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After one selects the proper
level of care the individual needs, the next step is determining
how to pay for those services. Will it be from your savings or
from something like elder care insurance (long term care insurance)?
Any nursing facility you are considering should conduct an assessment
to help you make this determination and to explain the individual
facility’s rate structure.
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One should plan for long-term
care the way one plans for retirement. In today’s nursing
facilities, forty percent of those admitted are sent home after
a rehabilitating stay. But that doesn’t change the fact
that 24-hour medical attention, plus food, shelter, and programming
offered in a nursing home, no matter how short or long the stay,
is a costly proposition for the average taxpayer. Quality nursing
home care in Illinois costs $40,000 a year on average, and can
quickly devour a person’s savings.
What payment sources are available
for people needing long-term care services?
Studies show most Americans believe
Medicare, the federal insurance program for people age 65 and
over, or their own health insurance plans will pay for long-term
care bills, but this isn’t true. People are surprised when
they learn that, in Illinois, Medicare pays for less than eight
percent of nursing home care, and nationwide is limited to the
first 100 days after a hospital stay. Medicare will pay for care
under certain limited conditions. To find out if you qualify
for Medicare, check with the Social Security Administration for
current criteria.
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An individual’s continued
need for Medicare-funded services is monitored carefully by the
Health Care Financing Administration (HCFA), and payment may
be terminated if skilled care is no longer justified on a daily
basis.
Once someone exhausts the small
amount of available Medicare coverage, they must run through
whatever personal financial resources they have accumulated in
their lifetimes in order to qualify for Medicaid, the program
which assists low-income people of all ages. Medicaid funds,
which currently pay for care provided to 61% of Illinois long-term
care residents, are allocated at the state level and matched
by federal funds. Illinois guidelines allow payment for skilled
and intermediate care, provided the facility participates in
the program.
The requirements for Medicaid
eligibility can be complex. A basic eligibility factor for Medicaid
is that a person has to spend down their savings to only $2,000.
This means less money for a spouse’s nest egg, for children’s
inheritances, or for charitable donations.
The nursing facility staff or
the local office of the Illinois Department of Public Aid can
assist you in obtaining the necessary information about Medicaid.
More people are turning to elder-care
or long-term care insurance to protect assets built up over a
lifetime of work and provide peace of mind. A recent study by
Deloitte & Touche noted that 60% of people over age 75 will
need long-term care services. Long-term care is clearly the number
one risk facing elderly Americans – yet it’s the least
insured for. Many veterans’ groups, trade unions, fraternal
organizations and private insurance carriers offer long-term
care insurance plans with applicable benefits. Long-term care
insurance plans are economical, especially for purchasers between
the ages of 40 and 55. Ask your local insurance agent about the
benefits of this type of insurance.
In General
The Insurance Counseling and
Assistance (ICA) program provides free help with questions on
long-term care costs. If you are confused about Medicare coverage
of nursing home services, Medicaid eligibility requirements,
or private long-term care insurance, contact the Illinois ICA
for help at (800) 548-9034.
No matter who is responsible
for the payment of long-term care services, it is important to
familiarize yourself with the procedures, finalize all the arrangements
in advance, and to secure copies of all financial details. If
you believe that Medicaid or Medicare may be a source of payment,
discuss this with the facility. Make certain to determine what
services are included in the basic rate. Secure a list of all
services and charges which are not included in the basic rate
and ask whether advance deposits are required.
The State of Illinois requires
certain safeguards for resident funds that facilities manage
on behalf of the resident. You may want to confer with the facility
on the way they handle resident funds.
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