What is Long Term Care?
It is critical to note that Medicare does not cover Long Term Care. If you are diagnosed with an ongoing condition that requires care in an Assisted Living Facility or a Nursing Home, Medicare will not cover these costs. It is impossible to predict what kind of care you may need in the future, or what the cost associated with that care may be. Like other types of insurance, Long Term Care insurance lets people pay a premium in exchange for protection against the risk of much larger out-of-pocket expenses.
Long Term Care is a wide range of services that people may need to meet their health or personal care over a long period. Individuals may need assistance when they are unable to care for themselves and need help with Activities of Daily Living (ADLs) – bathing, dressing, transferring, toileting, continence (control of bodily functions), and eating – or they have severe cognitive impairment such as Alzheimer’s disease. Long-term care can include help with simple daily tasks like bathing or dressing, skilled care in your own home, an assisted living facility, some other community resources, or a nursing facility. The need for long-term care can result from an accident, chronic illness, short-term disability, or advanced age.
You may never need long-term care, but there is a good chance you will. Women, for example, are more likely to need long-term care, because on average they live longer than men. The American population is growing older, and the group over 85 is now the fastest-growing segment of the population. The odds of needing the type of care a nursing home offers, and for staying for longer periods of time increases with age.
Some Misconceptions about Medicaid and Medicare:
Medicaid pays for health services for the very poor of any age. Qualifications for Medicaid vary by state. Being eligible for Medicaid does not guarantee placement in a nursing home. There may be long waiting lists for facility care. Under Medicaid, nursing home care is essentially the only option. Home care, assisted living facility care, adult daycare, outpatient services, and alternate caregiver services are not usually reimbursed under Medicaid.
Medicare pays for health care for people 65 and over and for those under the age of 65 who are awarded Medicare disability. Medicare does not pay for long term medical service such as assisted living or adult day care. Medicare pays only the first 100 days of skilled care, such as physical therapy or nursing, which only accounts for 5% of all long-term care costs. You are eligible for the care only if you have been in the hospital for at least three days. The personal care must relate to the treatment of an illness or injury.