Alzheimer’s Disease Medicare, Medicaid, and Out of Pocket Costs

The Alzheimer’s Association has published its 2020 report entitled Alzheimer’s Disease Facts and Figures (alz.org). The findings give pause when contemplating the future of many Americans who will be living with crippling dementia. Health care and long-term care costs for individuals with Alzheimer’s Disease and Related Dementias (ADRD) are staggering as dementia is one of society’s costliest conditions.

The year 2020 sees total payments for all individuals with dementia diseases to reach an estimated 305 billion dollars. This substantial sum does not include the value of informal caregivers who are uncompensated for their efforts. Of this 305 billion dollars Medicare and Medicaid are projected to cover 67 percent of the total health care and long-term care costs of people living with dementia, which accounts for about 206 billion dollars of the total cost of care. Out of pocket expenditure projections are 22 percent of total payments or 66 billion dollars. Other payment sources such as private insurance, other managed care organizations, as well as uncompensated care account for 11 percent of total costs or 33 billion dollars.

The Centers for Medicare and Medicaid (CMS) cite that 27 percent of older Americans with Alzheimer’s or other dementias who have Medicare also have Medicaid coverage. As a comparison, the percentage of those Americans without dementia is 11 percent. The addition of Medicaid becomes a necessity for some as it covers nursing home and other long-term care services for those individuals with meager income and assets. The extensive use of CMS services, particularly Medicaid, by people with dementia translates into extremely high costs. Despite the high rate of expenditure by federal social and health services, Americans living with Alzheimer’s and other forms of dementia still incur high out-of-pocket expenses compared to beneficiaries without dementia. Much of these costs pay for Medicare, additional health insurance premiums, and associated deductibles.

alz.org

Older Americans living with Alzheimer’s or other forms of dementia have twice the number of hospital stays per year than those without cognitive issues. Dementia patients with comorbidities such as coronary artery disease, COPD, stroke, or cancer, to name a few, have higher health care costs than those without coexisting serious medical conditions. In addition to more hospital stays, older Alzheimer’s sufferers require more home health care visits and skilled nursing facility stays per year than other older people without dementia.

Cost projections for Medicare, Medicaid, and out of pocket costs for Americans living with Alzheimer’s disease or other forms of dementia continue to increase. The average life span of an American with Alzheimer’s is 6 -8 years, and as the disease progresses, so do the requirements of care and support. This care and support include medical treatment, prescription medications, medical equipment, safety services, home safety modifications, personal care, adult daycare, and ultimately residence in a skilled nursing facility. Disease-modifying therapies and treatments remain elusive, and there is no cure for Alzheimer’s and other dementia diseases. ADRD imposes a tremendous financial burden on patients and their families, payers, health care delivery systems, and society.

In the absence of a cure, the Alzheimer’s Association predicts the total direct medical cost expenditures in the US for ADRD will exceed 1 trillion dollars in 2050 because of increases in elderly population projections. Health policy planners and decision-makers must gain a comprehensive understanding of the economic gravity that Alzheimer’s and other dementia diseases present to the US population. The direct and indirect total medical and social costs and accompanying solution-driven mandates must be identified to CMS, private insurance groups, facilities with dementia units, and family systems that function as non-compensated caregivers.

We help families plan for the possibility of needing long term care, and how to pay for it. If you or a loved one would like to talk about your needs, we would be happy to help.

Long-Term Care Insurance 2.0: The Hybrid Policy

You have probably heard about the astronomical costs of nursing-home care if you become seriously ill or injured. You might also know that Medicare would cover only a minimal amount of those costs. Private insurance doesn’t seem like a good bet either, if you’ve heard horror stories about skyrocketing premium costs and difficulties in even obtaining long-term care (LTC) insurance in the first place.

There may be a better way. “Hybrid” policies essentially combine life insurance or an annuity with LTC coverage. (The benefits can be known as “accelerated death benefits” or “living benefits,” or the coverage can be called “life/long term care,” “linked benefits,” or a “combo” policy.)

This type of policy will pay if you need nursing care, but, if you never need that, then the policy functions like standard whole-life coverage. It’s a win-win. Say, for example, you buy a hybrid policy with a $100,000 death benefit. You eventually need $50,000 of that coverage to pay for LTC. Then, when you pass, your beneficiary would receive a $50,000 payout from what’s left of the original $100,000 coverage.

