Paying for Long Term Care Services

There are three primary ways of paying for long term care services:

1. Self-Insurance
   You will have to cover the immense costs of long term care with your own resources and assets. You will not be able to seek federal or state assistance until you exhaust all of your own assets according to strict criteria.
2. Medicaid (Title 19 in Connecticut)
   Medicaid (a joint federal-state government program) provides care in a nursing home for those who have limited income and few assets. Medicaid pays for nursing facility care and some very limited home care.  When your assets have either been exhausted or reached a minimum threshold, Medicaid will provide coverage for your expenses only after a strict review process.
   • You will have to “spend-down” and exhaust your assets before becoming eligible for     Medicaid.
   • All your assets and income will be subject to review to determine eligibility.
   • Any gifts, trusts or transfers of assets within 60 months prior to your request for     coverage will be included in your assets for determining eligibility under Medicaid.
   • The State can dictate which facility you will go to.
3. Long Term Care Insurance
   This insurance pays for the cost of long term care services you require. It provides long term care services in your own home, nursing homes, adult day care, and assisted living facilities based on the policy and options you select.

In some limited circumstances the following programs can offer some assistance:

4. Medicare
   Medicare may pay for the front end of a long term care illness.  In a nursing home, Medicare will pay provided there has been a three day minimum inpatient hospital stay and you require daily skilled care.  However, this coverage will not exceed 100 days (the number of days that will be covered will be assessed by Medicare based on your condition). In many cases there are co-payments and deductibles that may or may not be covered by your Medicare Supplement or Medicare Advantage program. In short, Medicare does not cover long term care or custodial care.
5. Health Insurance
   In general most health insurance policies use criteria similar to Medicare’s when it comes to paying for long term care.  These plans were never designed to pay for long term care services.
6. Other Public and Private Funds
   There are other funds that can pay for long term care, but they all have strict criteria and guidelines that must be met. An example would be the Veteran’s Administration. The Veteran’s health care benefits include medically necessary hospital and nursing home care and some outpatient care. The VA prioritizes veterans that qualify for care according to several categories. The first priority is for those who have a service-connected disability.  There are also income and asset requirements which must be met.