Making Long Term Care Work: Options for Disabled Individuals

Importance of Insurance Planning-Guest Articles

Making Long-Term Care Work: Options for Disabled Individuals

Paying for long-term care can be a tricky proposition for disabled individuals who need to depend on safe, quality care later in life to help manage their conditions. Medicare and disability insurance coverage is limited and deals with very specific out-of-pocket expenses, which leaves a number of costly coverage gaps that could place a severe strain on your financial resources. It’s essential to be prepared and well-armed with information about care costs and funding options so you can develop an effective financial strategy that works for you and your family.

Overview – Medicare

Medicare covers health care costs for people over 65 or individuals who qualify due to disability or specific conditions, such as Lou Gehrig’s disease or renal disease. Strictly speaking, Medicare  doesn’t cover long-term care; however, it does pay a portion (up to 100 days) of costs associated with an inpatient hospital stay of at least three days, if you need care at a Medicare-certified facility within 30 days of a hospital stay, and if you require skilled nursing or therapeutic care. It will also pay for some social services and supplies that have been deemed medically necessary.

Medicare Enrollment

If you are enrolled in Medicare or are nearing age 65, pay careful attention to Medicare enrollment dates. If you have questions concerning coverage options in your state, check out this state-by-state information resource for detailed information about Medicare open enrollment; simply click on your state for additional information. This year, open enrollment begins October 15 and terminates on December 7.

Overview – Private Insurance

Many people mistakenly assume that Medicare will cover their needs if care is required in a care facility or at home. That is only partially true. Medicare is similar to the private or HMO

coverage you may have, in that generally only short-term, skilled, and medically necessary care services are covered. Home care is generally restricted to helping with medications and basic medical care, and certain forms of physical therapy, and is restricted to 100 days after hospitalization. Like Medicare, most private insurance doesn’t cover the cost of personal (custodial) care, including help with activities of daily living, though your coverage may assist with Medicare-imposed deductible or copayments.

Resources – Medicaid, State Aid, and More

Medicaid is a federally funded, state-administered program that provides coverage for eligible low-income individuals. It also provides assistance to more than 3 million Medicare-enrolled disabled individuals. It’s important to understand the eligibility requirements in your state, which may vary to some degree. Many state agencies, such as Health & Human Services, administer other forms of assistance through the TANF and HIPP programs.

Medicaid covers all or part of nursing home costs for individuals with Alzheimer’s disease, and many states offer home and community long-term care options for qualified individuals. Individuals suffering from Alzheimer’s and dementia may also apply for grant aid through the Alzheimer’s Foundation or Alzheimer’s Association. Additionally, the Social Security Administration has included early onset Alzheimer’s as a condition for expediting Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). In general, states are required to provide Medicaid to individuals who are eligible for SSI benefits. At present, 33 states allow Social Security to determine Medicaid eligibility based on SSI requirements.

Personal Funding Options

There are a number of personal options disabled individuals may pursue to fund long-term care, including long-term care insurance, cash-value life insurance, personal assets, and a reverse mortgage. Long-term care insurance is designed to help you maintain an acceptable quality of life through payments for services that ensure you’re able to take medications, eat, maintain basic hygiene, and have transportation to medical appointments. Long-term care insurance reimburses costs for home, assisted living, or nursing home care. It’s advisable to discuss long-term care insurance with an agent if you have a condition like Parkinson’s Disease, multiple sclerosis, or Alzheimer’s. The sooner you purchase an LTCI policy, the lower the premiums.


If you have a life insurance policy that accumulates in value, you may utilize it as a source of revenue for care expenses in a number of ways. You can seek advanced death benefits, sell your policy for cash to a third party, or “surrender” it to your insurer for a cash settlement. People with annuities, which provide payments for a specific period of time, may use their cash disbursements as a means of funding long-term care needs and medical expenses.

Knowing your rights and funding options is vitally important should you require long-term care. That means being well-informed about Medicare/Medicaid, other forms of state and federal disability assistance, and understanding how you might cover out-of-pocket long-term care expenses utilizing insurance policies and personal financial assets.

Article provided by: Ed Carter


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