The best way to deal with the costs of aging services is to plan and save. Long-term care in particular can be very expensive. Planning as early as possible for potential health needs gives you the most options for meeting them. Contrary to a common misconception, Medicare, other federal programs and private standard health insurance policies do not pay for long-term care. Medicaid is an options, but it is available only to those who have exhausted all financial resources. 

Start by figuring out your preferences, understanding what health needs might arise, and learning what the costs might be for the services you need or want. That may mean:

  • Talking with a financial planner
  • Buying a long-term care insurance policy
  • Meeting with your lawyer

Let your family know about your preferences, how you will provide and pay for services and whether you have long-term care insurance or other financial / investment tools to help.

If you or your loved one have not been able to save enough to cover the necessary costs, you may need to turn to Medicaid. All personal resources must be depleted to qualify for Medicaid. It's important to know that, if personal income or resources have been given away within five years - or assets have been transferred to a trust within five years - of applying for Medicaid, eligibility for benefits may not be approved for a period of time.

Below are brief explanations of the different types of coverage available. If you need help determining how to pay for care, admissions departments in communities or your local Area Agency on Aging can often help you understand your options and steer you toward the assistance you need. The National Council on Aging can also help you find programs for seniors who need assistance with the costs of prescription drug, health care, utilities and other essential items or services.

Long-term Care Insurance

Traditionally, this type of insurance was used for nursing home costs. Today, long-term care insurance is designed to cover a variety of aging services, including assisted living, retirement communities and adult day care.

Long-term care insurance typically pays daily rates to providers. Because every policy is different, be sure to find out:

  • Exactly what levels of care and services your potential insurers will cover
  • When, how, and if premium increases occur
  • How far the policy's payment cap might take you before you exhaust the benefit

That way, you can research providers with an open mind, not a limited budget.

Medicare Payment Options

Medicare is a health insurance program for people over the age of 65 and for certain disabled individuals. It covers a limited amount of long-term care, including:

  • Nursing home care after a hospital stay of at least three days - This coverage requires substantial insurance co-payments after the first 20 days and can be used for no more than 100 days.
  • Short-term services through a home care agency - These services can be provided wherever you live.
  • Home care if you are homebound and have been prescribed therapy or skilled nursing care by your physician - Medicare coverage is limited to services that will assist in recovery from a medical problem. It may not extend to chronic care needs, like those experienced by people with Alzheimer's disease.

Medicaid Eligibility

Medicaid is a program that covers individuals' heath care costs once all of their own resources have been expended. To qualify for Medicaid, you must complete a state application, verifying your assets. Federal policy requires states to examine your financial history for the previous five years to ensure that you have not transferred assets out of your name to avoid using them for health care costs.

You can find more information on the Centers for Medicare & Medicaid Services website.

Living Independence for the Elderly

Living Independence for the Elderly (LIFE) is a managed care program for older individuals that have been determined to need skilled nursing care but wish to remain in their homes and communities as long as possible.

To be eligible for LIFE services, you must:

  • Be 55 years or older
  • Qualify for skilled nursing care following a level of care determination by the Area Agency on Aging
  • Be eligible for medical assistance or able to pay privately
  • Reside in an area serviced by a LIFE provider
  • Meet criteria for being safely served in the community as determined by a LIFE provider

LIFE provides a comprehensive, all-inclusive package of services, including:

  • Primary medical care
  • Nursing care and therapies
  • Personal care, meals and transportation
  • Pharmaceutical services
  • Recreational and socialization activities
  • In-patient and outpatient care
  • Lab and X-ray
  • Eyeglasses, hearing aids and dentures
  • Emergency care
  • Nursing facility care

The LIFE program centers around adult day health centers, where most services are offered. Transportation is provided to and from centers and other services. Home care is provided as needed. If a participant can no longer be cared for in the community, a nursing facility placement will occur.

Pharmaceutical Assistance Contract for the Elderly

Pharmaceutical Assistance Contract for the Elderly (PACE), PACENET and PACE Plus Medicare are Pennsylvania's prescription assistance programs for seniors. These programs offer low-cost prescription medication to qualified people aged 65 and older. Only medications that require a physician's prescription are covered. Insulin, insulin syringes, and insulin needles are the only exceptions. Over-the-counter medications, such as aspirin, antacid and vitamins, are not covered, even if prescribed.

To be eligible for PACE, one must be:

  • Age 65 or older
  • A resident of Pennsylvania for at least 90 days prior to the date of application
  • Not receiving the Department of Human Services' Medicaid prescription benefit
  • Receiving income of $14,500 or less for a single person or a combined total of $17,700 or less for married couples.

To be eligible for PACENET, one must be:

  • Age 65 or older
  • A resident of Pennsylvania for at least 90 days prior to the date of application
  • Not enrolled in the Department of Human Services' Medicaid prescription benefit
  • Receiving income between $14,500 and $23,500 for a single person or a combined total of between $17,700 and $31,500 for married couples

For more information on the PACE programs, and to obtain applications, please visit the Pennsylvania Department of Aging website.

Community HealthChoices

Community HealthChoices is the Commonwealth's pan to deliver Medicaid-funded long-term services and supports, behavioral health, and physical health benefits to older Pennsylvanians and individuals with physical disabilities. If you have certain health conditions, Community HealthChoices can coordinate your care to make it easier to get the services you need, no matter where you live.

To learn more about Community HealthChoices, click here.

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