There are two approaches to paying for care.  Assume the responsibility yourself or rely on the State and Federal government to pay for the care.  

 

     If you choose to assume the responsibility to pay for your own care, you will use your own assets and income or purchase long-term care insurance to help pay for care in your home, in an assisted living facility or in a nursing home.

 

     If you look to the government to pay for your care, there are three programs currently available to help.  Be aware that our government is in the worst financial position ever, and its expenses exceed income, so these safety nets may be diminished in the future.  The three government programs that help pay for long-term care are Medicare, Veterans’ non-service connected "pension” benefits and Medicaid.  We will consider each of these three government programs.  In this article we will discuss the first Government program, Medicare.

 

MEDICARE

     Who is covered?  This is a federal health insurance program for people age 65 and older.

 

     What does Medicare pay for? 

        Part A = Hospital bills.

        Part B = Doctor, outpatient, home health and preventative services ($96.40/month premium up to $353.60 for higher incomes)

        Part C = Medicare Advantage program, really HMOs

        Part D= Prescription drug plan

 

     Does Medicare pay for residential, long-term care in your home, assisted living or a nursing home?  No, but with one exception.

 

     If you are admitted to a hospital for 3 days, then discharged to a rehabilitation facility and you are improving, Medicare will pay 100% of the cost for the first 20 days.  If you continue to improve, then from day 21 to day 100 the patient will pay $137.50/day [or their supplemental insurance pays] and Medicare pays the rest.  How is this safety net disappearing?  

 

     WARNING:  If you are not “admitted” to the hospital, but there for “observation” Medicare will not pay a dime and your supplemental Medicare insurance will not pay either.  Failure to get the first 20 days covered by the Medicare program can cost in excess of $6,000!  This is an Idaho and a nation-wide problem.¹

 

     THE SOLUTION:  Make certain you are “admitted” to the hospital before being discharged.  If you cannot get this accomplished, talk to the hospital social worker, or an independent Care Manager. 

 

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¹ "Hospital Stays Under Observation," AARP Bulletin, January-February, 2010

 

HAVE A GREAT 4th OF JULY