You already know what a complex world Medicare is. But another topic that raises many questions is long-term care. What is long-term care? Who needs it? And most importantly, how much does long-term care cost?
Plus, if you are already enrolled in Medicare, as many of our clients are, you’re probably also wondering how Medicare covers long-term care stays. Not to worry, we’ve got all these answers and many more right here! So, whether you are early in the planning stages, looking for long-term care now, or helping a loved one find help, you came to the right place. Let’s dive in.
Long-term care is a broad term that refers to a range of services designed to meet your healthcare and personal care needs over a long period of time. It’s commonly used by people who have chronic illnesses or disabilities to allow them to lead a higher quality of life.
Long-term care isn’t medical care per se. Instead, its primary focus is helping people with basic personal tasks, referred to as ADLs or Activities of Daily Living. This includes things like bathing, getting dressed, using the bathroom, transferring into beds or chairs, and eating. Long-term care can also help with Instrumental Activities of Daily Living (IADLs), which include grocery shopping, housekeeping, cooking, taking medications, and managing money.
Long-term can also encompass social and emotional support. Many people who require long-term care benefit from this kind of support since they must deal with prolonged disabilities and illnesses. The social and emotional support you get in long-term care is just as important as physical help.
You can have long-term care help at home, in a community, or in various types of facilities like nursing homes and assisted living groups. In many cases, other services are included, such as physical therapy, occupational therapy, and speech therapy.
It’s not uncommon for the need for long-term care to arise unexpectedly due to a sudden illness or serious accident. Or sometimes, it’s just a normal part of the aging process. In fact, 70% of people who reach the age of 65 will need long-term care assistance in their future. Given this statistic, understanding the impact of long-term care on your health and finances is crucial for effective planning.
It’s a common assumption that long-term care is only for the elderly. Sure, it’s true that older individuals are more likely to need long-term care, but it’s certainly not exclusive to them. Anyone can find themselves needing care due to illness, disability, or serious injury.
Of course, certain factors do increase the likelihood of needing long-term care in a person’s lifetime. Let’s look at some of the key factors.
Age: We covered this statistic earlier, but to reiterate, anyone who lives to the age of 65 has a 70% chance of needing some type of long-term care services. This statistic comes straight from the United States Department of Health and Human Services.
Gender: Women are more likely to need long-term care than men, primarily because they typically live about six longer. Plus, on average, women need 3.7 years of long-term care, and men only need 2.2 years.
Family History: Genetics can play a role in the likelihood of needing long-term care. For example, if chronic illness runs in your family, you’ll be more likely to require long-term services.
Health and Physical Condition: Chronic diseases like diabetes, obesity, and heart disease increase the chance you’ll need long-term care. Other habits like physical activity and smoking will have a significant impact.
You’ve probably heard us say this before, but when it comes to any kind of healthcare, there isn’t a one-size-fits-all solution. The kind of care you need will depend on your specific health condition, personal preferences, and lifestyle. Let’s run through a few of the main kinds of long-term care.
Home-Based Care: Many people prefer to stay in their own homes for as long as they can. The good news is, long-term care is something that can be provided for you while you’re still living at home. Maybe you just need help with some of the ADLs or IADLs we mentioned earlier. Or, maybe you need more specialized care provided by a registered nurse. Home health aides, personal care attendants, and visiting nurses can all provide this kind of care.
Assisted Living Facilities: These are residential communities for people who can still live independently, but could use some help with daily tasks. In an assisted living facility, you’ll have a communal environment and can enjoy social and recreational facilities with other residents. In addition, you’ll have help with things like meal preparation, taking medication, and other ADLs.
Nursing Homes: If you need a higher level of care and can no longer live independently, nursing homes provide 24-hour care with meals, activities, and healthcare management. Most nursing homes offer rehabilitation services like physical, occupational, and speech therapies.
Continuing Care Retirement Communities (CCRCs): CCRCs are a combination of assisted living and nursing home features. They have different levels of care based on your needs at any given time.
Specialty Care Units: Specialty care units focus on caring for your specific health need, like if you have Alzheimer’s or dementia. Many times, these units are located within a long-term care facility. They’ll have staff who have been specially trained to care for people with special conditions.
As you may have imagined already, all this extra care comes with a price. Long-term care can be quite expensive, regardless of how much care you need. Let’s take a look at the average cost of long-term care in the United States.
Home-Based Care: $4,000/month
Assisted Living Facilities: $6,500/month
Nursing Homes: $10,000/month
Continuing Care Retirement Communities: $5,000/month (plus an entry fee)
Keep in mind these are just rough estimates of what you might pay for long-term care. Plus, these costs don’t include any care you receive while under long-term care. You’ll still have doctor and hospital bills, prescription costs, and other medical expenses.
