What Is Long-Term Care?

Long-term care helps someone with a continuing physical illness, disability or cognitive impairment deal with the activities of everyday life. Someone with a physical illness or disability may need hands-on help, while someone with a cognitive impairment may need supervision, protection or verbal reminders to do everyday activities.

How Much Does Long-Term Care Cost?

The cost depends on the amount and type of care that is required. The average monthly cost for nursing home care in the DC metropolitan area is approximately $12,000. Keep in mind that the rates may vary significantly among long-term care facilities.

Does Medicare Or Medicaid Cover Long-Term Care Costs?

Medicare: Medicare's skilled nursing facility (SNF) benefit does not cover long-term custodial care in a nursing home. The SNF benefit only covers rehabilitation if a medical professional - determines you need daily skilled care after you have been in the hospital for at least three days, and you are receiving that care in a Medicare-certified SNF. Medicare will pay for the first twenty (20) days in a SNF. Thereafter, Medicare will co-pay for the next eighty (80) days only if you require skilled nursing services. You will be required to co-pay $ 164.50 per day (2017 rate). In addition, Medicare does not cover any costs for care in assisted living facilities.

Medicare does not cover homemaker services, and only covers personal care from home health aides if you are homebound and receiving skilled care such as nursing or therapy. You can only receive a limited amount of personal care per week.

Medicare Supplement Insurance: This is private insurance that helps pay for some of the gaps in Medicare coverage. No long-term custodial care costs are covered.

Medicaid: Public benefits, known as Medicaid, will pay for long-term custodial care. In some jurisdictions there are Medicaid Waiver Programs that provide services in the home. For both programs, federal and state guidelines for income and resources must be met, although some income and resources can be protected for a spouse who remains at home.

Should You Buy Long-Term Care Insurance?

It has been estimated that 80% of people over age 65 will require either nursing facility services or home or community services during their lifetime. It is important to consider your own situation in order to determine whether purchasing long-term care insurance is the right decision for you.

Questions To Consider When Deciding on a Long-Term Care Insurance Policy

What Services Are Covered?

Policies vary and may cover nursing home care, home health care, personal care in your home, services in assisted-living facilities, services in adult day care centers and/or services in other community facilities.

Where Are Services Covered?

Insurance policies cover different types of facilities. If your facility is not covered, the insurance company can refuse to pay for eligible services.

How Much Coverage You Will Have?

A policy may have a maximum benefit limit or a daily/monthly benefit limit.

When Are You Eligible For Benefits (Benefit Triggers)?

Some policies use more than one way to decide when to pay benefits, while some states require certain benefit triggers. Benefit triggers may include:

    • The inability to do activities of daily living such as bathing, continence, dressing, eating, toileting and transferring (most common benefit trigger)
    • Cognitive impairment/mental incapacity
    • Doctor certification of medical necessity

When Do Benefits Start?

Most policies have a waiting period, or elimination period. The period of time is set by the policy and can generally range up to six months before benefits start.

What Happens When Long-Term Care Costs Rise (inflation protection)?

You can usually buy inflation protection either by automatically increasing your benefits each year, or by choosing to increase your benefits periodically, such as every three years.

What Happens If You Can't Afford the Premiums Anymore?

If you have a nonforfeiture benefit in your policy, you will receive some value for the money you've paid into the policy.

Contact The Elder & Disability Law Center for a consultation by calling us toll free at 866-399-4324 or locally at 202-452-0000. You may also contact us online.