More than 40 million seniors rely on Medicare for their everyday health insurance needs, and many mistakenly assume that Medicare will also cover long-term care if it is needed. In fact, there are specific limitations to Medicare coverage for long-term care, and such care is often covered instead by Medicaid, which has eligibility requirements. Therefore, it is important to understand how these two public benefit programs affect long-term care expenses.
Medicare pays for health care for people age 65 years and older or with certain disabilities. Under certain conditions, Medicare will pay for short-term stays in skilled nursing facilities, hospice care, or home health care. Generally, Medicare focuses on medically necessary care such as doctor’s visits and hospital stays, rather than personal care services associated with long-term care.
Until recently, there was an unevenly enforced “improvement standard,” by which Medicare beneficiaries were denied coverage if their condition was no longer improving. However, the settlement of Jimmo v. Sebelius, a 2013 lawsuit, clarified that no such “improvement standard” can be enforced, and people with chronic conditions can continue to be eligible for Medicare to pay for their medical treatment.
Nevertheless, Medicare generally does not provide for room, board and custodial care such as that offered in a skilled nursing facility. Therefore, people needing such care usually use personal resources, long-term care insurance, and Medicaid. Medicaid has income and asset eligibility requirements, and many seniors will have to spend down some assets to qualify. The financial requirements for Medicaid can be complicated, and the advice of an experienced elder law attorney can be invaluable in planning for long-term care.
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Give certain assets away before any claims arise. When done properly, such a gift may succeed in transferring property while keeping it out of an estate that may face claims from creditors. However, creditors may try to claim the transfer is fraudulent if it is made after claims arise, if the gift makes you insolvent, or if you place limits on the gift such that you still maintain control over the assets.
While cognitive declines associated with Alzheimer’s diseases and other dementias are well-known, most people are unaware that seniors without dementia are also at risk for cognitive impairment, particularly in financial issues.
The Sarah Neuman Center at Jewish Home has introduced the NightCare program designed to comfort and engage elders with this level of dementia, and to provide respite for their caregivers. Offered several nights per week, from 7 PM to 7 AM, the NightCare program is staffed by experienced, caring professionals like Ruth Mederski, LPC. She explains, “At night when these seniors can become more anxious, we are there to give reassurance.”