Welcome to Health Insurance HQ—coming to you from the experts at The Actors Fund’s Artists Health Insurance Resource Center and special guests!
Dear Friends,
Did you know that about 70 percent of people who reach age 65 are expected to need some form of long-term care at least once in their lifetime?
What is long term care?
Long-term care is a range of services and supports you may need to meet your personal care needs. Most long-term care is not medical care, but rather assistance with the basic tasks of everyday life, sometimes called Activities of Daily Living (ADLs), including bathing, dressing, using the bathroom, transferring to bed or chair, caring for incontinence and eating.
Someone with a long physical illness, a disability or a cognitive impairment (such as Alzheimer’s disease) often needs long-term care. Long-term care is different from medical care, because it generally helps you to live as you are instead of improving or correcting medical problems.
Where is long-term care received?
Care may be given in a nursing home, an assisted living facility, a hospice facility, a day care facility or in your own home.
What does it cost?
Long-term care can be expensive. The cost depends on the amount and type of care you need and where you get it. In 2017, the national average cost of nursing home care was about $85,000 per year for a semi-private room. This cost doesn’t include items such as therapies and medications, which could greatly increase the cost. The average cost of care in an Assisted Living Facility was $3,750 a month for a one bedroom unit, or $45,000 each year, including rent and most other fees. The average cost for a home health aide in the U.S was $4,099 per month, or around $135 per day. The cost of home health care depends on the number of days a week the caregiver visits, the type of care required and the length of each visit. Home health care can be expensive if round-the-clock care is required.
Who pays for long-term care?
People pay for long-term care in different ways. Individuals and their families usually use some of their own money to pay for part or all of their long-term care costs, using savings, investments and sometimes selling assets like their homes. It is worth noting that about 80 percent of care at home is provided by unpaid caregivers (generally family members). Information on caregivers shows that approximately one in four adults in the U.S. were unpaid family caregivers to an adult or child in 2009; and about two-thirds of them are women.
Medicare and Supplement Insurance (i.e. Medigap plans) generally do not cover long-term care, except in very limited and specific medical circumstances. Medicare does have a skilled nursing facility (SNF) benefit, but it covers very little of nursing home care. It also doesn’t cover care in assisted living facilities, home care or custodial care services, unless you’re also getting “skilled care” at home, such as nurse’s services or physical therapy. You should not count on Medicare to pay your long-term care costs.
Medicaid pays for nearly a third of all nursing home care in the U.S. Medicaid also pays for some homemaker and custodial care services. To get Medicaid, you must meet federal and state guidelines for income and assets. Many people start paying for nursing home care out of their own money and “spend down” their income and assets until they are eligible for Medicaid.
State laws differ about how much income and assets you can keep and still be eligible for Medicaid. If you think you may qualify for Medicaid, contact your state Medicaid office, Department of Aging or Department of Social Services to learn about the rules in your state.
What is long-term care insurance?
Long-term care insurance is one way to pay for long-term care. This type of insurance will pay for some or all of your long-term care costs.
Unlike traditional health insurance, long-term care insurance is designed to cover long-term care services and supports, including personal and custodial care in a variety of settings such as your home, a community organization or other facility.
Long-term care insurance policies reimburse policyholders a daily amount (up to a pre-selected limit) for services to assist them with activities of daily living such as bathing, dressing or eating. You can select a range of care options and benefits that allow you to get the services you need, where you need them.
How can I get long-term care insurance?
There are many different ways to get long-term care insurance, including buying an individual policy from a health insurance agent, or getting it through an employer or membership in an association. In addition, some life insurance and deferred annuity policies have a built-in long-term care benefit, or can be cashed out to pay for expenses.
What does long-term care insurance cost?
The cost of a long-term care policy varies greatly based on your age at the time of purchase, the type of policy you get and the coverage you select. The American Association for LTC Insurance’s website has shopping tips and more info on how to compare policies, choose a broker and what questions to ask when applying.
A word of caution…
People with certain conditions may not qualify for long-term care insurance. Common reasons why you might not be able to buy long-term care insurance include:
- You currently use long-term care services.
- You already need help with Activities of Daily Living (ADL).
- You have AIDS or AIDS-Related Complex (ARC).
- You have Alzheimer’s Disease or any form of dementia or cognitive dysfunction.
- You have a progressive neurological condition such as multiple sclerosis or Parkinson’s Disease.
- You had a stroke within the past year to two years or a history of strokes.
- You have metastatic cancer (cancer that has spread beyond its original site).
Where can I find more information?
To learn more about long term care and long term care insurance, you can visit the US Department of Health and Human Services’ website on Long Term Care.
Yours in good health,
Elizabeth Tripp, MSW
Medicare Specialist
Do you work in performing arts and entertainment and have questions about health insurance? The Actors Fund provides assistance nationally. Contact our regional office closest to you to speak to a counselor.
New York City
917.281.5975
Los Angeles
855.491.3357
Don’t forget to use the resources section of our website. It contains tools to help you make decisions about your health insurance, including new online tutorials on how to choose providers and how to read an Explanation of Benefits. In addition, you’ll find an updated Stage Managers National Health Directory, our national online directory of health care providers recommended by industry professionals that can be used by theaters and touring companies. For these resources and more, visit actorsfund.org/HealthServices. You can also find out more about enrollment assistance and upcoming health insurance seminars near you!