When faced with the need for long term care, here are some important facts to know:
Medicare does not pay for long term care or assisted living facilities.
It is true that Medicare may cover a limited number of days in a rehabilitation facility after a medical event. However, should your stay exceed that period, or become indefinite, you will become either a “private pay” or a Medicaid patient, unless you happen to have long term care insurance.
Tricare does not pay for long term care.
Tricare offers great medical benefits for those who qualify. But just as with Medicare, it is not a long term care policy, and does not cover extended or indefinite stays in a nursing home or assisted living facility.
Supplemental insurance does not pay for long term care.
Just like other health insurance policies, supplemental health insurance is purely for medical care. When an individual needs long term care (or assisted care), it falls outside of medical care and supplemental insurance does not provide coverage.
How will I know if long term care is needed?
Your healthcare provider will be instrumental in assisting you and your family when and if that time comes. Typically, if an individual needs assistance with at least three activities of daily living (ADLs), long term care may be needed. ADLs include things such as dressing, eating, toileting, bathing, ambulating, etc.
I will have to sell my house before I can obtain Medicaid benefits.
Do not be lead to believe that you have to sell your house or transfer your house to a family member before receiving benefits. In fact, you should never do these things before consulting with an experienced Elder Law attorney, as either of these actions could actually cause you to be denied benefits. It is critical to obtain legal advice before doing anything with your homestead property or transferring any assets.
It is okay to “gift” my money to family members so I can qualify for Medicaid sooner.
Do not fall into this trap. IRS tax rules on gifting have no application to qualifying for Medicaid benefits, and such acts can cause an individual to be denied Medicaid benefits. Even well intended financial planners and CPAs can give bad advice in this area. Always consult with an Elder Law attorney before transferring any assets.