Dear Thoroughly Confused


Dear M,

I am thoroughly confused about my father’s Medicare and his long term care insurance. I  always thought that when the time came that he would need some kind of help, that between his Medicare and his LTCI he would be all set. Why would I think any different? Now I am finding out that this is not the case and that he will have to be able to come up with his own money to pay for some of his care. Would you be willing to explain what is what?

Dear Thoroughly Confused,

You are feeling this way because the vast majority of us become adults without ever having been taught this information. It’s by happenstance that some people learn about insurance coverage. It rarely occurs in a practical and timely fashion. If only our schools had a course in the practicalities of being a grown-up regarding finances and insurances. Right? Well, until that happens, let’s try to sort this out.

Medicare is the insurance that your father has because he is likely in his 60’s-90’s. Yes? This insurance covers much of his health care costs. He pays a premium. When you look at his Medicare card, you will see a number with a letter after it. You may recognize the digits as his Social Security number. As a side note, the Federal Administration is starting to re-issue all Medicare cards to no longer have the Social Security number as the identifier. Much too risky for identity theft! It will be replaced with a random number. His Medicare likely contributes toward hospitalization and/or medical appointments, labs, tests, and procedures.  He may have partial or full coverage for prescriptions. He may also have a coinsurance from a health insurance provider such as Blue Cross Blue Shield, Tufts, Aetna, United and such. If so, the majority of his health care costs will be covered. Now keep in mind that this coverage is only for medical care.

You are trying to figure out what might get paid through Medicare or LTCI for his daily care needs such as bathing, dressing, toileting, ambulating, transferring, meal preparation, etc.  Correct? This is where you may be confused. Most people are…that’s why. You are not alone. Medicare is likely to pay for a rehab stay in a nursing care facility or an acute rehabilitation hospital, but Medicare is not going to pay for what is referred to as long-term care. This could be care in the home, in a traditional assisted living facility, in an assisted living facility for memory care or in a nursing care facility. Unless you are eligible for certain programs in the community through your Area Agency on Aging, you must be prepared to either pay out of pocket for your daily care or make application to your long-term care insurance company to go on Claim. It is true, that through an application process, some individuals will be eligible for Medicaid, called MassHealth in Massachusetts to pay for long-term care. This program is based on income and asset eligibility.

It may be time to acknowledge all that your father is doing independently and then move on to talking about what tasks are getting to be a bit challenging. It is always wise to build in supports rather than waiting for an event or crisis to occur. In a home with a floor that is settling or slanted a bit, we often go to the source of the developing problem and place a lally column one floor below to support the floor from becoming weaker. That’s the same idea with all of us. Let’s recognize our areas needing a bit of shurring up and make it happen! That is in fact how we often live out our lives more independently. We are willing to put some supports into place.

So you see as an adult child that there are many moving parts to this whole aging process and it can be difficult to know what direction to take. You can’t go wrong with a supportive discussion and a sharing of financial/insurance information.

I trust that you are feeling less than thoroughly confused.

Yours truly,

Elder Care Industry Pioneer. Aging Expert. Founder & Managing Director of Elder Care Consultants of Choice. Mom & Daughter. Silver-Haired Queen of Purple.

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