Who Pays For Long Term Care?

The facts may surprise you.  There are many misconceptions about who will pay for your long-term care and it's important to clearly understand what is covered under Medicare and Medicaid, and what isn't.

Your eligibility for long-term care services, provided in any long-term care setting, will be determined based on your need for ongoing treatment, personal care and assistance, as well as the availability of service in your location.  Other factors, such as financial eligibility, VA disability status, insurance coverage, and/or ability to pay play a huge role in how your care will be covered.  And for many seniors, it may be very difficult to pay for long-term care all their your own unless they are wealthy or you are able to regularly save substantial amounts of money.

There are different ways that you can ultimately pay for your long-term care other than with Medicare, Medicaid, or most importantly, your life savings, either through long-term care insurance, reverse mortgages, life insurance options or annuities.

Peter Madine - Financial Consultation
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  See what Medicare and Medicaid will and will not cover: dividerline   Medicare and Medicaid Statistics
 

Medicare
Only pays for long-term care if you require skilled services or rehabilitative care for the following:

  • For nursing home services for a maximum of 100 days, however, the average medicare covered stay is much shorter (22 days)
  • For at home care, if you are also receiving skilled home health or other skilled in-home services.  Generally, long-term care services are provided only for a short period of time.

Medicare does not cover any of the following:

  • Does not pay for non-skilled assistance with Activities of Daily Living (ADL), which make up the majority of long-term care services
  • Long-term care services that are not covered by a public or private insurance program.

Medicaid

  • Pays for the largest share of long term-care services, but to qualify, your income must be below a certain level and you must meet minimum state eligibility requirements
  • Such requirements are based on the amount of assistance you need with ADL
  • Other federal programs such as the Older Americans Act and the Department of Veterans Affairs  pay for long-term care services, but only for specific populations and in certain circumstances.

Health Insurance

  • Most employer-sponsored or private health insurance, including health insurance plans, cover only the same kinds of limited services such as Medicare
  • If they do cover long-term care, it is typically only for skilled, short-term or medically necessary care.