It will never happen to me. Well, it could be an accident like a fall, an illness or issues of aging. It happens to more people than you would think. About 70% of people 65+ will need long term care assistance. If this would happen to you or a loved one, how would you pay for these expenses? The intent of this article is to consider your options if you or a loved on would have a LTC need. Your options may include:
Private Pay — Be Prepared for the sticker shock
Nursing homes in our area vary in cost from about $200 - $270 or more a day. At $6,000 to near $9,000 a month it would not take too long for one to exhaust their savings.
Medicare — A Limited Benefit
Medicare is most generally for people over age 65 or after 2 years on Social Security Disability. While Medicare is not intended for custodial care, it does provide limited care at skilled nursing facilities (SNF). This care must be for skilled care such as rehab with the goal to return home. Medicare supplements have different benefits than Medicare Advantage Plans (MA). A supplement requires skilled care treatment, a 3 day hospital stay and then pays 100% of 20 days and then all but a $170.50 copay (in 2019) days 21-100. MA plans may not require a 3 day hospital stay and benefits vary plan to plan. The best case would be that Medicare would pay, with copays, up to 100 days. So, what happens after Medicare‘s benefit ends?
Long Term Care LTC Insurance
For people that have LTC insurance, this plan may help or cover the cost of care. There are some requirements such as an elimination period (# of days before benefits begin), and usually 2 of 6 activities of daily living (ADLs) also called “triggers” must be met. These ADLs are usually bathing, eating, dressing, continence, toileting, transferring or a degree of cognitive impairment. One must health qualify to buy these policies and benefits vary. LTC also may cover home care and assisted living. The maximum payment may be for a time period or a payment of dollar limit. This is a very simplified explanation of a very complicated subject.
There are basically two types of benefits possibly available through the VA. The first is the Aid & Attention Pension (A&A). For Veterans who served during war time and were not dishonorably discharge may qualify for $1,830 a month. Widowed spouses may also qualify for a lesser pension; more for a Vet and dependent. Again this pension is more complex and this column will address it in more detail in the next few months (or call our office). The other possible benefit is to be admitted into one of the four VA homes in Illinois. While a little more restrictive, this can provide a valuable benefit for those who served.
This is the last resort “catch all” for people. Note, there are requirements to spend assets and a portion of your income on care. Your selection of homes may be decreased. Medicaid may also affect a spouse’s assets and income. This subject is too long to add into this article; however Medicaid planning is a very good idea.
No one wants to go to a nursing home stay, but happens more often than we think and before we know it. If you desire more information or materials on these subjects feel free to contact our office. Also there are resources available www.Medicare.gov has “star ratings” for many types of senior communities, www.MRMS-INC.com and at www.LivingByYourDesignInc.com. Gather information before a crisis so that you can be better prepared if you need to make a sudden decision.