|
As a caregiver, you will need to evaluate the long-term care
needs of your loved one. In making this evaluation, it is important to
consider financial options. Long-term financial planning is important for
everyone, but it is essential when you are coping with the expense of chronic
illnesses such as Alzheimer's or Parkinson's disease.
Developing a plan
Long-term financial planning is very important for the security of the
caregiver and the patient. If you wish to handle your loved one’s finances,
you must receive written legal authorization to do so. This authorization can
be obtained through documents such as a power of attorney.
When considering a financial plan, you might want to contact a professional
financial manager and/or a medical lawyer who deals with financial planning for
people facing chronic or progressive illnesses. You also might want to talk to a
social worker and investigate other resources, such as those available on the
Internet. Ask your loved one's doctor for a referral, or speak with a national
association or support group to find reputable professionals in your area.
Understanding medical coverage
- If your loved one is insured, either through his or her employer or a
retirement policy, read all of the policies pertaining to chronic/progressive
illnesses.
- If you are unsure about the language or terminology, contact the
personnel department or your financial planner.
- If your loved one is unemployed and does not have coverage, look for the
highest level of affordable coverage.
- If your loved one is 65 or over, he or she qualifies for Medicare. This
insurance can be supplemented with a "Medigap" policy available
through a private insurer. Many states have prescription
assistance/reimbursement programs for low-income senior citizens.
- If your loved one is disabled but does not qualify for Social Security, he
or she might be eligible to receive a form of Medicare for the disabled.
- If your loved one cannot get insurance and his or her income is low, he or
she might qualify for Medicaid, a government "safety net" program that
pays for medical costs that exceed a person's ability to pay.
Investigating long- and short-term disability insurance
If your loved one is employed, he or she should check with the employer
regarding private disability insurance. The employer’s human resources
department can provide information about eligibility, the cost of enrollment,
and the amount of salary the insurance will cover.
If your loved one is not working, he or she might want to apply for Social
Security.
If your loved one does not qualify for Social Security, you might want to
consider state-run
disability programs.
If your loved one's total income is below a certain level, he or she might
qualify for federally subsidized Supplemental Security Income (SSI). If an
individual collects SSI, he or she is a candidate for Medicaid regardless of
age.
Medicare and Medicaid
What is Medicare?
Medicare is a federal health insurance program providing health care
benefits to Americans 65 and older, as well as to some disabled individuals
under age 65. Eligibility for Medicare is linked to Social Security and
railroad retirement benefits.
Medicare has co-payments and deductibles. A deductible is an initial amount
the patient is responsible for paying before Medicare coverage begins. A
co-payment is a percentage of the amount of covered expenses the patient is
required to pay.
What are Medicare's coverage options?
Medicare has two parts: Part A (hospital insurance) and Part B
(medical insurance).
Part A Medicare coverage includes:
- Inpatient hospital care
- Skilled nursing facility care (not
custodial or long-term care)
- Home health services, including a
visiting nurse, or a physical, occupational, or speech therapist
- Blood that you receive at a hospital or
skilled nursing facility during a covered stay
- Medical supplies
- Hospice services
- Mental health care given in a hospital
Part B Medicare coverage includes:
- Doctor charges (not routine physical
exams)
- Medically necessary ambulance services
- Physical, speech, and occupational
therapy
- Home health care services (physician
certification is necessary)
- Medical supplies and equipment such as
wheelchairs, hospital beds, oxygen, and walkers
- Transfusion of blood and blood components
provided on an outpatient basis
- Outpatient medical/surgical supplies and
services
- Outpatient mental health
Part B Medicare benefits require payment of a monthly premium. A patient
must be entitled to Part A benefits in order to receive Part B benefits.
Medicare coverage of skilled nursing care facilities
If nursing home care becomes necessary, your loved one might be eligible for
Medicare. There are certain requirements that must be met in order to receive care in a skilled nursing home under Medicare.
- Most patients' HMO plans require them to
have had a three-day hospital stay prior to admission into a skilled
nursing facility. There are exceptions, however, and the patient's
insurance provider should be consulted to determine whether these
restrictions apply.
