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LONG TERM CARE COVERAGE


What is Long Term Care?


Long Term Care is the assistance individuals need when they are unable to care for themselves and need help with Activities of Daily Living (ADLs) - bathing, dressing, transferring, toileting, continence (control of bodily functions), and eating - or they have severe cognitive impairment such as
Alzheimer's disease. The need for long term care can result from an accident, chronic illness or short-term disability, or from advance age. Long term care can include a broad range of services, provided in any setting outside a hospital. It might be help with simple daily tasks like bathing or dressing. It might include skilled care in your own home, an assisted living facility, some other community resources, or a nursing facility. 


Who Needs Long Term Care?

  • 19% of Americans aged 65 and older experience some degree of chronic physical impairment. (AHIP, "A Guide to long term Care Insurance", 2004)
  • About 55% of those ages 85 and older are impaired and require Long Term Care. (AHIP, "A Guide to long term Care Insurance", 2004)
  • By 2020, 12 million older Americans will need long term health care. (AHIP, "A Guide to long term Care Insurance", 2004)
  • Family and friends are the sole caregivers for 70% of elderly people and most will cared for at home. (AHIP, "A Guide to long term Care Insurance", 2004) 
  • People age 65 or older face at least a 40% lifetime risk of entering a nursing home. 10% will stay more than five years. (AHIP, "A Guide to long term Care Insurance", 2004) 
  • 22% of people over age 85 are in a nursing home. (AHIP, "A Guide to long term Care Insurance", 2004)
  • Women, because they outlive men, face a 50% greater likelihood of entering a nursing home after age 65. (AHIP, "A Guide to Long Term Care Insurance.", 2004)


Some Misconceptions about Medicaid and Medicare

Medicaid

Medicaid pays for health services for the very poor of any age. Qualifications for Medicaid vary by state. Being eligible for Medicaid does not guarantee placement in a nursing home. There may be long waiting lists for facility care. 


Medicare

Medicare pays for health care for people 65 and over and for those who are disabled. Medicare does not pay for long term medical service such as assisted living or adult day care. Medicare pays only the first 100 days of skilled care, such as physical therapy or nursing, which only accounts for 5% of all long term care costs. You are eligible for the care only if you have been in the hospital for at least three days. The personal care must relate to the treatment of an illness or injury. Medicare pays 100% for the first 20 days then you pay $128/day for the next 80 days.

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