Since Medicare is geared towards older adults, many people assume it will help with long-term care costs. But let’s just be blunt about this. Medicare won’t be very helpful when it comes to long-term care. Below is a general overview of what might be covered if you are enrolled in Original Medicare, which consists of Parts A and B.
In-Home Care: Medicare will cover some in-home services, but only to an extent and only if those services have been deemed medically necessary. If they are, you’ll have some coverage for part-time or intermittent skilled nursing care and physical, speech, and occupational therapy. Medicare will not cover 24-hour care at your home, meal delivery, or homemaker services.
Skilled Nursing Facility Care: Medicare Part A does cover your room and board fees if you are admitted to a skilled nursing facility. Certain conditions must be met prior to your admission and coverage is limited to a certain amount of time. In addition, you’ll have a deductible and copayments unless you have additional coverage in place, like a Medicare Supplement plan or Medicare Advantage plan.
Nursing Homes and Assisted Living Facilities: While Medicare may cover a portion of a short-term stay, it does not typically cover any costs if you’re admitted to one of these facilities.
Hospice Care: Medicare will cover hospice if you meet the qualifications. To be eligible, a doctor must confirm that you are likely to pass away within six months. Hospice coverage includes pain management and medications to control your symptoms, social services, durable medical equipment, and other necessary items.
Keep in mind that regardless of which Medicare plan you have, you’ll still likely have cost-sharing amounts due for services.
Given all the limitations we just discussed, most people turn to long-term care insurance to offer additional protection. Long-term health care insurance is designed to cover all the services we’ve mentioned in a variety of settings. These policies will reimburse policyholders a daily or monthly amount up to a pre-defined limit.
The cost of long-term care insurance depends on a few personal factors, as well as the kind of policy you want. A few factors include:
Age: The younger you are when you purchase the policy, the lower your monthly premium.
Policy Maximum: The higher the daily (or monthly) reimbursement, the higher the premium.
Policy Life: Policies with longer time limits (like 5 years instead of 3 years) will cost more per month.
Optional Benefits: Most long-term care insurance plans are customizable. You can add options like inflation protection and other riders. Each of these things will increase the monthly premium.
It’s important to know that long-term care policies often have an elimination period. An elimination period in long-term care is a certain amount of time during which you must need assistance with ADLs before the policy kicks in. Plus, you’ll need to know what long-term insurance covers to identify any other gaps in coverage.
There are other options for long-term care financing. You may want to consider life insurance with a long-term care rider, annuities, or even reverse mortgage products. Each of these has its pros and cons and should be considered as part of an overall retirement and financial plan.
The possibility of needing long-term care is one of the biggest health and financial challenges we’ll face as we age. Despite this, many of us still overlook or postpone planning until it’s too late.
As we said earlier, long-term care is not just about aging. A sudden accident or an adverse health diagnosis can quickly bring long-term care into the present. It’s crucial to start planning early while we’re still relatively young and healthy. This gives you more options and control over your future, and ensures you can actually get long-term care insurance. Long-term care policies have strict medical underwriting requirements, so not everyone can get one of these plans. The healthier you are, the better chance you have to secure your future.
Let’s go through a few of the steps you can take to start planning for long-term care.
Understand the Need: Familiarize yourself with the facts and figures surrounding long-term care. Knowing the risks is the first step in effective planning.
Assess Your Risks: Do you have any health risks? Take a look at your current lifestyle as well as your family history.
Plan Your Finances: Estimate how much money you might need for long-term care and begin planning accordingly. This could mean a special savings account, investing, long-term care insurance, or a combination of strategies.
Communicate Your Wishes: Chat with your loved ones about your preferences for long-term care. This will help ensure your wishes are respected and make it easier on your family if they have to make decisions on your behalf.
Stay Healthy: While there are no guarantees, stay healthy and lead an active lifestyle to avoid long-term care as long as possible! Regular exercise, a healthy diet, regular checkups, and preventive care all contribute to your long-term health and well-being.
Having a solid plan will give you peace of mind in case the need arises. You’ll be prepared and have the resources you need to get the care you deserve. It also helps protect your family and other loved ones from carrying the burden in a time of crisis.
If you’ve made it this far, we’re proud of you! Long-term care isn’t something most of us want to think about. It’s confusing and scary. That’s why our team at Local Medicare Specialists is happy to help you with this process, guide you through the best long-term care insurance for you, and provide you with a long-term care insurance quote.
We specialize in Medicare and other insurance plans for older adults, including long-term care insurance. Schedule an appointment with one of our local insurance advisors and learn more about which policies might be of greatest benefit to you. We’ll give you personalized recommendations and year-round support to ensure you have the coverage you need. Don’t wait until it’s too late - call us today!
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We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area which are United Healthcare, Aetna, Humana, Cigna, Blue Cross Blue Shield of Arizona, Centene, Devoted, and Scan. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options.