Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, June 17, 1990 TAG: 9006270038
SECTION: SENIOR STYLE PAGE: SS-12 EDITION: METRO
SOURCE: By KIM SUNDERLAND
DATELINE: LENGTH: Medium
And the likelihood of chronic illnesses increases with age. In 1988, about 6.9 million older people needed long-term care services, according to statistics gathered by the American Association of Retired Persons.
It is estimated that by the year 2000, the number will increase to almost 9 million.
Because of this, many older people will incur huge medical costs from long-term nursing care, which in turn places the elderly at a greater risk of being wiped out financially.
This is why health insurance is so vital.
Coping with exorbitant financial demands means planning ahead by thinking about potential needs, personal preferences and costs that may be associated with your choices.
According to the AARP, the cost of long-term care averages $20,000 to $25,000 a year in a nursing home. Costs can reach $50,000 in some areas of the country.
Long-term care services provided at home also can be costly, ranging from $50 to $200 a day, depending on the level and hours of care needed.
Following are brief summaries of different kinds of health insurances that can be considered:
Medicaid - This is a state-administered program that covers services for the aged, blind, disabled and poor. Some states offer a variety of services to individuals who have met financial eligibility criteria defined by the state. In many states the income criteria are well below the federal poverty levels, which means many poor are not eligible for Medicaid. Although it varies from state to state, services such as inpatient care, outpatient services, X-rays, skilled nursing care and home health care services are paid for. Many states also pay for dental care, prescription drugs and eye glasses. Check with your welfare office for more details.
Medicare - This is a federally-administered health insurance program for people 65 and over and for younger disabled people who qualify for Social Security disability benefits. It is not intended to cover long-term care and coverage for nursing home care is limited. Custodial care, the level of care most commonly needed by those with chronic illnesses, is also not covered. Hospital and medical insurance is provided under certain conditions and restrictions.
Medicare requires hospitals to accept their payments as payment in full and prohibits them from charging patients for anything other than the usual deductible and co-insurance amounts. Medicare determines what is a reasonable doctor bill; you make up the difference. You need to find a doctor who will accept Medicare assignment.
Medicare does not cover routine physical check-ups and related tests or private-duty nursing. Nor does it pay for immunizations, most dental work, foot care, vision and hearing exams, prescription glasses or treatment outside the United States.
Medicare better protects people against costs of acute illnesses.
Medicare-Supplement Insurance - Commonly called Medigap. These can fill some of the gaps between Medicare and actual medical charges. Available from many insurance companies, these differ widely in quality and price and do not cover long-term care. There are some Medigap policies that provide a skilled nursing home benefit, but these policies typically only cover the costs Medicare doesn't pay for covered services, such as hospital deductibles and physician co-payments. Some plans may cover drugs or special services such as a private duty nurse. Understand coverage and limitations. One comprehensive Medigap policy should be all you need.
Health Maintenance Organizations - An HMO is a health delivery system comprised of a group of hospitals, doctors and other health care personnel who have joined together to provide members with prepaid medical care. Members pay a flat monthly or quarterly fee instead of an insurance premium. Some contract with Medicare to provide care on a prepaid basis.
Long Term Care Insurance - Investment in a good long-term care policy could considerably reduce the assets you'll need in your old age. Neither Medicare's new catastrophic coverage nor Medigap policies pick up these costs. Commercial insurers offer long-term care coverage in either a nursing home or the patient's home. Most of these policies involve restrictions. The majority pay a fixed amount each day; none provide blanket coverage for all expenses. Premiums vary greatly depending on age at the time of purchase and on the benefits offered. Contact your state department of insurance for names of insurers that offer affordable long-term care policies.
Life Care Communities - These organizations guarantee for their residents food, housing, social activities and, if necessary, nursing home care until death. They provide a full range of services, including physical therapy, home nursing care and housekeeping services. They are geared to the comfort and physical limitations of older people, but only for those who can afford them.
by CNB