Representing not-for-profit, community-based senior care providers throughout Western New York.


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Paying For Senior Care
Knowledge is a valuable asset when you try to plan for the future, especially in light of the fact that costs associated with all forms of health care are on the rise. Individuals and families must educate themselves on the financial realities of senior care services and anticipate the needs of aging.

Use the following information to gain a basic understanding of the financial options available to pay for senior care. To find out more, utilize the resources in this article or consult with your financial advisor or attorney.

 

Private Pay Long Term Care Insurance Medicare Medicaid Supplemental Security Income Housing Subsidies


Private Pay
The senior or his/her family pays for services from personal income, including savings, pensions and other resources. Personal assets are the first consideration when determining ability to pay for senior care services. Market-rate housing (not subsidized) and assisted living are almost always private pay.

Long Term Care Insurance
Long term care insurance offers a way for individuals to maintain control of their assets and to retain the choice of where they receive services. This insurance covers various levels of services in nursing facilities and assisted living facilities. In addition, some policies will cover home health care services, respite care and adult day care services.

Several insurers in New York State offer long term care insurance policies, and New York has a special program called the NYS Partnership For Long-Term Care (www.nyspltc.org).

Unlike Medigap policies, long term care insurance is not a supplement for Medicare. It is designed to cover what Medicare does not.

For more information on long term care insurance, discuss your needs with a qualified insurance professional or elder law attorney. You may also contact the New York State Health Insurance Information, Counseling and Assistance Program (HIICAP) through your local county department of senior services (Office for the Aging), or view information at www.hiicap.state.ny.us.


Medicare
Many people mistakenly assume that Medicare will pay for all their senior care. Medicare is a federal health insurance program that provides limited coverage for services provided in nursing facilities and in home care settings. Medicare will cover the first 20 days in a nursing facility that are determined to be medically necessary. The next 80 days require a co-payment. Coverage can end at any time during the stay if the resident does not meet Medicare's strict medical criteria. Medicare does not usually pay for assisted living and will only pay for extended home health care services if a stringent set of conditions is met. Hospice care services in both a nursing facility and home care setting are covered.

Medigap policies and private supplemental insurance will generally pay part or all of the Medicare co-payments. These policies will not pay for extended nursing facility stays. Medigap coverage always ends when Medicare coverage ends. For information on Medicare coverage of long term care services, contact your local Medicare agency or visit the Medicare website at www.medicare.gov.


Medicaid
Medicaid is a federal, state and locally financed program that pays health care expenses for those who qualify financially and medically. It is very common for residents in nursing facilities and those receiving home health care services to turn to Medicaid because they have spent down, or exhausted, their assets.

Medicaid also covers some home health care services, but does not cover most housing pro-grams with the exception of the New York state-administered Assisted Living Program.

Medicaid eligibility is determined by both need for service and the applicant's financial resources. Income and resource eligibility guidelines vary based on marital status and other variables. Medicaid will review the income and resources of the applicant and spouse for 60 months to determine if they have made any asset transfers.

Hospice services, in both a nursing facility and home care setting, are covered as long as Medicaid is the only insurance.

Individuals may contact their county Department of Social Services for more information on eligibility for Medicaid, or call the social work department at any facility listed on this website.


Supplemental Security Income (SSI)
Administered through the Social Security Administration, this program supplements payments for assisted living facilities and housing for individuals with low incomes. Like Medicaid, financial qualification is necessary for this program. Individuals can be dually eligible for Supplemental Security Income (SSI), and Medicaid (for health care needs), as well as other government assistance programs.

Information on applying for SSI is available through your local Social Security office, or through the Social Security website at www.ssa.gov.


Housing Subsidies
Rent for senior housing complexes varies widely based upon the accommodations offered. Senior housing may be government subsidized, requiring that applicants meet certain income specifications.

Subsidized housing programs for low to moderate income seniors include: rental units in public and assisted housing complexes (HUD Housing); the Section 8 Housing Choice Voucher Program; and Section 202 housing, which provides housing to low income seniors and generally includes some supportive services.