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California Long Term Insurance

Married or Single: If you have a spouse or other family members who can provide care you are more likely to be able to remain in your own home when you need care. If family members are unable to provide care, and you cannot pay someone to take care of you, then a nursing home may be the only available option. The condition that causes you to need care, and the severity of that condition, may determine whether you can be cared for at home or whether institutional care is the only option. For instance, a severe stroke could be so disabling that care at home is impossible, or an Alzheimer’s patient may need constant supervision.

Health factors: Certain health conditions, like Alzheimer’s or a stroke, can cause a need for long term care. If you know that certain health conditions run in your family, you may have a greater risk of needing long-term care than another person of the same age and gender. Unfortunately, it may be that this known health condition could also make you ineligible to buy this type of insurance.

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How Much Does Long-Term Care Cost?
In 2002, the cost of nursing home care in California averages $141 a day. Costs may be lower in rural areas and higher in suburban and urban areas. A short 30-day stay could cost $4,230 or more; a 3 month stay, $12,690 or more; and, a year stay, $50,000 or more. The cost of care in the future will be much higher than it is today. California nursing home rates increased at an average rate of over 5% per year during the past twenty years¹ and are likely in the future to continue to increase by at least 5% per year. A 5% annual increase means a year of care that costs $50,000 today will cost twice that amount in 14
years, or $100,000 a year!

Who Usually Pays for Long-Term Care?
• Medicare may pay for skilled care in a nursing home for a very short period of time – but no longer than 100 days – and only when the patient meets all the Medicare requirements for daily skilled care. While people do get personal care services at the same time, Medicare will not pay unless there is also a need for daily skilled services that only a nurse or therapist can provide. Medicare may pay
for some personal care services at home but again, only if you also need skilled care on a daily basis that only a licensed person can provide. For more details, see the Medicare benefits book available from your Social Security office or by calling the Social Security Administration, toll-free at800-772-1213.

• Medi-Cal (called Medicaid outside California) pays for necessary health care that is not covered by Medicare, but only if you meet federal and state poverty guidelines. In 2002, a single person over 65 would qualify for Medi-Cal if he/she had $2,000 or less in non-housing assets. A married spouse, living in the community, however, can keep up to $89,280 in non-housing assets and $2,232 in joint monthly income, when his or her spouse is in a nursing home and applies for Medi-Cal. These guidelines and the amount of assets and income a person may keep can change annually.

Note: Non-housing assets are mentioned several times in this guide. In general, the value of a person’s house is not counted when applying for Medi-Cal. While the state does have estate recovery rights after the death of a Medi-Cal beneficiary, there are certain exemptions that apply, particularly for surviving spouses. There are certain rules that the state must follow if it is to be successful in recovering any amounts the program paid. You can get the most current information about Medi-Cal from your local county Department of Social Services, Legal Services Program, or an elder law attorney.

¹ Issuers Bulletin for 2002, California Partnership for Long-Term Care, based on data from the California Office of Statewide Health Planning and Development.

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