Insurance can be a headache to navigate, even for those that have worked in the healthcare industry for years. For those that don’t have much experience with insurance, other than renewing it once in a while and using it to pay for doctor visits and the occasional trip to the pharmacy, insurance might seem like an unknowable obstacle.
In reality, this is completely untrue. Each insurance company is a little bit different in how they handle things, but there are general guidelines that all companies follow. Knowing what the procedures are and what types of things are covered (and to what point) is actually a lot easier than what it might seem on the surface level, especially if you are on the outside looking in.
Insurance is important. On one hand, you want your medical and care issues to be handled with accuracy. On the other, it would be nice if things were plainly spelled out for you as far as coverage went. This way, a lot of the guessing would be eliminated and you’d have a better idea of what your bills are going to be like before you receive them.
Hopefully, this brief guide can help you gain a better understanding of how insurance works in the world of senior care. This is not a definitive guide by any means, but rather a tool to help you better understand what certain types of insurance cover and what they don’t.
Paying for Care
There are a number of ways that families pay for senior care. Some don’t worry too much about insurance because they can afford to pay for care out of their savings. Unfortunately, this is a small number of people. Care can be expensive and the costs can add up over time. Depending on health needs, this might not be realistic, no matter how well you have prepared in the years leading up to retirement. Sometimes, other methods are needed.
That’s where insurance can be incredibly helpful.
Private Long Term Care Insurance
Private long term care insurance was really popular about a decade ago, but thanks to rising costs, it is not bought as widely as it once was. Insurance companies sold this type of insurance to help offset the costs of various types of care, including in-home care. Typical policies would include a cost per day and a timeframe that that cost would be covered, usually between three and five years. So, you could purchase a policy and have $80 in costs covered per day for five years. After that, the policy would expire and any additional costs would need to be covered with an alternate method. These policies do still exist and may be worth looking into, especially if you are a little bit younger. However, for a lot of seniors, the costs of such policies are prohibitive.
Medicare
Medicare is the insurance that all senior citizens are eligible for. Medicare comes in different forms, though. Part A is something that everyone is entitled to and covers a short term stay in the hospital or another qualifying facility.
Part B is more comprehensive, covering things like doctors, lab results, and tests. This insurance has a monthly cost associated with it.
Part D is for prescription drug costs. There is a monthly cost for this insurance, and depending on the specific policy that you purchase, your drug copays will vary based on the tier that the medication is placed in.
Part C is a separate insurance and is often referred to as Medicare Advantage. It is offered by private insurance companies and can come in many different forms. These vary from state to state. Cost will depend on the company selling it and the specific things that are covered. It is designed to fill in the gaps that Parts A and B alone do not cover.
Medicare alone does not cover long term care. Typically, only the first 30 days in a rehabilitation facility are covered with Medicare. This is a common misconception about Medicare. It will cover some short term costs, but this varies depending on the needs of the individual.
Medi-Cal
Medi-Cal, California’s incarnation of Medicaid, is designed for those that meet low income qualifiers. It is much more comprehensive in what it will cover as far as long term care goes, but it does so at the expense of choice sometimes. More and more private care services are accepting Medi-Cal, but not all of them do yet. Your care service of choice might not be on board with this at this time.
Many states are now using Medicaid to help with in-home care costs, too. New Jersey and Minnesota have really helped to lead the way here, with other states noticing how much money it has saved. California is not perfect at this yet, but we are moving toward more comprehensive coverage. This may be something that your family qualifies for so it is worth looking into the specifics of your unique situation.
Other Resources
Insurance is not the only tool out there that can help offset care costs. VA benefits, local programs, and other non-profit initiatives can be helpful. Check out what local resources are available to you and your family before you make any finalized decisions regarding paying for care.
Do you have questions about health insurance and how it can help offset costs? If so, please reach out to us. One of our caregivers would love to sit down with you and go over your options.
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