Chapter V.
Paying For Long Term Care Services
There are a number of possible ways to pay for long term care. Some of the methods require your loved one to meet certain physical and/or financial criteria in order to qualify.
Primary Methods of Covering the Expenses of Long Term Care
Medicare
Medicare is a federally funded and administered program that provides health insurance for older Americans and people with disabilities. Individuals contribute to Medicare during their working years. In general you can qualify for Medicare coverage once you turn 65 or have disabilities. Since Medicare is a federal program, eligibility guidelines and services are much the same all over the country.
Medicaid
Medicaid is a health insurance program financed and run jointly by the federal and state governments for people who are 65 or older, blind or disabled and meet certain financial eligibility requirements. Medicaid is a state administered program, so guidelines and services vary by state. In Indiana, the program is operated by the Indiana Family and Social Services Administration.
Medicaid Waiver
Federal law requires Medicaid to pay for long term care services only when they are delivered in a nursing home or other long term care facility. However, states may negotiate a "waiver" of that requirement in order to provide a full array of home and community based long term care services. To qualify for Medicaid Waiver services, a person must be eligible for Medicaid and in need of the same level of care as those who qualify for Medicaid nursing home care. Eligibility for a Waiver is based on an in-home assessment done by a care manager from the local Area Agency on Aging, and then reviewed by a state Medicaid case manager.
There are a number of different kinds of waivers. The most common waiver for older adults is known as the Aged and Disabled Waiver. To access Medicaid Waiver services, you must work with your local Area Agency on Aging. For more information read this Consumer Waiver Guide.
CHOICE
CHOICE is Indiana’s state funded home care program. Any cost to the individual is based on a sliding fee scale—referred to as a "cost share." To qualify for CHOICE funding, you must be limited in at least two activities of daily living. A person seeking services funded by the CHOICE program must also work with their local Area Agency on Aging (AAA). The process starts with an in-home assessment conducted by the AAA care manager from that person's local agency. Once a person is screened and their home care needs are determined, the AAA case manager works with the person and his or her family to design a care plan that is tailored to meet the person’s specific home care needs within the bounds of available funding. Care voluntarily provided by family members, friends, neighbors, and local service organizations is incorporated into the care plan in order to maintain their involvement and to control costs. People of any age may apply to enter the CHOICE program. For more information on CHOICE, click here.
Long Term Care Insurance
Long term care insurance policies cover long term care expenses once an individual has met a pre-defined set of qualifying criteria. Policies pay for nursing home care, and in some cases, home care, adult day services, and assisted living as well. Coverage will last for a certain number of years. Long term care insurance is not for everyone, and it is very important that consumers carefully evaluate the pros and cons and their own financial situation before purchasing a policy. One evaluation tool available to consumers is “The 2007 Self-Assessment Guide for Long Term Care Insurance,” which is produced by the Indiana Long Term Care Insurance Program. That guide, and "The Buyer's Guide to Long-Term Care Insurance," are useful resources for anyone looking into long term care insurance.
Veterans Aid and Attendance Benefit
The Aid and Attendance Pension Program provides financial assistance to a qualifying veteran, veteran and one dependent, or a surviving spouse. This benefit can cover care at home or in assisted living or a nursing home. To qualify, a veteran must be eligible for a VA pension, meet service requirements, meet certain disability requirements, and meet income and asset limitations. Aid and attendance is paid in addition to a veteran’s basic pension. It can take up to six months to process an application, so starting early is important. For more information, go to: www.veteranaid.org/.
Private pay
Your loved one (or someone else) pays for the service out of their own pocket.
Assistance With Financial Questions
BenefitsCheckUp
This is a comprehensive resource for locating financial assistance programs which may help pay for medications, health care, utilities, meals and other expenses.
SHIP
The State Health Insurance Assistance Program is a free counseling program provided by the Indiana Department of Insurance. Trained counselors provide answers to questions related to Medicare, Medicare Supplement Insurance, Medicare Advantage, Medicaid, long term care insurance, prescription coverage, and low-income assistance.
