Does Medicare Pay for a Long-Term Care Need?

Toni:

Recently my older sister had a stroke and needs extra care at home.  I was told from friends at church that Medicare will help to pay for her at-home care.  I cannot find any information about Medicare paying for at-home care in the Medicare and You Handbook and have heard that she could use Medicaid or even receive help from home health agencies.

Please help me understand what her options can be because she does not qualify for a long-term care policy and now her savings is being eaten up and her family is having to sell her house. Thanks, Cindy from Bellaire, TX

Great question, Cindy:

As you are aware Cindy the cost of long-term care has gone through the roof.  Today the average cost in a nursing home nationwide is $93,000 for a semi-private room or $105,000 in a private room.  In Texas, where I live the average cost is $60,000 to $77.000 depending on either a semi-private or private stay. This is what your sister is experiencing.

On page 51-52 of the Medicare & You handbook, it states that “What’s not covered under Parts A and B and that you will have to pay for long-term care yourself.  Also states on page 52 is that “one may be eligible for care under Medicaid or by purchasing a private long-term-care insurance”.

Let’s discuss a few of the myths surrounding choosing one’s long-term care insurance options which keep America confused.  These myths leave someone like your sister without a long-term care insurance plan and then must pay 100% out of pocket.

• Myth #1: A government program will help take care of my LTC needs when it happens.  It is not easy to qualify financially for a government program for a long-term care need.  Medicare, Medicaid, and certain VA programs may help to pay for some illness needs in certain circumstances.  Each program has specific rules and qualifications for that program. It is important to note that government programs are generally qualified based on financial resources.  The more assets one has the less likely to qualify.
• Myth #2: Don’t need LTC because I have a health policy that takes care of my medical. Medical insurance plans such as group or individual health insurance, Medicare supplement or Medicare Advantage plans only take care of your medical needs. Long-Term care plans take care of one’s activity of daily living such as bathing, dressing, continence, or moving around which are caused by chronic illnesses, accidents, or advanced aging and cognitive impairments over time.
• Myth #3 LTC plans are only for nursing home care. LTC benefit plans let you design how you wish to receive your help for daily care whether at home, in an assisted living facility, or a skilled nursing facility. Without an LTC plan, most needs are provided at home by unskilled family members. LTC benefits can provide caregiver training, care coordination, respite care, and even hospice care in end-of-life situations.
• Myth #4: My family will take care of me. An individual does not realize the emotional and financial burden that taking care of an ill family member creates on the whole family whether it is the wife or husband taking care of their spouse or the family members who take care of their elderly parents.

Take your time and explore what your, your spouse’s, or elderly parent’s LTC options are. Waiting too long may keep one from qualifying due to health issues.

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