How Not To Pull Your Family Apart

Erik, unfamiliar with the ins and outs of government programs, brings up Medicare and Medicaid as possible options. “According to the summary, Grandma and Grandpa both qualify for Medicare and have Medicare Advantage plans.”

Jodi responds. “I looked into that option before investigating long-term care insurance. Medicare is an entitlement program, meaning that everyone who reaches age sixty-five and is entitled to receive Social Security benefits also receives Medicare. Medicare covers medically necessary acute care, such as doctor visits, prescription drugs, and hospital stays. Except for specific circumstances, Medicare does not pay for most long-term care services or personal care, such as help with bathing or supervision, which is considered custodial care. Medicare does not provide long-term care coverage or custodial care unless medical care is needed.”

Erik continues the query, “But they also have Medicare Advantage coverage. Does that cover long-term care?”

“Medicare Advantage plans generally cover specialized care, such as stays in a skilled nursing facility, hospice, respite care, and eligible home health services,” Jodi says. “Some Medicare Advantage plans now cover certain long-term care and at-home care services. However, emphasis is on certain. It doesn’t provide the care and services that we need to keep your grandparents at home over the long haul, as you put it. I also looked at Medigap plans. Medigap plans are intended to fill the gaps in Medicare insurance. However, even the most comprehensive of Medigap plans does not cover long-term care needs. These policies currently do not pay for assisted living, Alzheimer’s disease, custodial care, personal care, or adult day care.”

Erik, hoping to find the right answer, asks, “Maybe they qualify for Medicaid?”

Jodi looks a bit sheepish as she responds. “Your grandparents don’t like the idea of the government controlling their care options.”

“Medicaid is a welfare program,” Grandpa states forcefully to make sure everyone understands how strongly he feels about this option. “Medicaid is a public assistance program that helps pay medical costs for individuals with limited income and assets. To be eligible for Medicaid coverage, you must meet the program’s strict income and asset guidelines. We don’t qualify, we don’t want to qualify, and we don’t expect to access a government assistance program. It’s for people who haven’t been as lucky as us. We don’t want to have to spend or give away what we have in order to qualify for government assistance.”