Paying for Long-Term Care: Know your Options
By Leu & Peirce, PLLC
One of the greatest myths surrounding planning for long-term care is that Medicare will cover all of our health care needs as we age. Unfortunately, that is wrong. Medicare is health insurance for individuals who paid into the system and are age 65 or older. Medicare does not pay for custodial care or personal care services. Misconceptions about Medicare prevent many individuals from pursuing the planning assistance they need, so when the time comes to implement long-term care, they are not financially prepared. Prudent planning for long-term care begins with learning the facts and knowing your options.
In-Home Care is an option for individuals who want to remain in their homes, but need additional support. In-Home Care can range from assistance with daily chores and meal preparation to help with bathing, toileting, and dressing. Medicare covers only healthcare prescribed by a doctor in certain circumstances, not assistance with other issues such as meals or daily chores that are provided by In-Home Care.
Assisted Living Facilities offer their residents a secure place to live, typically in an apartment-like setting, with meals. For an additional cost, residents may be able to receive assistance with activities of daily living, such as bathing, grooming, incontinence care, and medication management. Medicare does not pay for Assisted Living.
Memory Care is a type of assisted living that has been specifically designed and structured to support individuals with dementia. Memory Care tends to offer specialized programs aimed at offsetting common obstacles for their residents, such as separating day from night and avoiding boredom. Medicare does not pay for Memory Care.
Skilled Nursing Facilities are for individuals who require a higher level of medical care. Skilled Nursing Facilities provide 24-hour nursing care and usually provide speech, occupational, and physical therapy to residents. At most, traditional Medicare and a Medicare Supplement (MediGap) policy will cover 100 days of rehabilitation in a skilled nursing facility. Medicare Advantage plans cover much less.
Some people are fortunate to have the ability to private pay for long-term care, which ranges from $3,000 to $16,000/month in the Dallas-Fort Worth area. Long-term care insurance is another option for funding long-term care. Newer policies allow for coverage of care provided in all types of settings, including In-Home Care, Assisted Living, Memory Care, and Skilled Nursing, thus providing some flexibility and ability to choose the proper level of care. However, long-term care policies may not be available if you have certain existing health problems, and the costs can rise as you age. Therefore, the earlier you apply and the more you shop around, the better your policy may meet your needs.
Beyond private pay and long-term care insurance, the only remaining option is to seek public assistance, which includes VA benefits or Medicaid. VA benefits are limited to veterans (and their surviving spouses) who served a 90-day continuous period in the military, at least one day of which occurred during a wartime period, and who were honorably discharged. Medicaid is a federally funded, state-managed program. Eligibility requirements and services covered vary widely from state to state. Both VA benefits and Medicaid are needs based, so income and assets must be evaluated to determine eligibility. While VA benefits will reimburse all types of long-term care costs, in Texas, Medicaid is primarily a skilled nursing benefit.
An analysis of whether to apply for VA benefits requires consideration of the potential need for Medicaid to avoid future penalties caused by transferring assets. Providing advice on Medicaid eligibility includes the interpretation of statutes and administrative rules and constitutes the practice of law according to Texas statutes. Only attorneys are legally allowed to provide assistance with Medicaid eligibility. Applicants should beware of the non-attorney individuals and companies who try to profit from their need for Medicaid assistance. These persons are operating illegally, often charge more than attorneys, and are within the realm of those who prey on seniors for their own financial gain.
How will you pay for long-term care needs that lie ahead? Making smart decisions now ensures that when the time comes, you will be able to afford the quality and level of care you need. For a better understanding of your funding options for long-term care and to find an Elder Law attorney in your area, go to www.naela.org.
Lori Leu, Erin Peirce, Lauren Olson, Laura Chavero, and Brisha Gardner are Elder Law attorneys with Leu & Peirce, PLLC. They can be reached at 972-996-2540.