Last week I discussed the prices for my preferred delivery types of long term care. This week I will describe HOW I will have the money to pay for the care.

Long term care insurance comes in many different forms these days, but gone are the policies with unlimited amounts of time included. They all are for a certain amount of time in long term care. My favorite kind of long term care insurance is one where you give the company a lump sum of money, ($20,000 or more last time I looked into it) and that ‘buys’ you a guaranteed benefit of so much per day for a certain length of time. If you don’t use it (if you never need long term care) you are guaranteed a certain amount of money back for your heirs.

Before I knew that kind of policy existed I purchased a two year policy with Mutual of Omaha that paid up to $200 per day and included home and community based services. If I spent less than $200 a day, the coverage would last longer than two years, depending on how much less. It included a 3% inflation protection, but I could have purchased %5 for more money. My premiums were $78 a month. But because of the financial needs of keeping the health club for seniors open, I could not afford the premiums and my policy lapsed.

Perhaps someday I can afford to purchase another long term care policy of some kind. The older one is when one purchases a policy, the higher the premiums, of course.

So, what if I need long term care but I don’t have the income or insurance benefits to cover it all? If I had been in the military during a war I could apply for Aide and Attendance Benefits. Those might pay me up to $1800 a month in today’s dollars, depending on my income. I am not a veteran, however, so I would have to rely on Medicaid to cover the cost of my care. Medicaid will take all my income to pay for my care and allow me to keep $40 a month to pay for toiletries or whatever. Medicaid currently does have Home and Community Waiver openings, but who knows what will be available in the future? Today the Home and Community Based Waivers are a nightmare for providers and participants alike because it is notorious for late payments and non-payments of claims. Isn’t it interesting that the government considers home and community based care a “waiver”—an exception to the rule of putting most Medicaid eligible people in a nursing home. Medicaid is much better about reimbursing nursing homes for the care they give.

Medicaid pays for adult day center attendance, and it pays for what they are now calling “Participant Directed Services” (formerly Consumer Directed Option) so a family member or someone else can get paid for caring for someone in need of long term care in their home. The program is very difficult to implement and manage. It requires someone to be responsible as the “manager” of the caregiver. They have to keep track of hours, pay periods, job duties and duties performed, etc., just like any other employer would. The caregiver has a lot of paperwork to fill out, too. There is also a case manager involved, who makes sure the manager and the caregiver are doing the right things. There is a lot of abuse of the system and of the ones in need of care in the form of neglect.

If I have to rely on Medicaid dollars for my care, all my assets will be used to pay for the care while I am alive and after I die. I am allowed to live in my house while using Medicaid money for my care, but after I die, the house will be sold and the money used to pay back what was spent by the government for my care. My life insurance policy will be used for that too. I am allowed to keep a car, too, while receiving care and my caregiver can use it to get me to appointments, etc., but I am not sure how to pay for the car’s maintenance and insurance on Medicaid benefits. If a family member lives with me and cares for me for two years before I access Medicaid dollars, they will be allowed to keep my house for themselves. They have to document and keep good records to prove the care was actually given, though. I recommend using an elder care attorney.

If someone lives with me who drives a car and I am using Medicaid to pay for my care, Medicaid will not pay for transportation. If I live alone and Medicaid pays for my care, Medicaid will pay for my transportation. To me, this seems prejudiced against families trying to take care of their loved ones.

Please get involved in what the lawmakers are doing with Medicaid Rules and Regulations. Even if you do have lots of money now and don’t think you will ever need to use Medicaid dollars, you may get dementia and lose it all. It happened to my father in law. Or, you may out live your savings, like what happened to another close elderly family member.

May you and yours have a blessed week ahead!