Legal & Financial
PAYING FOR LONG-TERM CARE
Paying for long-term care is a topic that
causes worry and stress for older adults and
caregivers. It can be expensive and wading
through the payment options can be daunting.
Long-term care can be paid for in a variety of
ways. We break them down for you here.
PRIVATE PAY
Funds may come from personal savings, pensions,
investment income, distributions from an
IRA or 401(k), annuity payments, and the sale of
real estate/personal property. If you have assets
which could be used to pay for care, it is a good
idea to consult with an Elder Law Attorney for
assistance in structuring and protecting assets
to facilitate care through end of life.
MEDICARE
Medicare is health insurance for people
65 and older, people under 65 with certain
disabilities, and people of any age with endstage
renal disease (permanent kidney failure
requiring dialysis or a kidney transplant).
Medicare Part A: (also called Original
Medicare) provides benefits and coverage for:
• Inpatient hospital care
• Inpatient stays at certain skilled nursing
facilities (not long-term)
• Hospice and home health services
Medicare Part B: (also called Original
Medicare) provides benefits and coverage for:
• Doctor and clinical lab services
• Outpatient preventive care
• Home health care
• Screenings, surgical fees and supplies
• Physical and occupational therapy
Medicare Part C: (also called Medicare
Advantage) is a different way of getting
Medicare Part A and Part B coverage.
Medicare Advantage (MA) Plans combine
Part A (hospital insurance) and Part B (medical
insurance) together in one plan. They can
also be combined with Part D prescription
drug coverage creating a Medicare Advantage
Prescription Drug (MA-PD) Plan. Generally,
these plans are offered as:
• Medicare Advantage Health Maintenance
Organizations (HMO plans)
• Medicare Advantage Preferred Provider
Organizations (PPO plans)
• Medicare Advantage Private Fee-for-Service
(PFFS plans)
• Medicare Advantage Special Needs Plans
(SNP plans)
Medicare Part D Prescription Drug Plan
(PDP): can be a stand-alone plan (not joined
with other insurance) or it may be combined
with a Medicare Advantage Plan, also called a
Medicare Advantage Prescription Drug (MAPD)
Plan. Part D plans:
• Help cover the cost of prescription drugs
• May help lower prescription drug costs and
protect against higher costs in the future
MEDICAID
Medicaid is the medical assistance program
that provides access to health care for eligible
families and individuals. Medicaid assists the
elderly and people with disabilities with the
costs of nursing facility care and other medical
and long-term care expenses. In Florida,
the Agency for Health Care Administration
(AHCA) is responsible for Medicaid. Medicaid
recipient care is managed through the
Statewide Medicaid Managed Care (SMMC)
program, implemented in 2014. Under the
SMMC program, most Medicaid recipients
are enrolled in a health plan. Medicaid covers
long term care expenses at home, an assisted
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