund for the first premium. Reverse mortgages are also a way to fund long-term care for seniors who are desirous in staying in their homes. Seniors who live at home and have a low or no mortgage balance can use a portion of their home equity for in-home care through a federally-insured loan program.


Veterans' benefits may also be a way to fund long-term care. Aid & Attendance, a largely unknown benefit provided through the VA provides monetary assistance to qualified veterans who have served during times of war as well as their surviving spouses. This benefit can be used to fund long-term care.


Life insurance. Life insurance may also be a way to fund long-term care. Private third party organizations now allow seniors to use a life insurance policy to help pay for home health by converting a portion of the policy's death benefit into a long-term care benefit paid directly to a care provider.



Funding long-term care takes proper planning. And Waller & Mitchell has the tools to assist you and/or your loved one with this endeavor. Please contact us at 727-847-2288 to set up an appointment to discuss all of your planning needs and we will be happy to assist you.