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What is Long-Term Care
Long-term care is the assistance individuals need when they are unable to care for themselves and need help
with Activities of Daily Living (ADLs) - bathing, dressing, transferring, toileting, continence (control of bodily
functions), and eating - or they have severe cognitive impairment such as Alzheimer's disease. The need for
long-term care can result from an accident, chronic illness or short-term disability, or from advance age. Long
term care can include a broad range of services, provided in any setting outside a hospital. It might be help with
simple daily tasks like bathing or dressing. It might include skilled care in your own home, an assisted living
facility, some other community resources, or a nursing facility.
Who Needs Long-Term Care
In the year 2002 about seven million men and women over age 65 needed long-term care. (HIAA, "A Guide to
Long-Term Care Insurance", 2002)
By 2005, the number will increase to nine million. (HIAA, "A Guide to Long-Term Care Insurance", 2002)
By 2020, 12 million older Americans will need long-term health care. (HIAA, "A Guide to Long-Term Care
Family and friends are the sole caregivers for 70% of elderly people and most will cared for at home. (HIAA, "A
Guide to Long-Term Care Insurance", 2002)
People age 65 or older face at least a 40% lifetime risk of entering a nursing home. 10% will stay more than five
years. (HIAA, "A Guide to Long-Term Care Insurance", 2002)
22% of people over age 85 are in a nursing home. (HIAA, "A Guide to Long-Term Care Insurance", 2002)
Women, because they outlive men, face a 50% greater likelihood of entering a nursing home after age 65.
(HIAA, "A Guide to Long-Term Care Insurance", 2002)
Some Misconceptions about Medicaid and Medicare
Medicaid pays for health services for the very poor of any age. Qualifications for Medicaid vary by state, but
generally the law says you must first spend down to the poverty level, using up all but about $2,000 of your
assets. Being eligible for Medicaid does not guarantee placement in a nursing home. There may be long
waiting lists for facility care. Depending on the state and facility, Medicaid patients often receive lesser-quality
care than patients who are paying on their own. Under Medicaid, nursing home care is essentially the only
option. Home care, assisted living facility care, adult daycare, outpatient services, and alternate caregiver
services are not usually reimbursed under Medicaid.
Medicare pays for health care for people 65 and over and for those who are disabled. Medicare does not pay
for long term medical service such as assisted living or adult day care. Medicare pays only the first 100 days of
skilled care, such as physical therapy or nursing, which only accounts for 5% of all long term care costs. You
are eligible for the care only if you have been in the hospital for at least three days. The personal care must
relate to the treatment of an illness or injury. Medicare pays 100% for the first 20 days and all but the first $95
per day for the next 80 days.
Medicare supplement insurance is a private insurance that helps pay for some gaps in Medicare coverage.
Plans D, G, I, and J do pay up to $1,600 per year for services to people recovering at home from an illness,
injury, or surgery.
Exceptions, Limitations and Exclusions
Most long term care insurance policies will not pay benefits for any confinement, care, treatment, or service(s):
- That results from attempted suicide or intentionally self-inflicted injury;
- That results from voluntary participation in a felony, attempted felony, or illegal occupation;
- That results from a sickness or injury for which benefits are provided under any state or federal worker's
- Provided outside the United States or Canada;
- Provided in a government facility (unless otherwise required by law);
- Provided for the treatment of alcoholism or drug addiction, or in facilities operated primarily for such
- Provided in facilities operated primarily for the treatment of mental or nervous disorders or disease, other
than Alzheimer's disease or dementia.
You could be declined coverage if you already have the following condition(s):
- Severe Arthritis with functional limitations;
- Diabetes which is not under control;
- Cancer within the past 6 months;
- Stroke within the past 6 months;
- A Stroke at any time, which has caused functional limitations;
- Congestive Heart Failure within the past 6 months;
- Emphysema, if severe or still smoking;
- Chronic Obstructive Pulmonary Disease, if severe or still smoking
- Any conditions which require the assistance of another human being for the basic activities of daily living:
bathing, eating, toileting, or transferring in and out of a bed or chair
Long-Term Care Quote
If you would like to obtain a long-term care quote simply click here: Long-Term Care Quote.
RJ Insurance & Travel Services
RJ Insurance & Travel Services
Long Term Care