Q. I’ve been hearing a lot about “long-term-care insurance.” Won’t Medicare cover my needs?
The short answer is, no, probably not.
Unlike other types of medical procedures and treatments, long-term care is not primarily intended to cure a medical condition. It focuses, instead, on helping a person cope with a reduced level of function over an extended period of time — sometimes indefinitely.
Generally, an individual in such circumstances needs assistance with what are called “activities of daily living,” i.e., bathing, dressing, feeding, toileting and transferring.
Years ago, “long-term care” was virtually synonymous with “nursing-home care.” However, today most long-term care is actually provided in the patient’s own home — either by family or friends (called “informal caregivers”) pressed into duty by the circumstances, or by paid healthcare professionals who visit to provide the needed services.
Long-term care also is delivered in other settings, including “assisted living” or community-based facilities such as adult daycare centers. Only the most intensive care is still delivered in skilled nursing homes.
Most healthcare insurance policies do not cover long-term-care costs. Neither does Medicare, except under very specific circumstances, and following a qualifying hospital stay. You must be hospitalized for at least three days before being transferred to a skilled nursing facility. Medicare will pay for the first 20 days, days 21-99 have a co-payment of up to $141.50 (in 2011) and after day 100 you pay 100% (in each benefit period.) In order to qualify for skilled nursing care you must need services that can only be administered by a registered nurse, MD, or physical or occupational therapist on a daily basis. You also must be “making progress,” or improving each day.
The only care that Medicare will provide at home is the same care needed to qualify for skilled nursing care, but on a less-than-daily basis. Medicare does not pay for assistance with “activities of daily living.”
Nor will MediCal (the federal program for the needy) provide any benefits until one has exhausted almost all his/her assets and is virtually destitute. (You can consult with an elder law attorney about the possibility of protecting your assets.)
In order to find out what best suits your needs you should:
Consult with your financial planner.
Meet with an insurance agent who specializes in long-term care insurance.
Meet with an elder-law attorney.
Educate yourself through independent research.
But however you choose to proceed, you really owe it to yourself and your family to become long-term-care aware. Take the time now to explore your options. As with all insurance, the time to look is before you need it.
NANCY TURNEY received a bachelor's degree in social work and a certificate in gerontology. If you have a specific question you would like answered in this column, email it to email@example.com or call Turney at the Crescenta-Cañada YMCA, (818) 790-0123, ext. 225.