Long Term Care Insurance

What is Long-Term Care

Long term care is the assistance individuals need 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. The need for long-term care can result from an accident, chronic illness, short-term disability, or from advance age. Long term care can include a broad range of services, provided in any setting outside a hospital. It might be help with simple daily tasks like bathing or dressing. It might include skilled care in your own home, an assisted living facility, some other community resources, or a nursing facility.

Who Needs Long-Term Care

  • 28% of Americans aged 65 to 75 experience difficulty in physical functioning. (Centers for Disease Control, “Summary Health Statistics: National Health Interview Survey”, 2014)
  • Among the population aged 65+, 69% will develop disabilities before they die, and 35% will eventually enter a nursing home. (The Retirement Project, “Meeting the Long-Term Needs of the Baby boomers: How Changing Families Will Affect Paid Helpers”, 2007)
  • The average cost for a nursing facility is $87,600 per year (America’s Health Insurance Programs, “Long Term Care Insurance: Financial Stability and Security for Consumers“, March 2016)
  •  Bringing an aide into your home just three times a week (two to three hours per visit) to help with dressing, bathing, preparing meals, and similar household chores can easily cost $1,000 a month. (America’s Health Insurance Programs, “A Guide to Long-Term Care Insurance“, 2013)

Some Misconceptions about Medicaid and Medicare

Medicaid

A joint federal and state program that helps low-income individuals or families pay for the costs associated with long-term medical and custodial care, provided they qualify. Although largely funded by the federal government, Medicaid is administered by each state, and programs may vary. (sited from https://www.medicaid.gov/medicaid-chip-program-information/by-topics/benefits/downloads/416-glossary.pdf)

Being eligible for Medicaid does not guarantee placement in a nursing home. There may be long waiting lists for facility care. Depending on the state and facility, Medicaid patients often receive lesser-quality care than patients who are paying on their own. 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
Medicare pays for health care for people 65 and over and for those who are disabled. Medicare does not pay for long term medical service such as assisted living or adult day care. Medicare does pay for the first 100 days of skilled care,during each benefit period such as physical therapy or nursing. This accounts for 5% of all national 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.

First Jersey Agency can help you navigate the complicated world of long term care planning and find out what plans are available to you.