Marilee Driscoll: Long-term care questions answered
The questions recently raised on the www.LTCmonth.com Web site ranged from Medicare to financially preserving a house to a son worried about his 84-year-old mother. I’m hoping some of these readers questions are also your questions.
What is the difference between Medicare and Medicaid?
Medicare is the health insurance that most of us are eligible for when we turn age 65. We paid, or our spouse paid, payroll taxes during our working lives in order to be eligible for and reduce the cost of Medicare. Once we are age 65, our Medicare premiums and benefits are the same, no matter what our income or assets. In other words, Medicare is not means-tested (though this could change). Medicare does a great job of covering medical costs for doctor’s visits and hospital bills. Medicare almost never covers long-term custodial care, the kind of long-term care that might be paid out of your own pocket, by Medicaid and/or long-term care insurance. Most long-term residents of nursing homes or those who receive care in their own homes are receiving custodial care, the kind of care not covered by Medicare.
Medicaid is a means-tested program that provides health care for the poor, including long-term care. Medicaid is a joint federal and state program, which means there are sometimes differences from one state to another in eligibility requirements and benefits.
How do I save my house from nursing home costs?
By this question, you probably mean how can I pass my house along to my kids if I rely on Medicaid to pay for my long-term care? Each state is obligated by the federal government to attempt to recover money paid out under Medicaid. This is usually done via a Medicaid lien once the recipient has passed away, and there is no spouse, adult child caregiver or disabled person living in the house. You will want to consult with an elder law attorney to find out exactly what your options are.
However, if you want the full range of choices in long-term care – from one, two or three shift of care in your own home to a continuing care retirement community (CCRC) or a private room in a high-end nursing home that doesn’t accept Medicaid, you must be able to pay privately. Medicaid does not cover these private-pay only options. Please make sure you understand what care choices you may be giving up by planning on Medicaid paying your long-term care bill.
My 84-year-old mother is a widow and I’m afraid she won’t be able to live on her own much longer. What should I do?
If you think that it’s not safe for your mother to live on her own anymore, now is definitely the time to take action. Difficult as it may be, you need to bring up the topic with her, and ask her where she would like to live in the future.
These conversations usually go best when you are not facing a crisis, and you are not facing the need to move. Age 70, but certainly before 80, is a better time to bring up this topic. But, like many other readers, this time has passed for you and your mom.
Ask her what her friends have done when their homes became too much for them. If your mom is not willing to talk about this topic, a family physician, friend or other family member may be able to help you broach the subject. From a financial and legal point of view, an attorney, insurance agent or even the branch manager of her bank may help you in navigating your mom’s situation and decisions. Other great resources include the director at the local senior center (free advice) or an independent geriatric care manager (charges a fee). Just be sure any advisor on whose help you rely is competent in life planning, estate planning AND elder law issues.
Visit www.LTCmonth.com, and click on the “free newsletter” link to ask your question and also to sign up for the FREE consumer newsletter.
Plymouth resident Marilee Kern Driscoll is a professional speaker and the author of “The Complete Idiot’s Guide to Long-term Care Planning.” She has been quoted in hundreds of newspapers and magazines, including “The Wall Street Journal” and “Kiplinger’s Personal Finance,” and has been interviewed on the CBS Early Show. She encourages you to ask your questions, subscribe to her free newsletter, and final local help with this topic at www.LTCmonth.com.