- The patient must meet specific criteria
to receive treatment. The patient's doctor or nurse will help him or her
to determine if the criteria are met.
- The patient must be admitted into the
skilled nursing facility within 30 days of discharge from the hospital.
- The patient must enter the skilled
nursing facility for treatment of the same condition for which he or she
was hospitalized.
- The patient must require daily skilled
care.
- The condition must be one that can be
improved.
- The facility must be Medicare-certified.
- The patient's doctor must write a care
plan. The care plan must be carried out by the skilled nursing facility.
(Once the skilled needs are met, Medicare will no longer pay for
services.)
Medicare coverage of home care
Medicare does not cover private duty care. The following are needed in order to receive home care
under Medicare.
- The patient must be homebound.
- The doctor must certify a plan of
care.
- Care must be needed on an intermittent
(not continuous) basis.
- Care cannot exceed 35 hours per week or 8
hours per day.
- Physical or speech therapy must be
provided on a "necessary and reasonable" basis. There are no
restrictions on the number of days or hours per week of these therapies.
If a person qualifies for home health
care, he or she is entitled to a home health aide to provide some personal
care.
What is Medicaid?
Medicaid is a joint federal-state health insurance program providing
medical assistance primarily to low-income Americans who have limited
resources. It is also available to people under 65 if they are blind or
disabled. The purpose of Medicaid is to provide preventive, therapeutic, and
remedial health services and supplies that are essential to attain an optimum
level of well-being.
How do people receive Medicaid benefits?
There are two ways to receive Medicaid:
- Supplemental Security Income (SSI) —
People who receive a cash grant under SSI and Aid to Dependent Children
are automatically eligible for Medicaid benefits.
- Medicaid "spend-down" — This
is similar to a deductible or a co-payment that a patient must pay every
month. Once the patient meets the "spend-down" amount, the
patient is eligible for Medicaid for the remainder of the month.
Who is eligible for Medicaid?
Medicaid eligibility requirements depend on financial need, low income, and
minimal assets. In determining Medicaid eligibility, officials do not review
rent, car payments, or food costs. Officials only review medical expenses,
which include:
- Care from hospitals, doctors, clinics,
nurses, dentists, podiatrists, and chiropractors
- Medicines
- Medical supplies and equipment
- Health insurance premiums
- Transportation to get medical care
The four eligibility tests required to receive Medicaid are:
- Categorical — A patient must be age 65,
blind, or disabled.
- Non-financial — A patient must be a U.S.
citizen and a state resident. A patient also must have a Social Security
number.
- Financial — A patient's total gross
income, personal assets, and property will be evaluated and must meet a
certain standard. This amount varies from state to state.
- Procedural — A patient must complete and
sign an application, and have a personal interview with a Medicaid
official.
Each eligible Medicaid recipient receives a monthly medical identification
card. The card is valid for one month only.
Medicaid coverage
Medicaid coverage varies from state to state. For specific coverage
guidelines, contact your state's Department of Human Services. Generally,
Medicaid benefits include:
- Transportation — This might include
ambulance services when other means of transportation are detrimental to
the patient's health or it might include transportation to and from the
hospital at time of admission or discharge when required by the patient's
condition. Transportation also might cover trips to and from a hospital,
outpatient clinic, doctor's office, or other facility when the doctor
certifies the need for this service.
- Ambulatory centers — Ambulatory
health care centers are private corporations or public agencies that are
not part of a hospital. They provide preventive, diagnostic, therapeutic,
and rehabilitative services under the direction of a doctor. Ambulatory
services covered by Medicaid include dental, pharmaceutical, diagnostic,
and vision care.
- Hospital services — These services
include inpatient hospital care up to 60 days for an illness. Private
hospital rooms are covered only when the illness requires the patient to
be isolated for his or her own health or the health of others. Outpatient
preventive, therapeutic, and rehabilitative services also are covered, as
are professional and technical laboratory and radiologic services.
- Home health care — These services
include those provided by a visiting nurse, home health aide, or physical
therapist.
- Skilled nursing facilities — Skilled
nursing facilities and intermediate care facilities (providing short-term
care for a patient whose condition is stable or reversible) are covered
through Medicaid with a doctor's authorization.
|
