Phew! While helping a friend navigate through the financial maze of his parents’ care, we were wading through all the documents and happened to stumble across an unknown Long Term Care insurance policy that his dad had wisely purchased long ago. What a huge relief! I can’t tell you how many times I’ve been asked about the basic financial pieces of long term care, so I thought it would be helpful form me to prepare a “Primer” on the basics. There is too much information so I’m breaking it into two parts. Here is Part 1:
Medicare – A medical insurance for seniors over the age of 65, for short-term hospital stays, rehabilitation and therapy. There are, however, exceptions. For example, a person who is deemed permanently disabled and people with End- Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD) can apply for Medicare earlier than age 65. Medicare only covers short term medically necessary care and focuses on medical acute care such as doctor visits, drugs, and hospital stays, not long term care directly. (http:// medicare.gov/)
Medi-Cal (Medicaid) – Medi-Cal is a state “safety net” for both short term medical care as well as long term care. Medi-Cal is a government low income health care assistance program for adults and children. Many people that receive Medi-Cal have no premium, no co payment and no out of pocket costs. Medi- Cal has very similar benefits to Covered California at a lower cost. For a Medi- Cal eligible person needing long term care in California, they can either live in a skilled nursing facility or, in some limited areas, in an assisted living facility. (http://www.medi-cal.ca.gov/).
Social Security Supplemental Insurance: This is a federal program that provides monthly cash payments to people in need. To qualify for supplemental income you must be over the age of 65 and have income and assets less than 2,000 dollars (single) and 3,000 dollars (married). In California if one’s social security is below $1,133 dollars and they are in a non-medical out of home care, such as an assisted living facility, they can qualify for a supplemental income. Very few assisted living facilities take only SSI payments, however, you can combine SSI with private pay funds from family or in conjunction with the Limited Medi-Cal Assisted Living Program. (http://www.ssa.gov/pgm/ssi.htm)
Long term care insurance: An insurance policy purchased either privately or through an employer, that will later down the road pay for long term care, including skilled nursing, assisted living, in-home care support, and possibly adult day care. The amount paid out in benefits (or reimbursed) depends upon the premium paid. The earlier these polices are purchased during one’s life, the less the monthly premium. Polices vary widely, so examine carefully. Hopefully this brief synopsis helped clarify some of the commonly asked questions. My goal was to give many people a better understanding of the differences of each resource and what it takes to qualify. If you would like more specifics regarding the above, please feel free to email me at Mark@ciminocare.com and I will try my best to help you.
Mark J. Cimino is Chief Executive Caregiver of CiminoCare, a Sacramento-based assisted living provider. Mark started in his caregiving profession at age six when he and his siblings would tag along as their mother visited her in home care clients. In addition to his job, Mark is actively involved in Rotary International. His interests include hiking and doing fun things with his three boys. Mark can be reached at mark@ciminocare.com