Health Insurance Guys: Does the government pay for Long Term Care insurance? | Business

I’ve already got my Medicare care so I’m ready to get started come April 1. Along with all the mail they’re sending me, my friends (and wife) are pushing me to look into long term care.

Doesn’t Medicare cover some of this? Is there a government plan?

Tom: First, Medicare covers a small portion of Long Term Care (LTC).

Second, the government plan that covers LTC is Medi-Cal. In fact, about 65 percent of residents in California nursing homes are on Medi-Cal.

To qualify, you must have limited income and typically have to spend down assets.

Medicare covers up to 100 days in a Skilled Nursing Facility (SNF), but no more than that. Medicare does offer some limited home care benefits.

People are also reading…

If you have an LTC policy, once you are unable to do two of the Activities of Daily Living (ADL) you can begin the process of receiving benefits. Those activities include walking (AKA transporting), toileting, dressing, eating, etc. Yes, at age 65, an LTC policy is expensive.

Kyle: In the February “California Broker” magazine:

“The California Long Term Care Insurance Task Force has been charged with ‘exploring the feasibility of developing and implementing a culturally competent statewide insurance program for long-term care services and supports.'”

The 15 member committee has scheduled 12 meetings for 2022 with a report to the legislature in 2023.

Most of the discussions so far have been on adapting the Washington State Cares Act.

For residents of Washington State, there is a mandatory .58 percent payroll tax on those who are W-2 employees. The lifetime benefit is only $36,500, so the main purpose of the act is to encourage individuals to buy their own private LTC policy.

So far, the Governor of Washington has delayed the imposition of the tax to April 1.

Al: Say, that’s when Henry starts his Medicare!

Anyway, according to the Legislative Analyst report, our governor is proposing a budget that includes Medi-Cal coverage for all income-eligible undocumented immigrants.

I was not aware that over the past several years the legislature had expanded Medi-Cal coverage to include all income-eligible undocumented immigrants under the age of 26; or, over the age of 49.

The Governor’s proposed budget fills that gap between 26 and 49 beginning 2024. The budget also shows a plan to improve affordability and access to health care through California Health Benefit Exchange (AKA, Covered California).

Tom: Back to our reader’s original question, the government, at least the California one, is encouraging you to get private LTC insurance if you can afford it.

If the task force recommends, and the legislature approves, and the Governor signs a law establishing a mandatory program like the one in Washington State, then those who are employed will help pay for an LTC plan for California residents.

We would be happy to meet with Henry and go over elimination periods, inflation riders, daily or monthly benefit amounts, and all the other facets of LTC.

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