Long-term care services include personal care services like bathing, doing household chores, and other activities, to help you stay independent in your community. Long-term care also includes community services, such as meals, adult day care, and transportation services. Residential facilities, such as assisted living facilities and nursing homes, also provide long-term care services along with housing.
Depending on how much you need, these types of services can be expensive. Medicare and other health insurance do not include most long-term care services, so planning for how you might pay for long-term care becomes important. If you have fairly low income and savings, you may qualify for Medicaid, the federal public program that pays for most long-term care services. Other federal public programs, such as the Older Americans Act, and state-funded programs, pay for long-term care services, but, like Medicaid, these programs cover services for people with high levels of disability and low income and savings.
With 70 percent of us needing long-term care services at some point during our lives after turning age 65, and the limited coverage of public programs, there is a good chance you will have to pay for some or all of the services out of your personal income and savings. Even if you only need a little assistance at home with personal care, paying for long-term care out of your personal income and savings can be difficult. For example, you would pay more than $19,000 on average for a home health aide to assist three times a week, in 2010.
Costs of Care
Long-term care includes a range of health and support services that you may need as you age or if you have a disability. Most of these services are personal care services, such as bathing and dressing. Family members may be able to provide some or all of these services at no charge. But if your care and support needs increase, you may need paid care in addition to the services that your family members provide, or to give them respite. In addition, if your needs increase to the point where you need services in a facility like a nursing home or assisted living, you may need to plan how to pay for these services.
The cost of long-term care depends on the type and amount of care you need, the provider you use, and where you live. Here are a few examples:
- Home health and home care services, provided in two-to-four-hour blocks of time referred to as “visits,” are generally more expensive in the evening, on weekends, and on holidays.
- The costs of services in some community programs, such as adult day service programs, are provided at a per-day rate, but vary based on the program’s costs and activities.
- Many facility-based programs charge extra for services provided beyond the basic room, food and housekeeping charges, although some may have “all inclusive” fees.
The average costs for long-term care in the United States (in 2010) are:
- $205 per day or $6,235 per month for a semi-private room in a nursing home
- $229 per day or $6,965 per month for a private room in a nursing home
- $3,293 per month for care in an assisted living facility (for a one-bedroom unit)
- $21 per hour for a home health aide
- $19 per hour for homemaker services
- $67 per day for services in an adult day health care center
Who Pays for LTC Services?
If you have enough income and savings, you will likely need to pay for long-term care services on your own, from your income, savings, and possibly from the equity in your home. You can also purchase long-term care insurance to cover your personal care needs.
Three main government programs might help you pay for services if you meet their rules, though these programs cover limited numbers of people.
Medicaid
Medicaid may pay for your care if you qualify based on your level of need or disability (also called “functional eligibility”) and have limited savings, or if you use up your savings paying for long-term care services yourself.
The Older Americans Act
The Older Americans Act may also help you to pay for some long-term care services.
Department of Veterans Affairs
If you are a Veteran, the U.S. Department of Veterans Affairs may provide some long-term care services.
State programs
In addition, some states offer their own programs to cover some long-term care services.
You may use a variety of payment sources, some from public programs and others from private insurance, or from your own income and savings as your care needs and financial circumstances change.
Many people think Medicare or their regular health care insurance from their employer that covers hospital stays and doctor visits will pay for long-term care. Health care insurance and Medicare may pay for your care if you need skilled care or care for a short time to recover from an illness or injury. They do not cover ongoing personal care needs, like help with bathing and dressing.
Coverage Limits of Long-Term Care Offered by Health Insurance
Public |
Private |
||
|---|---|---|---|
Long-Term Care Service |
Medicare |
Medigap Insurance |
Private Health Insurance |
| Overview | Limited coverage for nursing home care following a hospital stay and home health if you require a nurse or other skilled provider. | Insurance purchased to cover Medicare cost sharing. | Varies, but generally only covers services for a short time following a hospital stay, surgery or while recovering from an injury. |
| Nursing home care | Pays in full for days 1–20 if you are in a Skilled Nursing Facility following a recent 3-day hospital stay.If your need for skilled care continues, may pay for the difference between the total daily cost and your copayment of $137.50 per day for days 21-100. After day 100 does not pay. | May cover the $137.50 per day copayment if your nursing home stay meets all other Medicare requirements. | Varies, but limited. |
| Assisted living facility (and similar facility options) | Does not pay. | Does not pay. | Does not pay. |
| Continuing Care retirement community | Does not pay. | Does not pay. | Does not pay. |
| Adult day services | Not covered. | Not covered. | Not covered. |
| Home health and personal care | Limited to reasonable, necessary part-time or intermittent skilled nursing care and home health aide services, some therapies if a doctor orders them, and a Medicare-certified home health agency provides them.Does not pay for on-going personal care or only help with Activities of Daily Living (also called “custodial care”). | Not covered under current policies.Some policies sold prior to 2009 offered an at-home recovery benefit that pays up to $1,600 per year for short-term at-home assistance with activities of daily living (bathing, dressing, personal hygiene, etc.) for those recovering from an illness, injury, or surgery. | Varies, but limited. |
Costs in Your State
Go to http://www.longtermcare.gov/LTC/Main_Site/Tools/State_Costs.aspx for information.
