Long Term Care Planning in Oregon
A summary of long term care planning in Oregon including an explanation of the differences between Medicare and Medicaid.
Long Term Care Planning in OregonLong-Term Care:
Long-term care refers to a range of services and support a person may need to meet their individual health care needs. Recent research shows that most individuals reaching age 65 will need some type of long-term care during their life. Many people do not realize that their private health insurance and Medicare will not cover the costs and expenses of long-term care, including care in the home, in an assisted living facility, or in a nursing facility.
Typically, long-term care is not medical care, but rather it involves assistance with the basic, personal tasks of everyday life. These personal tasks are often referred to as Activities of Daily Living (or “ADLs”) such as:
• Using the toilet;
• Transferring (to or from bed, or chair);
• Caring for incontinence; and
People often believe that "long-term care" refers only to certain types of insurance policies. Although a thorough long-term care insurance policy may be part of the overall solution, long-term care should be an ongoing family plan involving a strategy for long-term health care services, finances, and personal decisions such as where you would like to live.
For Medicaid eligibility purposes, long-term care services are the services provided to an individual who requires a level of care equivalent to the type of care received in a nursing facility.
Medicare & MedicaidMedicare
A common misconception is that Medicare will pay for long-term care costs. However, Medicare generally will not cover long-term care except in certain, specific circumstances. Medicare distinguishes between medical care (which is generally covered) and what is referred to as "custodial care," which typically is not covered. Custodial care includes assistance with bathing, eating, using the toilet, and mobility. This is the level of care equivalent to the type of care provided in a nursing facility.
Generally, Medicare will briefly cover the costs incurred while staying in a skilled nursing facility. First, a determination is required that the care you are receiving is "skilled care." If so, Medicare will pay for those costs for up to 20 days, and then a co-payment will be required. Medicare will stop payment for all services after a 100 day stay at a skilled nursing facility. Also, Medicare may stop all payments if it is determined that the condition for which you need skilled care is no longer improving.
Medicaid is a government program that pays for both medical costs and long-term care costs. Medicaid is a "means-tested" government program, which means that to qualify you must meet strict financial requirements as well as other eligibility requirements. Upon application, a Medicaid caseworker will evaluate the individual's ability to function independently and their need for assistance with ADLs. Those applicants who need more assistance will have a higher priority for eligibility in the Medicaid system.
Oregon is an income cap state, which means that Oregon applies a limit on the amount of income that an individual receives, and that amount must be no higher than Oregon's limit at the time of application for Medicaid. Currently, an individual's income is limited to $2,250 per month in order to qualify for Medicaid.
Oregon also has a limit on the amount of resources a person can have on hand. In Oregon, a single individual may retain no more than $2,000 in assets in order to qualify for Medicaid. The limits for a married couple are evaluated differently because the well-spouse (often referred to as the community spouse) may retain between $24,720 and $123,600 of assets. The amount of assets that the well-spouse may retain depends on the total value of assets the married couple owned when one spouse begins long-term care for a 30-day continuous period.
However, certain assets are exempt and will not be counted by Medicaid including the following:
• Your personal residence (with an equity limit of $572,000) is exempt if you are planning to return to your residence, or if a spouse, child under 21, or a disabled person resides in it;
• One automobile;
• Personal property including household furnishings, furniture, clothing, jewelry, etc.;
• A pre-paid burial fund with a value under $1,500;
• The value of life insurance policies if the total face value of the policies is under $1,500.