Dallas County Living Well Magazine Spring 2015 | Page 17
PAYING FOR LONG-TERM CARE
By Lori Leu, Erin Peirce, and Lauren Olson
L
ong-term care in the United States is currently one
of the most uncertain issues faced by seniors. As
technology evolves, Americans have the ability to
live longer, while the cost of long-term care continues to rise. Ongoing political battles on both the federal
and state levels continually result in new legislation that
affects publically-funded government programs, which are
the only means many seniors have to pay for health care
and long-term care. While no one can predict the future,
becoming educated about available public benefits and
payment of long-term care can help ensure you are protected.
One of the greatest myths is that Medicare will pay for all
health care needs of seniors, including long-term care: “I
want to stay at home as long as possible and when I get
sick, Medicare will pay for it. And, if that runs out, I’ll just
be a ward of the State.” This belief about Medicare and the
“State” handling long-term care is mistaken and prevents
many seniors from pursuing the planning assistance that
they need.
In general, Medicare is health insurance for people who
are age 65 and older or have certain disability qualifications, and who paid Medicare taxes through payroll deductions for a sufficient period of time (or who qualify through
a working spouse or parent). Contrary to popular belief,
Medicare does not pay for assisted living or custodial care
in a skilled nursing facility. At most, traditional Medicare
and a Medicare Supplement (MediGap) policy will cover 100 days of rehabilitation in a skilled nursing facility.
Medicare Advantage plans typically cover only 20 days
of rehabilitation. The next step requires affirmative action
on the part of the patient, or the patient’s agent, to secure
payment for ongoing long-term care.
There are essentially three
ways to pay for long-term care:
1. Private Pay – Some people are fortunate to have the
ability to pay for their own long-term care, which currently
ranges from $3,000 - $7,000/month or more in the DallasFort Worth area.
2. Long-Term Care Insurance – Long-term care
insurance policies are improving and are becoming the option of choice for funding long-term care for many people.
Newer policies allow for coverage of care provided in all
types of settings, including home health, assisted living,
and skilled nursing, thus providing some independence
and flexibility. The cost of long-term care policies can rise
quickly for people who are older, those with existing health
problems, and those who desire broader benefits. Therefore, the earlier you apply and the more you shop around,
the better your policy may meet your needs.
3. Government Benefits
VA Pension – There are varying levels of veterans’
benefits, depending on your needs, including basic, housebound, and aid & attendance benefits. These benefits are
limited to veterans (and their surviving spouses) who served
a 90-day continuous period in the military, at least one day
of which occurred during a wartime period, and who were
honorably discharged. The program is needs-based, so income and assets must be evaluated to determine eligibility.
Medicaid – This encompasses federally funded, statemanaged programs that are needs-based, with strict limitations on income and assets, but with exceptions that are
important to consider. Eligibility requirements and services
covered vary widely from state to state, with Texas routinely ranking as one of the worst states for Medicaid coverage. Providing advice on Medicaid eligibility includes
the interpretation of statutes and administrative rules and
constitutes the practice of law under the rules of the Texas
Health & Human Services Commission. Only attorneys are
legally allowed to provide assistance with Medicaid eligibility. While there are several non-attorney individuals and
companies who try to provide this assistance, Medicaid
applicants should beware. These persons are operating illegally, often charge more than attorneys, and are within
the realm of those who are preying on seniors for their own
financial gain.
How will you pay for your and your loved one’s healthcare
and long-term care needs that lie ahead? For a better understanding of your funding options for long-term care