|
LONG TERM CARE
Someone with a prolonged physical illness, a disability or a cognitive impairment(such as Alzheimer's disease) often needs long-term care. Many different services help people with chronic conditions overcome limitations that keep them from being independent. Long-term care is different from traditional me ducal care. Long-term care helps one live as he or shoe is now; it may not help to improve or correct medical problems. Long-term care services may include help with activities of daily living, home health care, respite care, hospice care, adult day care. care in a nursing home or care in an assisted living facility. Long-term care may also include care management services, which will evaluate your needs and coordinate and monitor the delivery of long-term care services.
Someone with a physical illness or disability often needs hands-on or stand by assistance with activities of daily living. People with cognitive impairments usually need supervision, protection or verbal reminders to do every day activities. The way long-term care services are provided is changing. Skilled care and personal care are still the terms used most often to describe long-term care an the type of level of care you may need.
People usually need skilled care for medical conditions that require care by medical personnel such as registered nurses or professional therapists. This care is usually needed 24 hours a day, a physician must order it, and it must follow a plan. Individuals usually get skilled care in a nursing home, but may also receive it in other places. For example, you might get skilled care in your home with help from visiting nurses or therapists. Skilled care includes physical therapy, caring for a wound, or supervising the administration of intravenous medication.
Common misconceptions
Many people assume they have their coverage when they do not. It is common to confute long term care insurance with other types of coverage such as employer-provided health or disability insurance. Since long term care isn't considered medical care, most health insurance plans won't pay for it, and traditional disability insurance only replaces lost income.
At age 65, a lot of us think Medicare will take care of us in the event of a lengthy illness. But the fact is, it generally only covers skilled care after you have been in the hospital for at least 3 days, and the coverage is limited. With respect to nursing home care. Medicare was designed to pay for short term skilled nursing home care following hospitalization. Medicare also pays for some skilled at-home care, but only for short term health conditions and not for the on going assistance that many elderly, ill or injured people may need.
In order to qualify for Medicaid to cover your long term care expenses, you may have to spend down your savings. In many states, the assets you've worked so hard to build up over the years will have to be depleted first.
HOW TO QUALIFY FOR LONG-TERM CARE BENEFITS
You qualify for benefits when:
1. You need substantial assistance with at least two of six activities of daily living. In addition, it is expected that you will need the substantial assistance for at least 90 days.
OR
2. You need substantial supervision because you have a severe cognitive impairment, which generally means that you have significant deterioration in or loss of your intellectual capacity(e.g. Alzheimers's)
and
3. Your doctor, nurse, licensed social worker or the Privileged Care coordination team certifies at least annually that you need the assistance or supervision as described above. Also in determining qualification for benefits, we can ask your doctor and your care providers for information that supports your need for care.
Benefits are paid as reimbursement for expenses paid for you for covered care and services you receive consistent with a Plan of care that has been developed for you by your doctor, nurse or licensed social worker, or the Privileged care coordination team. Please review the eligibility for payment of benefits section in your out line of coverage or certificate of insurance for details.
The six activities of daily living:
Bathing Eating
Dressing Toileting
Continence Transferring
Once you are insured, there is no exclusion for preexisting conditions. A preexisting condition is a sickness, physical, medical, mental or nervous disorder, or brain condition such as Alzheimer's disease that existed before the coverage effective date. However, any incorrect or omitted material information in your application may cause this coverage to be rescinded(voided) or a claim to be denied.
|
|