Introduction to Long-Term Care

What is Long Term Care

Long Term Care is the assistance persons need when they are unable to care for themselves and need assistance with activities of daily living or have severe cognitive impairment such as Alzheimer’s disease.  The need for long-term care can be the result of an accident or illness or advanced age.  Long-term care provides a broad range services including skilled care in your home, an assisted living facility, or a nursing facility.

Senior couple meeting with agent

Who Needs Long-Term Care?

  • 19% of Americans aged 65 and older experience some degree of chronic physical impairment
  • Approximately 55%  of those age 85 and older are impaired and require Long-Term Care
  • By 2020, 12 million older Americans will require long-term care.
  • Family and friends are the care-givers for 70% of elderly people.
  • People aged 65 and older face a 40% risk of entering a nursing home.
  • 22% of people over 85 are in a nursing home.
  • Women face a 50% higher likelihood of entering a nursing home after age 65.

Some Misconceptions about Medicare and Medicaid

 Medicaid pays for the health services for the very poor of any age.  Being eligible for Medicaid does not insure placement in a nursing home.  Under Medicaid, nursing home care is the only option.  Home care, assisted living centers, adult day care, outpatient services, and alternative caregiver services are not usually paid under Medicaid.

 Medicare pays for health care for people 65 and older 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 only if you have been in the hospital for at least three days immediately prior to entering skilled care.

 Exceptions, Limitations and Exclusions

 Most long-term care insurance policies will not pay benefits if the care is a result of:

  • Attempted suicide or intentionally inflicted injury
  • Voluntary participation in a crime
  • Care provided outside of the U.S. or Canada
  • Care provided in a government facility
  • Alcoholism or drug addiction
  • Care for nervous or mental disorders other than dementia or Alzheimer’s disease

 Pre-existing Conditions

 Coverage may be declined if you already have the following conditions:

  • Alzheimer’s Disease
  • Severe Arthritis
  • Diabetes which is not controlled
  • Cancer within the last 6 months
  • Stroke within the last 6 months
  • Functional limitations as a result of a stroke
  • Congestive heart failure in the last 6 months
  • Parkinson’s Disease
  • Severe Emphysema
  • Chronic Obstructive Pulmonary Disease

Senior man speaking to a nurse while at the hospital

 Contact Hatcher Kimrey Insurance to help you select the long-term care coverage best suited for you.  Remember… We are always there for you!

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