How people pay for long-term care–whether delivered at home or in a hospital, assisted living facility or nursing home–depends on their financial situation and the kinds of services they use. Often, they rely on various payment sources, including personal funds, government programs and private financing options.
Personal funds
At first, many older adults partly pay for care with their own money. They may use personal savings, a pension or other retirement fund, income from stocks and bonds or proceeds from the sale of a home.
Much home-based care is paid for using personal funds (“out of pocket”). Initially, family and friends often provide free personal care and other services, such as transportation. But as a person’s needs increase, paid services may be needed.
Many older adults also pay out-of-pocket to participate in adult day service programs, meals and other community-based services provided by local governments and nonprofit groups. These services help them remain in their homes.
Professional care given in assisted living facilities and continuing care retirement communities is almost always paid for out of pocket, though, in some states, Medicaid (see below) may pay some costs for people who meet financial and health requirements.
Government programs
Older adults may be eligible for some government health care benefits. Caregivers can help by learning more about possible sources of financial help and assisting older adults in applying for aid.
Several federal and state programs provide help with healthcare-related costs.
Centers for Medicare and Medicaid Services
The Centers for Medicare & Medicaid Services (CMS) offers several programs. Over time, the benefits and eligibility requirements of these programs can change, and some benefits differ from state to state. Check with CMS or the individual programs directly for the most recent information.
Medicare:
Medicare is a federal government health insurance program that pays some medical costs for people aged 65 and older and for all people with late-stage kidney failure. It also pays some medical costs for those who have gotten Social Security Disability Income for 24 months. It does not cover ongoing personal care at home. Here are brief descriptions of what Medicare will pay for:
Medicare Part A:
Hospital costs after you pay a certain amount called the “deductible”
Short stays in a nursing home for certain kinds of illnesses
Hospice care in the last six months of life
Medicare Part B:
Part of the costs for doctor’s services, outpatient care and other medical services that Part A does not cover
Some preventive services, such as flu shots and diabetes screening
Medicare Part D:
Some medication costs
Medicaid:
Some people may qualify for Medicaid, a combined Federal and State program for low-income people and families. This program covers the costs of medical care and some types of long-term care for people who have limited income and meet other eligibility requirements. Who is eligible and what services are covered vary from state to state.
Program of All-Inclusive Care for the Elderly (PACE)
Some States have PACE, Program of All-Inclusive Care for the Elderly, a Medicare program that provides care and services to people who otherwise would need care in a nursing home. PACE covers medical, social service and long-term care costs for frail people. It may pay for some or all of the long-term care needs of a person with Alzheimer’s disease. PACE permits most people who qualify to continue living at home instead of moving to a long-term care facility.
State Health Insurance Assistance Program
SHIP, the State Health Insurance Assistance Program, is a national program offered in each state that provides counseling and assistance to people and their families on Medicare, Medicaid and Medicare supplemental insurance (Medigap) matters.
Department of Veterans Affairs
The U.S. Department of Veterans Affairs (VA) may provide long-term care or at-home care for some veterans. If your family member or relative is eligible for veterans’ benefits, check with the VA or get in touch with the VA medical center nearest you. There could be a waiting list for VA nursing homes.
Social Security Disability Income
This type of Social Security is for people younger than age 65 who are disabled, according to the Social Security Administration’s definition.
For a person to qualify for Social Security Disability Income, he or she must be able to show that:
They are unable to work
The condition will last at least a year
The condition is expected to result in death
Social Security has “compassionate allowances” to help people with Alzheimer’s disease, other dementias and certain other serious medical conditions get disability benefits more quickly.
Source: NIH National Institute on Aging: www.nia.nih.gov