Elder Care Insurance - Is there a Safety Net for Seniors?

Is There an Insurance Safety Net for Seniors?

Insurance is a must, but many seniors can’t afford it these days. Seniors are especially vulnerable to the availability, as well as their options when it comes to policies, exclusions and benefits. While most seniors do qualify for Medicare, many don't understand what ordinary Medicare covers and doesn't cover. Many seniors believe that Medicare will take care of long term health care needs, but it doesn't. Seniors need to be aware of supplemental Medicare plans, as well as long-term and nursing home care policies when it comes to their future.

Understanding the difference between Medicare, Medicaid, and long term coverage will help seniors make better decisions regarding long-term health care needs versus their current insurance coverage. After all, Medicare only goes so far.

Medicare and Medicaid

Medicare covers inpatient care at a skilled nursing facility for a limited period of time after an eligible hospital stay. After the initial period has ended, individuals must co-pay on a per day basis for that care.

Medicare Gap and Medicare supplemental policies helped to cover costs of Medicare Part A and Part B.

insurance for elder care

Medicaid is a federal program that is funded on a state-by-state basis by the State Department of Insurance. Maximum income in order to be considered eligible for Medicaid varies by state.

Supplemental Security Income Program (SSI)

Some seniors qualify for Supplemental Security Income because of disabilities or circumstances as well as low income. However, certain assets as well as “countable” income may reduce amount of payments.

The Importance of Long Term Care Coverage

Long term care coverage enables seniors to access nursing home care as well as care in assisted living facilities, and is often utilized by those suffering from chronic illnesses and disabilities.

A one year year stay in a nursing home in an average community can range between $25,000 and $42,000 - a year. Medicaid does not pay for long term health care, and in order to enjoy the benefits of Medicaid services, your parent may have to sell his or her home and show very limited assets.

A long term care policy covers costs of visiting nurses, health monitoring, assisted living services, community programs as well as daily activity care in your home.

However, when it comes to looking for the benefits of a long-term care policy, seniors must also take into consideration:

  • What insurance policies cover

            o Home care?

            o Nursing home care?

            o Caregiver training for home care?

  • How many years will policy pay benefits?
  • What is the policy regarding preexisting conditions?
  • What is the daily payment rate?
  • What types of medical benefits are covered?
  •  Is there a waiting period before coverage starts?
  • Will the policy coincide with Medicare Gap or other managed care coverage?
elder care insurance

Tax Qualified Long Term Care Insurance

Long-term care insurance is available as a tax qualified or non-tax qualified policy. Tax qualified plans offer a variety of tax advantages, including the exclusion of qualified long term care costs from taxable income. Non-tax qualified plans don't offer the same benefits.

Tax qualified long-term care policies often cover disabilities or illnesses for prolonged periods of time. Policyholders must meet basic requirements, such as "substantial assistance" in at least two of five daily living activities (ADLs) for at least 90 days, or be diagnosed with severe cognitive impairments.

Non tax qualified policies offer different benefits, as well as eligibility guidelines, which often offer individuals faster access to benefits. However, premiums for non-tax qualified plans are generally higher and benefits may be taxable. In addition, seniors should be aware that premiums for such policies might not be allowed as a deductible medical expense.

Prescription Drug Assistance Programs

Some pharmaceutical companies offer medication assistance programs, though eligibility criteria differ from company to company. For more information regarding prescription drug assistance programs sponsored by drug companies, speak with your pharmacist, or contact drug manufacturers via their websites.

In addition, seniors are encouraged to ask health care providers for help determining whether or not he or she may qualify for such assistance.

These days, seniors need to take advantage of every benefit that is available to Medicare, as well as Medicare Gap or supplemental plans in order to meet the rising cost of health care. Don’t wait until the last minute. Start looking into long term health coverage before you need it.

Senior Insurance


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