The Need for Expansion and Standardization in Long-Term Health Care Policies

Part 4, Chapter 14: Specialized Situations: Coverage for Long-Term Care Page 13

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Table 18 is based on the assumption that a skilled nursing facility represents a temporary treatment center -- where the individual will soon be returning home -- and that an assisted living facility or a nursing home represents a more permanent arrangement. In all cases where coverage may be available to eligible individuals for either home-based care or for long-term care in a specialized facility, such coverage is always limited by specific rules and regulations. In addition, claims for services or medical equipment must meet the plan's definition of medical necessity before they will be covered.

As the population ages and Americans become more aware of the importance of coverage for long-term care, government-sponsored programs and health insurance policies may be expanded to cover all such needs, or perhaps a new approach to meeting long-term care needs may be developed for all individuals. In the meantime, if you have particular concerns about the lack of coverage for long-term care under existing health insurance policies or government programs, write to your state and federal legislative representatives and let them know of those concerns.

Summary

The lack of universal health insurance coverage for long-term care and the movement toward maximum independence for people with disabilities makes careful planning for long-term care essential. In addition to long-term care insurance policies, it may be possible to provide for home-based long-term care needs through a reverse mortgage or a home equity loan. In some areas, local community agencies may also offer housekeeping, meals, and transportation services. Depending on circumstances, it may also be possible to obtain coverage for long-term care through Medicaid, through local or state government-sponsored programs, or through veterans' benefits.

Given the complexity of the issues involved in planning for long-term care, it's important to research the subject carefully before making any decision. That research should include a review of booklets published by various agencies and organizations, and discussions with family members, a financial advisor, and an attorney.

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