Long Term Care Insurance Specialist
"The Government Will Take Care of Me"
Medicare is health insurance that is available to those age 65 and over. It pays for things like doctor visits and hospital stays, but is not intended for long term care.
Medicare will pay for some portion of a nursing home stay if these requirements are met:
- The nursing home stay follows a hospital stay of at least three days, not including the day of discharge.
- It is skilled medical care that is needed, not just custodial care.
- The patient’s condition must be improving, meaning the care is more rehabilitative.
Many people needing long term care in a facility may not be admitted to a hospital first. Individuals with dementia or Alzheimer’s, or those with diseases like Parkinson’s or MS may go directly from a home setting to a facility setting when their family caregivers are no longer able to care for them sufficiently. Medicare would not cover people in those situations.
For those who do meet the criteria, Medicare will pay for up to the first 100 days of their stay, subject to a deductible for part of that time.
- If someone does qualify and the state pays for their care, who will determine placement of that individual? The state, of course. The individual or the family is not given the choice of facilities, and the availability of Medicaid beds is shrinking, as fewer facilities are accepting Medicaid patients.
- Washington State is a recovery state. That means that if a person is cared for with State funds, the State can ‘recover’ those funds after the person has passed on by putting a lien on the home that was excluded from assets in determining eligibility.
- But most importantly, the intent of Medicaid is not to pay for care for people of means who find ways to get around the requirements. It is meant for those who truly have no other options when it comes to their care. With state budgets shrinking, and the population aging, there is a tremendous strain on programs like this that are meant to help people who really need it.
Medicaid is a program jointly funded by the federal government and individual states. It is a safety net for those who are impoverished and are unable to pay for their own care. To qualify, an individual needs to meet certain income, resource, age, or disability requirements under the Medicaid guidelines.
Many people have tried to get around the requirements by hiding or giving away assets. The idea is that, if someone can appear to be impoverished, they can qualify for Medicaid and the state will pay for their care.
There are many problems with that:
Veteran’s Benefits are health care benefits and not intended to pay for long term, custodial care. Some veterans do qualify for care in Veteran’s Hospitals, if they have a service-related disability and meet certain financial criteria
- The Deficit Reduction Act of 2005 significantly changed the rules governing gifts and transfers, as well as what assets are excluded when determining eligibility. If someone gives away assets or puts them in a trust, there is a 5 year look back period. If the action was taken within 5 years of applying for Medicaid, those assets will be counted and will delay eligibility.