Senior moments: Medicare not necessarily the best plan for long-term care By JACKIE BYRD For the Blade-News
A column for seniors
and those who love them
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Life is full of miracles, but they're not always the ones we pray for. - Actress Eve Arden
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The main reason for this column is to share information that will assist seniors and their caregivers as they struggle with the unexpected and continuing challenges of everyday life.
One of the major challenges in that category is the lack of education regarding how to pay for care needed by our elderly loved ones. Many people do not see this as a problem because they believe that either Medicare or the health insurance they carry will pay for such care. The sad and surprising truth is that Medicare, our government's universal health care for those 65 and older, does not pay for long-term care. Furthermore, as Jane Gross, writing in her New York Times blog, The New Old Age says, "Medicare does not pay for so many of the things the frail elderly require. Not home health aides for those who can't get out of bed, bathe, dress or feed themselves. Not an assisted living facility, with handicap-accessible apartments, congregate meals and transportation services. Not nursing homes where the most helpless of the elderly live out their days with round-the-clock supervision."
Gross is correct. Medicare was enacted, she continues, in the 1960s when life expectancy was shorter and fewer people lived long enough to require long-term care. Although a revamp of Medicare to pay for long-term care is pretty much not going to happen in our lifetime, the government Centers for Medicare and Medicaid Services has a new Web site for caregivers which will, at least, make it easier to find information regarding what Medicare does pay for. Additionally, the site is easy to use and provides links to other elder care resources.
The site is called Ask Medicare, www.medicare.gov/caregivers. It is easy to navigate. One section titled "What are you looking for?" links you, among other places, to information about whether a service is covered, how to read a Medicare Summary Notice and how to file a claim. Also, there is easy to understand information comparing prescription drug plans and comparing care facilities.
This site is supported by public and private funds. Nongovernment supporters include AARP, the Alzheimer's Association, the National Alliance for Caregiving and Johnson & Johnson, who have their own site for caregivers: www.strengthforcaregiving.com. Check it out.
On the topic of paying for care for the elderly, there is a little known benefit for veterans and their families that can be invaluable. Known as the Aid and Attendance benefit, it can be used to help with care in an assisted living facility, or for care at home.
Many readers are probably already familiar with service-connect veterans' compensation. This compensation is provided to veterans for disabilities caused or made worse by military service. It is normally expressed as compensation for a certain percentage disability.
Pensions, or nonservice-connected benefits, are available to veterans and some widows or widowers of veterans who meet certain conditions. Retirement from military service is required for Aid and Attendance. However, it is a needs-based program with specific rules for eligibility. The veteran must have served 90 days on active duty with at least one day during wartime. He or she must have received a discharge under conditions other than dishonorable. The veteran must be over the age of 65, or permanently and totally disabled because of a nonservice-connected condition.
The Aid and Attendance benefit is an increased benefit for veterans who require "care or assistance on a regular basis" to protect them from dangers in their daily living environment. Veterans living in assisted living facilities are presumed to need this level of assistance, but the veteran should include a letter from his or her personal physician regarding the veteran's disability.
To qualify for Aid and Attendance benefits, your income must be less than $1,554 per month (with no dependents) and from $1,220 to $1,842 per month (with one dependent.) The income can be reduced by paid but not reimbursed medical expenses including insurance premiums, Medicare premiums, prescriptions, dental and vision care, and the costs of an assisted living facility, in-home aid or adult day care. In many cases, these costs can easily reduce the applicant's income to a level that would permit the applicant to receive the benefit.
The net worth of the applicant is also considered in the evaluation for Aid and Attendance benefits. A net worth below $80,000 for a couple, or $50,000 for an individual has been acceptable. The VA looks to the net worth at the time of application. Unlike applications for Medicaid, there is no penalty period for the transfer of assets. The Aid and Attendance benefit payments are made directly to the veteran or eligible surviving spouse, and they are specifically excluded from the definition of income for Medicaid purposes. The benefit is reduced to $90 per month if the veteran lives in a nursing home. This is a valuable benefit worth looking into. For information, visit www.va.gov.
Thanks for reading, stay well, see you next week.
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The writer, a longtime resident of Bowie, is secretary of the Maryland/D.C. chapter of the National Academy of Elder Law Attorneys and a member of the Elder Law Section of the Maryland State Bar Association. You can e-mail her at jbyrd@byrdandbyrd.com.