Some plans offer tax-free death benefits to your heirs if your LTC benefits are not fully used or needed. They may return your premiums if you change your mind down the road. Premiums can be locked in from the initial purchase date, with a guarantee that they will never increase. Those who already hold a legacy policy with a large cash value may be able to roll that value over, tax free, into a new hybrid policy.

For those who can afford to pay premiums in a lump sum in advance, LTC coverage could amount to as much as twice the face value of the policy. Compare that with simply setting money aside for LTC expenses at a rate of five percent interest. It could take as long as thirty years to save for what this policy offered on its face.

There is a wide range of coverage, depending on the policies. They may cover different services, delivered at-home, in a facility, or both. The monthly or daily benefits can vary. Some policies require an elimination period (a delay between the time a doctor qualifies you for coverage, and actual payment); some do not. Some provide inflation protection. Some provide adjustable rates, depending on how much the insured might need LTC as against the death benefit.

Always also remember that the carrier must have the long-term financial stability to pay claims, and to remain in business, for decades to come.

To sort through all these intricacies, the National Association of Insurance Commissioners has issued a free and comprehensive Shopper’s Guide to LTC Insurance. It provides especially helpful shopping tips at pp. 31-36. Find the publication here

https://www.naic.org/documents/prod_serv_consumer_ltc_lp.pdf

We can create a long-term care plan that incorporates a hybrid plan like this with an irrevocable trust that will protect all of your bank accounts and real property (like your home) in the event you need long term care. If you are interested in protecting your savings and your home, we would welcome the opportunity to discuss a plan that works for you.

How Elder Law Attorneys Can Help Seniors and Their Loved Ones

Many aging Americans depend on family members or friends to help manage their financial, health, and other affairs during retirement and beyond. They often believe that their family members will be able to take care of any issues that arise. While consulting with loved ones about plans and wishes can be beneficial, relying solely on them can cause problems in the long run for both seniors and their families.

Instead, it is best to seek the advice of an elder law attorney when it comes to putting proper planning in place. The issues around retirement, wills, and estate planning are often complex. Working with a legal professional can help seniors navigate these details to ensure that decisions and plans are suited to their specific situation.

Having legal arrangements in place related to retirement benefits, assets, and to determine who will be responsible for the welfare of an aging loved one can also help to avoid family disputes, and ensure that assets are preserved as intended. And although we’d like to assume family members always have seniors’ best interests at heart, legally-binding arrangements also protect against abuse and financial exploitation.

But it isn’t just seniors that benefit from working with a legal professional. Elder law attorneys can also assist heirs and beneficiaries by ensuring that assets don’t fall into wrongful hands due to debts, divorces, or other extenuating circumstances. They can also help beneficiaries avoid the long and complicated probate process.

Elder law attorney expertise

Elder law attorneys have the expertise to help seniors and their loved ones navigate all of the legal issues impacting the elderly. They can help clients to better understand Medicare and Medicaid programs and laws, and assist clients and families with all of the legal aspects of planning, including drafting wills, estate plans, and trusts.

Below is a list of some of the services elder law attorneys provide:

  • Medicaid Eligibility, Applications, and Planning
  • Medicare Eligibility and Claims
  • Social security and disability claims and appeals
  • Long-term care planning
  • Financial planning for long-term care
  • Drafting wills and trusts
  • Medical Power of Attorney
  • Financial Power of Attorney
  • Elder abuse case management
  • Patient rights
  • Nursing home issues and disputes
  • Establishing and managing Estates and Trusts
  • Tax advice and planning strategies
  • Probate services
  • Asset protection

… and more

Seniors tend to procrastinate planning due to the unpleasant associations of illness and death. Elder law attorneys can alleviate that discomfort by facilitating family conversations and shifting the focus to the positive benefits of planning and preparedness. Cost can also deter seniors from seeking legal advice and services, however, failing to plan can ultimately end up being far more expensive.

No matter the issue at hand, seniors and their loved ones will benefit from working with a legal professional. If you’d like to learn more about how elder law services can help you or an aging loved one, contact our firm today.