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 or 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?
- In the year 2002 about
seven million men and women over age 65 needed long-term
care. (HIAA, "A Guide to Long-Term Care Insurance",
2002)
- By 2005, the number will increase
to nine million. (HIAA, "A Guide to Long-Term
Care Insurance", 2002)
- By 2020, 12 million older Americans
will need long-term health care. (HIAA, "A Guide
to Long-Term Care Insurance", 2002)
- Family and friends are the sole
caregivers for 70% of elderly people and most will
cared for at home. (HIAA, "A Guide to Long-Term
Care Insurance", 2002)
- People age 65 or older face at
least a 40% lifetime risk of entering a nursing home.
10% will stay more than five years. (HIAA, "A
Guide to Long-Term Care Insurance", 2002)
- 22% of people over age 85 are
in a nursing home. (HIAA, "A Guide to Long-Term
Care Insurance", 2002)
- Women, because they outlive men,
face a 50% greater likelihood of entering a nursing
home after age 65. (HIAA, "A Guide to Long-Term
Care Insurance", 2002)
Some Misconceptions about Medicaid and Medicare:
Medicaid
Medicaid pays for health services
for the very poor of any age. Qualifications for Medicaid
vary by state, but generally the law says you must first
spend down to the poverty level, using up all but about
$2,000 of your assets. 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
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. Medicare pays 100%
for the first 20 days and all but the first $95 per
day for the next 80 days.
Medicare supplement insurance
is a private insurance that helps pay for some gaps
in Medicare coverage. Plans D, G, I, and J do pay up
to $1,600 per year for services to people recovering
at home from an illness, injury, or surgery.
Exceptions, Limitations
and Exclusions
Most long term care insurance policies
will not pay benefits for any confinement, care, treatment,
or service(s):
- That results from attempted suicide
or intentionally self-inflicted injury;
- That results from voluntary participation
in a felony, attempted felony, or illegal occupation;
- That results from a sickness or
injury for which benefits are provided under any state
or federal worker's compensation law;
- Provided outside the United States
or Canada;
- Provided in a government facility
(unless otherwise required by law);
- Provided for the treatment of
alcoholism or drug addiction, or in facilities operated
primarily for such treatment;
- Provided in facilities operated
primarily for the treatment of mental or nervous disorders
or disease, other than Alzheimer's disease or dementia.
Pre-existing Conditions
You could be declined coverage if
you already have the following condition(s):
- Alzheimer's Disease;
- Severe Arthritis with functional
limitations;
- Diabetes which is not under control;
- Cancer within the past 6 months;
- Parkenson's Disease;
- Stroke within the past 6 months;
- A Stroke at any time, which has
caused functional limitations;
- Congestive Heart Failure within
the past 6 months;
- Emphysema, if severe or still
smoking;
- Chronic Obstructive Pulmonary
Disease, if severe or still smoking;
- Any conditions which require the
assistance of another human being for the basic activities
of daily living: bathing, eating, toileting, or transferring
in and out of a bed or chair.
Long-Term Care
Quote
If you would like
a quote on Long-Term Care, Call or email us today!
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