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Article: Guide To Financial Benefits

Long Term Care Coverage and Financing

Table of Contents
  1. Social Security Benefits
  2. Medicare
  3. Medicaid
  4. Family Medical Leave Act (FMLA)
  5. Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA)
  6. Omnibus Budget Reconciliation Act of 1989 (OBRA)
  7. Health Insurance Portability and Accountability Act (HIPAA)
  8. Private Health Insurance
  9. Long Term Disability (LTD) Insurance
  10. Long Term Care Coverage and Financing

Overview of Long Term Care
Medicare Coverage of Long Term Care
Medicaid Coverage and Long Term Care
Choosing and Financing Long Term Care

Overview of Long Term Care

Long term care includes medical and non-medical care for people who have a chronic illness or disability. Long term care helps meet the health or personal needs of individuals. Most long term care assists people with support services such as activities of daily living (climbing out of bed, dressing or bathing, etc.). Long term care can be provided at home, in the community, in assisted living facilities, or in nursing homes. Each year the elderly population continues to grow. Individuals over the age of 80 are the fastest growing segment of the U.S. population. Unfortunately, as people age, they are more likely to suffer from chronic diseases such as stroke or Alzheimer's. A study by the U.S. Department of Health and Human Services states that people who reach age 65 will have a 40 percent chance of entering a nursing home. About 10 percent of the people who enter a nursing home will stay for five years or more.

Medicare Coverage of Long Term Care

Long term care services can be very expensive. It is important to think ahead about how you will pay for the care you need. Generally, Medicare doesn't pay for long term care. Medicare pays only for a medically necessary skilled nursing facility or home health care. Skilled nursing care and home health aide services are only covered on a part-time or "intermittent" basis. You must also meet certain conditions in order for Medicare to pay for these types of services when you get out of the hospital.

Medicare does not pay for custodial care. It also does not cover care that helps you with activities of daily living. Custodial care is care that most people do for themselves like diabetes monitoring. Some Medicare + Choice plans may offer limited skilled nursing facility and home care coverage if the care is medically necessary. However, you may have to pay some of the costs.

Medicaid Coverage and Long term Care

Medicaid is a state and federal government program that pays for certain health services. It also covers nursing home care for older people with low income and limited assets. In most states, Medicaid also pays for some long term care services at home and in the community. Eligibility and service coverage varies from state to state. Most often, eligibility is based on your income and personal resources.

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Choosing and Financing Long term Care

Choosing long term care is a very important decision. Planning for long term care requires you to think about possible future health care needs. It is very important to look at all of your choices so you will have more control over decisions and have more independence. It is very important to think about long-term care before you need care or before a crisis occurs. Even if you plan ahead, making long term care decisions can be hard.

The Medicare website has a link to comprehensive information on long term care, including planning tools and payment options.

The AARP website has comprehensive information and choices on long term care, in partnership with MetLife.

Disability Benefits 101
Disability Benefits 101, supported by the World Institute on Disability, has updated and accurate information on employment, health coverage, and benefits. It assists people with disabilities in making good financial choices and serves as a much-needed tool for benefit planners and service providers.

Federal Long Term Care Insurance Program (FLTCIP)
Approximately 20 million people are eligible to apply for this insurance. It is for federal and postal employees and annuitants, active and retired members of the uniformed services, their qualified relatives, and a few other groups. This website answers valuable questions about long term care programs for federal employees.

The National Center for Assisted Living and the American Health Care Association maintain a comprehensive resource for consumers receiving long term care. Its content includes descriptions on types of long term care, information on selecting the right level of care and what you should look for in a long term care insurance policy. It also provides guidance for families.

Last Updated on 12/27/2017