Professional care for people with dementias such as Alzheimer’s is commonly referred to as “Long-Term Care”. 70% of people turning age 65 can expect to use some form of long-term care during their lives. Get a clear picture of who pays for what.
The facts may surprise you.
Consumer surveys reveal common misunderstandings about which public programs pay for long-term care services. It is important to clearly understand what is and isn’t covered.
Medicare:
- Only pays for long-term care if you require skilled services or rehabilitative care:
- In a nursing home for a maximum of 100 days, however, the average Medicare covered stay is much shorter (22 days).
- At home if you are also receiving skilled home health or other skilled in-home services. Generally, long-term care services are provided only for a short period of time.
- Does not pay for non-skilled assistance with Activities of Daily Living (ADL), which make up the majority of long-term care services
- You will have to pay for long-term care services that are not covered by a public or private insurance program
Medicaid:
- Does pay for the largest share of long-term care services, but to qualify, your income must be below a certain level and you must meet minimum state eligibility requirements
- Such requirements are based on the amount of assistance you need with ADL
- Other federal programs such as the Older Americans Act and the Department of Veterans Affairs pay for long-term care services, but only for specific populations and in certain circumstances
Good To Know
Like public programs, private sources of payment have their own rules, eligibility requirements, copayments, and premiums for the services they cover.
Health Insurance:
- Most employer-sponsored or private health insurance, including health insurance plans, cover only the same kinds of limited services as Medicare
- If they do cover long-term care, it is typically only for skilled, short-term, medically necessary care
Your Options:
The U.S. Department of Health and Human Services offers some detailed information on payment options at the following links. The increasing number of private payment options include:
LongTermCare.gov
