When the difficult decision has been made that mom or dad can no longer take adequate care of themselves or each other, relocation to an assisted living community may be the best option. Senior care can be a daunting concept – emotionally and financially – but there are viable insurance options to help with the expenses. Medicare, Medicaid, Veteran’s Benefits, long term care and other private insurance can all offset the costs. You need to be cognizant of not only the costs of the facility itself, but also the medical and other insurance needs of your senior loved one.
Medicare
If seniors are 65 and older they are qualified for Medicare if they or their spouse worked in Medicare-covered employment for at least 10 years. They must be permanent residents or citizens of the United States. Medicare recipients do pay a portion of the costs of benefits in the form of copayments, deductibles, co-insurance and premiums. Do keep in mind that Medicare costs are billed depending on a senior’s financial resources. If your parent is also eligible for Medicaid, it may help pay their medical costs. If they have limited income, your state or Medicare may help cover the costs.
Medicare coverage is divided into four parts: Part A, Part B, Part C and Part D.
-
Medicare Part A (aka Hospital Insurance) covers all or part of inpatient hospital care. It also covers home health care, skilled nursing facilities, and hospice care.
-
Part B (aka Medical Insurance) resembles standard health insurance: doctor’s visits, outpatient care, medical equipment, preventive services, and home health care.
-
Part C - Medicare Advantage Plan (like an HMO or PPO) is offered by private companies approved by Medicare
-
Part D covers some prescription drugs.
What won’t it cover? Medicare will not pay for long-term healthcare (aka custodial care), routine visits for eye care, dental care, dentures, foot care, or hearing aids. It does not cover cosmetic surgery or acupuncture.
Medicaid
If your senior loved one has a limited income and cannot afford their Medicare premiums, they can apply to get help. Medicaid helps pay for their premiums and out-of-pocket medical expenses. Services covered by both programs paid first by Medicare with Medicaid filling in the difference up to the state's payment limit. It also covers many of the services not covered by Medicare like:
-
A nursing facility care beyond the 100-day limit
-
Prescription drugs
-
Eyeglasses
-
Hearing aids
Veteran’s Benefits
If your senior loved one is a veteran, they, and certain family members, may receive veterans’ retirement benefits through the VA pension or its Aid & Attendance (A&A) programs. Both programs provide financial support to low-income veterans aged 65 and above who served during specific periods of war: WWI or WWII, the Korean War, the Vietnam War, or the Persian Gulf War. They must be at least 65, and have a countable annual income that is less than the Maximum Allowable Pension Rate (MAPR) provided by Congress. The government views countable income to include: social security benefits, annuities and retirement funds and other taxable income sources. To determine one’s countable annual income, the VA totals the applicant’s annual income, reduces it by “excessive” healthcare costs, and then subtracts that final amount from the applicable MAPR. Excessive healthcare costs include:
-
insurance premiums
-
uncovered prescription drugs
-
long-term care
-
and other healthcare expenses whose combined total is greater than five percent of the claimant’s MAPR
An assisted living community manager should be familiar with the rules and regulations regarding requesting VA benefits for their community members. Want to learn more about the VA and its benefits? Click here.
Long Term Care Insurance
Long-term care insurance was hopefully purchased by your parents when they were younger. This policy is designed to safeguard a family’s assets in case they need to be relocated to an assisted living or other facility. A long term care insurance policy will keep beloved seniors safe and well cared for in cases of physical illness, disability, or cognitive impairment, such as Alzheimer’s disease. Depending on the level of mobility and ability to perform tasks, long term care insurance covers skilled care (conditions requiring medical personnel) and personal care (assistance with normal activities).
Food for Thought - Seniors and the Affordable Care Act
With a government focused on meeting budgets and an ever increasing senior population, the Affordable Care Act is of great benefit. If your senior loved one is on Medicare, the Affordable Care Act provides peace of mind. It ensures that their benefits will never be reduced or eliminated. It also ensures that they will always be able to choose his or her own doctor.
Do you have questions about how you can meet the financial obligations of your parents as they age? Contact Senior Solutions. We have beautiful communities based in Tennessee and Georgia that offer life enrichment, security and safety that is important to the entire family.
Do your senior loved ones have plans in place for assisted living?
