Long-term care is so expensive that many people risk losing their life savings within a year of having such care. A year in a nursing home can cost from $40,000 to $80,000, depending on the area of the country. Even a temporary stay in a nursing home can derail years of careful financial planning.

Insurance experts estimate that about one-third of all long-term care services are paid for by individuals out of their own savings or investments. The funds may come from pension plans, employee stock ownership plans, single premium annuities, the cash value of life insurance or savings.

* Business Week 7/19/99
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Medicare is the federal government’s health insurance program for the disabled and those 65 years and older. Many Americans believe Medicare will pay their long-term care bills, but in fact it pays for a small percentage of all nursing home costs. At present, it may cover skilled care in a nursing home for the first 20 days (and a portion of the cost for the next 80 days) if admission follows a three-day hospital stay. The biggest gaps in Medicare’s long-term coverage are:

• No coverage for custodial care, either at home or in a nursing home
• No coverage in a nursing home without prior hospitalization
• No coverage for nursing home care after 100 days
• Coverage only in a Medicare-approved facility

To apply for Medicare or obtain information about the program, contact your local office of the Social Security Administration. For a free copy of The Medicare Handbook, write to CMS, Office of Public Affairs, 200 Independence Ave. SW, Washington, DC 20201, or call the Medicare Hotline at 1-800/772-1213.

Medicare supplement insurance (often called Medigap) is private insurance that supplements Medicare benefits and may cover copayments and deductibles for medical and hospital expenses. Medigap policies generally do not provide coverage for long-term care.

Medicare managed care. Instead of purchasing a Medigap policy, some people enroll in a Medicare HMO to supplement their Medicare benefits. Such plans may provide more preventive services and charge lower copayments. However, you are generally restricted to participating providers (physicians, hospitals, nursing homes, etc.). Again, such plans generally do not provide coverage for long-term care. Short-term nursing home care covered by Medicare and your Medicare HMO is usually available only in participating facilities.

Medicaid is a joint federal/state program that pays for health care for people with limited income and assets. More than half of all nursing home costs are picked up by Medicaid. To be eligible for Medicaid reimbursement, nursing home care must be provided in a Medicaid-approved facility. To receive Medicaid you must meet federal poverty guidelines for income and assets and may have to “spend down” or use up most of your assets. Some assets, such as your home, may not be counted when determining Medicaid eligibility. To obtain information about the program, contact your local Medicaid office or Department of Social Services.

Long-term care insurance is private insurance designed to help pay for nursing home or home health care expenses. It is available to individuals and may be available under a group policy. You pay a premium to an insurer in return for protection against the high costs of long-term care.