Frequently Asked Questions
Q. What is long term care?
A. 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 problem 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 received 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. You can receive it in your own home, at a nursing home or other long term care facility.
Q. What is long term care insurance?
A. It is insurance that helps you pay for long term care services, such as home care or care in a nursing home or assisted living facility.
Q. I'm healthy. I won't need long term care. Or, will I?
A. 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. They may have had an accident, a stroke, developed 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.
Q. Is long term care expensive?
A. 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.
Q. But doesn't my health plan already cover long term care?
A. 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. No health plan that we know of will cover all of your long term care needs.
Q. But won't Medicare cover long term care?
A. No, in most cases it will not. Medicare is a Federal health insurance program for people who are age 65 or older, some people with disabilities under age 65, people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant), and people with Lou Gehrig's disease (ALS, amyotrophic lateral sclerosis). Medicare will cover the first 100 days of care in a nursing home 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 copays (meaning you have to pay part of the cost). Medicare also covers limited home visits for skilled care.
It's very important to realize a few things about long term care versus Medicare's coverage:
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most long term care is not skilled care,
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most long term care does not take place in a nursing home,
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most nursing home stays do not immediately follow a hospital stay,
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most people who require care in their home usually need more or different types of care than Medicare covers, and
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most people won't start Medicare coverage until age 65.
So don't count on Medicare to cover your long term care needs.
Q. I recently read that Medicare is now covering Alzheimer's Disease. Is this true?
A. 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.
Q. But won't Medicaid cover long term care?
A. 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. People that you wouldn't consider poor sometimes qualify for Medicaid by "playing the game" and "beating the system", usually with legal help. States react with more rules.
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, and aren't interested in (or don't want to count on) beating the system, the Federal Long Term Care Insurance Program deserves your attention.
Q. Doesn’t the Veteran’s Administration cover long term care?
A. The Department of Veterans Affairs (VA) health system makes certain long term care services available to veterans based on a priority ranking system, with highest priority given to those with severe service-related disabilities. VA-funded long term care may be worth investigating, especially for veterans with service-related disabilities and/or low incomes and assets. Keep in mind, however, that in addition to the priority ranking system, the availability of long term care services from the VA may be subject to funding limitations and may vary by geographic area.