WHO PAYS FOR LONG TERM CARE?

MEDICARE/MEDICAL INSURANCE LONG TERM CARE BENEFITS

MEDICARE PART A

Hospital Deductible (coinsurance per day):

  • Days 1-60: $1,184
  • Days 61-90: $296
  • Days 91-150: 592

Each day beyond 150 days, you pay full cost.

If a person has been admitted for three 24-hour days, then Medicare pays as follows:

  • Skilled Nursing Facility, Days 1-20: covered 100% by Medicare
  • Skilled Nursing Facility, Days 21-100 coinsurance: $148 per day

As of 2013, Medi-Cal allows the following resources without court order:

  • Community Spouse Resource Allowance (CSRA): $115,920
  • Single person needing skilled care: $2,000
  • Couple, both needing skilled care: $3,000
  • Minimum Monthly Maintenance Needs Allowance (MMMNA): $2,898 (spousal income allowed)
  • Average Private Pay Rate (APPR): $7,549

*** These numbers will be changing soon.

The following assets are NOT counted towards eligibility, but may be available for recovery unless protected:

  • The home — totally excluded, if it is the principal residence. The applicant must state “intent to return to the home.” Includes a mobile home, houseboat, or an entire multi-unit dwelling, as long as any portion serves as the principal residence of the applicant.
  • Other real property — may be excluded if it is used in whole or in part as a business or means of self-support. You should see an attorney if you have other real property.
  • Household goods and personal effects — totally exempt.
  • Jewelry for a single person — wedding rings, engagement rings, heirlooms, and items of jewelry with a net market value of $100 or less are totally exempt
  • Jewelry for spouses — there is no limit on exempt jewelry for determining the institutionalized spouse’s eligibility.
  • One car — generally exempt if used for the benefit of the applicant/beneficiary or if needed for medical reasons.
  • Whole life insurance policies — excluded if they have a total face value (also called “combined death benefit”) of $1,500 or less.
  • Term life insurance — totally excluded.
  • Burial plots — totally excluded, includes headstone, crypts, etc.
  • Prepaid irrevocable burial plan — any amount is excluded.
  • Designated burial funds — excluded if funds are $1,500 and kept separate from all other accounts.
  • Cash surrender value
  • Balance of pension funds
  • IRAs and certain types of annuities — you should see an attorney if you are considering buying an annuity. Call CANHR for a referral!
  • Cash reserve up to $2,000 — this includes cash in savings, checking, etc., for the Medi-Cal applicant.

PAYING FOR NON-MEDICAL LONG TERM CARE IN ASSISTED LIVING, BOARD AND CARE HOMES, AND YOUR HOME

Home Health Services

Medicare covers up to 100 home health visits per period of illness following a hospital stay. Additional home health benefits are available under Part B. Home health visits under both Parts A and B must meet the following conditions:

  • A physician has certified you as home-bound
  • Intermittent skilled nursing or therapy services are required
  • Services are provided by a Medicare-certified home health agency

Hospice Care

Hospice care is available for terminally ill patients. The goal of hospice care is to keep the patient as comfortable as possible. It does not provide treatment for the terminal illness.


In-Home Supportive Services or SSI Payment

In order to qualify for these programs, income must be below the poverty level for people over 65. If you are under 65, you must qualify as disabled.

The current poverty level numbers are $1,188 for an individual and $1,603 for a married couple. The pay for these services is minimal, so providers are limited.


Waiver for Assisted Living

If you qualify for nursing home care, there are a few beds available in assisted living. Few facilities have waivers, so for most people, this is not an option.


Long-Term Care Insurance

Payment depends on the contract, and once you have a diagnosis, the product is not available.