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Long-Term Care Issues and Gaining Health Insurance Funding to Cover Disabilities

Appendix A: Ten Frequently Asked Questions about Health Insurance Page 5

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Question 9:

My father lives near us. He owns his own house, and he's basically healthy at this point. However, I'm worried that he may need long-term care as he gets older. He's not wealthy, and so he may not be able to afford the care he needs on his own, and we may not have the economic resources to help him. Although he's covered by Medicare, I know Medicare does not provide much coverage for long-term care. What should we do to make certain his health care needs are met in the future?

Answer:

There are a number of ways to provide for long-term care. A long-term care policy can provide for a variety of needs. However, such policies are not standardized. Thus, it's important to review various policies carefully to make certain that the policy that's eventually chosen will meet your father's needs in the future. Since your father owns his own house, it may also be possible for him to meet his long-term care needs through a reverse mortgage or a home equity loan. If he is a veteran with a service-connected disability, he may also be entitled to veterans' benefits. In addition, there are community agencies in most areas that provide services such as meals and house keeping. Since providing for long-term care for an elderly person involves complex decisions that may have a number of important implications, it's essential to discuss the issues with other family members and with an accountant and an attorney before making any decision.

Question 10:

My daughter has a serious disability. She's not old enough to go to school yet, but as she gets older she'll need a variety of medical equipment, including a power wheelchair. In addition, we'll need to add a wheelchair lift to our van in order to transport her more easily, and we'll need to install ramps throughout our house. We may eventually have to rebuild the bathroom, as well, to make it fully accessible. Although we have good health insurance coverage, I'm not sure that the equipment she will need will be covered by the policy. We won't be able to afford the equipment on our own. What can we do?

Answer:

Health insurance policies often provide coverage for power wheelchairs, but they will not usually cover related expenses such as a wheelchair-lift or home modifications. Fortunately, there are other available sources of funds for medical equipment and services for a child with a disability. For example, in many areas state agencies have funds available to purchase medical equipment for a child with a disability. Depending on the state, those funds may be provided through the state Department of Health, the Department of Insurance, the Division of Developmental Disabilities, or the Division of Vocational Rehabilitation Services. Funds may also be available through the local Independent Living Center.

When your daughter begins to attend school, the local public school district may also provide help with the purchase of medical equipment. However that equipment must be clearly related to your daughter's educational needs, and the need for the equipment must generally be noted in her IEP. Local fraternal organizations may provide support, as well, and groups such as the Disabled Childrens' Relief Fund may provide funds for equipment that's not covered by your health insurance policy.

You may also be able to purchase used medical equipment inexpensively through your state Tech Act equipment recycling or equipment exchange program. Your local Protection and Advocacy Office or Independent Living Center should be able to help you explore those possibilities.

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