WHO PAYS FOR LONG TERM CARE?

MEDICARE/MEDICAL INSURANCE LONG TERM CARE BENEFITS

MEDICARE PART A

Hospital Deductible (Day 1-60): Coinsurance per day: $1,184
Day 61-90: $296
Day 91-150: 592
All cost for each day beyond 150 days.

If a person has been admitted for 3 24-hour days, then Medicare pays as follows:
Skilled Nursing Facility Days 1-20 Covered 100% by Medicare
Skilled Nursing Facility (SNF) Coinsurance: $148 per day days 21-100

In 2013 Medi-Cal Allows the Following Resources without Court Order:

Community Spouse Resource Allowance (CSRA): $115, 920
Single Person $2,000.00 (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 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, engagement rings and heirlooms, and items of jewelry with a net market value of $100 or less are totally exempt; for spouses; there is no limit on exempt jewelry for determining the institutionalized spouse’s eligibility.
  • One car is generally exempt if used for the benefit of the applicant/beneficiary or if needed for medical reasons.
  • Whole life insurance policies with 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 of any amount and $1,500 in designated burial funds. These designated funds must be kept separate from all other accounts.
  • Cash surrender value or 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).
  • Up to $2,000 in cash reserve, e.g. 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 homebound
  • 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$1,603.00 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.