Payment Options

How much do long-term care services cost?

Prices for home-based and institutional services vary depending on where you live and which organization provides them. While government programs such as Medicaid offer free or low-cost services to those with low incomes, many programs and agencies make services available to anybody, on a sliding-fee basis.

Who pays?

Programs that require a fee can often be calculated on a sliding scale, based on ability to pay.

Other services may be cost-free or be attainable with a voluntary donation because they are provided by volunteers, government, or charitable organizations.

Some programs also have age, income, or other eligibility requirements. When calling an agency, state your needs as clearly as possible and remember to ask about eligibility requirements and costs.

One member of your caregiving team can be designated as the contact for agencies, so that information can be gathered and organized by one person.

Your local Area Agency on Aging is a good place to start investigating the programs and services available in your community. It may also be called Senior Service Division, Aging Services, or the Office on Aging.

How can I find out what we’re eligible for?

www.BenefitsCheckUp.org is a convenient, Internet-based tool that helps identify benefits for which you may be eligible and where to get them.

What about Medicare?

Medicare is the federal health insurance program for persons age 65 and over (and certain disabled persons under age 65). If you are eligible for Social Security benefits (including disability benefits), you may apply for Medicare. There are two basic parts to Medicare: hospital insurance (called Part A) and medical insurance (called Part B).

Medicare Part A covers hospitalization, hospice care, some skilled nursing care and some home health care. Specifically, it covers:

All costs for up to 20 days of skilled care in a skilled nursing facility after 3 consecutive days in a hospital (within 30 days of discharge) during a benefit period.
All costs over the daily coinsurance amount for days 21 through 100 in a skilled nursing facility during a benefit period.
Hospice care.
Medically necessary home health visits from a Medicare-certified home health agency.
Eighty percent of the Medicare approved amount for durable medical equipment (such as a hospital bed or wheelchair).

Medicare Part B covers 80% of necessary medical services and equipment, including doctors’ fees; physical, occupational, and speech therapies; durable medical equipment, X-rays and lab tests.

If eligible for Medicare, you do not pay a premium for Part A, though you may have to pay yearly deductibles or co-payments for hospital care or skilled nursing care. If you are 65 or older and do not otherwise qualify or if you are under 65, are disabled, and have received Social Security disability benefits for Medicare benefits, you may purchase Part A benefits (certain qualifications apply). Whether or not you are eligible for Part A, you can receive Medicare Part B benefits by paying a monthly premium and any deductibles and co-payments.

Important to note:

Medicare nursing home coverage doesn’t go into effect until after a hospital stay of at least three days. This coverage also requires substantial insurance co-payments after the first 20 days and can be used for no more than 100 days.
Medicare does not cover assisted living costs. However, if you contract short-term services through a home care agency while living in an assisted living center, Medicare may cover this care.
Medicare covers home care only if the aging individual is unable to leave their home and needs therapy or skilled nursing care. These needs will likely have to be documented by a medical professional.

For more information about Medicare Part A, call toll-free 1-877-602-2430. For more information about Part B, call toll-free 1-800-282-0530. For general information about Medicare, contact your local Social Security office or the Social Security Administration. If you have Medicare-related complaints or are concerned about quality of care, contact the Quality Improvement Organization (1-800-589-7337).

What is Medicare+Choice?

Medicare+Choice replaces the traditional “fee-for-service” health care delivery system. Under this system, persons eligible for Medicare can join a health maintenance organization (HMO) for a wider range of services with fewer out-of-pocket costs. In exchange, the beneficiary agrees to follow procedural rules and use a selected group of physicians and other health care providers. www.medicare.gov and from your state’s Senior Health Insurance Information Program.

What is Medicaid?

Medicaid is federal and state funded medical assistance to low-income individuals of all ages. Services under Medicaid are free, but strict financial eligibility requirements may require you to reduce, or “spend down,” your assets, income and savings to reach the eligibility level. Generally, Medicaid covers:

All care provided in a Medicaid-certified nursing facility;
Home health care;
Homemakers and chore services;
Hospital care;
Physician care;
Hospice care;
Community mental health services;
Medical transportation;
Prescription drugs;
Assistive devices;
Some Medicare Part A and B premiums, deductibles and co-payments, if you are financially eligible (through the Qualified Medicare Beneficiary and Special Low-Income Medicare Beneficiary programs).

Medicaid generally covers long-term care expenses in a Medicaid-certified nursing facility. Check with your county Department of Job and Family Services for current requirements, rules and restrictions. It is important to note that Medicaid does not cover assisted living or continuing care retirement communities (except for their skilled nursing units). Medicaid pays only for care at nursing homes and intermediate care facilities for people who have mental retardation.

Are there alternatives or supplements to Medicare and Medicaid?

Several programs and insurance programs help you pay for long-term care, depending on your needs and preferences. Options may include: - Medigap insurance is a supplement to Medicare designed to fill in “gaps” in Medicare coverage, such as co-payments. - Funding from the Older Americans Act is distributed to the Area Agencies on Aging to pay for in home and community based services such as home delivered services, chore services, homemaker services and adult day care. Contact your Area Agency on Aging for information. - Long-term care insurance policies pay for long-term care services that Medicare and Medigap policies do not cover. Ask your state’s Department of Insurance for information, or contact your insurance agent for more information. - Some states have savings programs for senior citizens. Check with your state’s Department of Aging. - Many counties sponsor services for older adults through tax revenue. They may be offered free of charge or on a sliding fee scale basis. Contact your county department on aging to determine what is available. - Veterans’ Affairs offers benefits to veterans, and in some cases, their families. Contact your county veterans services office or your local or state V.A. office.

Ohio Passport Program

In Ohio, the PASSPORT program covers the cost of home and community based services for very low-income older adults.

The Costs of Care

Many families are unprepared for the costs of long-term care. When your loved one has need of aging services, you will very quickly become aware of why these costs are a major concern to many American families. AARP found in a recent study that Americans aged 45 or older generally don’t know much about the costs of long-term care, including the costs associated with in-home nursing care. Many believe their insurance covers long-term care, but only about six percent have purchased such insurance. In this area, it is helpful to gain all the information you can in order to be prepared. Ask for rates and financial plans when you inquire about long-term care services. Take notes. Do research on the internet. Educate yourself as much as possible. Talking with a professional financial planner or attorney is an excellent idea.