Know the Long Term Care System

Stay Informed -- Section Two:

Know the System

"If a resident spends all their savings paying for long term care, Medicaid can continue payment to the facility."

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What Long-Term Care (LTC) organizations are good sources of Information in Washington State?

Long-Term Care Ombudsman Program:

King County: 206-623-0816

Washington State: 1-800-562-6028

The Long Term Care (LTC) Ombudsman Program advocates for residents and families by offering education, consultation, and complaint resolution.

Citizens for the Improvement of Nursing Homes: this not-for-profit grassroots, citizens organization offers advice and support to consumers and has a long history of fierce advocacy for the residents.

Senior Information and Assistance:

206-448-3110

1-888-4ELDERS (1-888-435-3377)

TDD 206-448-5025

This non-profit program can answer almost any question about the aging services network; they will tell you how to access and qualify for the many services and programs available to seniors in King County (and help you find your local program if not a resident of King County) and will mail you materials you may need.

Centers for Medicare & Medicaid Services (CMS): CMS is the federal agency responsible for administering the Medicare and Medicaid Program.

Residential Facility Surveys or call 800-422-3263: Aging And Disability Services Administration (ADSA) inspects every care facility in our state at least once a year.

You can contact ADSA office and ask to have copies sent to you. They are free up to 100 pages.

Or you can visit the facility itself. The surveys are public record and each facility has a copy of their survey. You will find their most recent inspection report in a binder at the front desk.

How Medicare and Medicaid Work

Medicare and Medicaid can be very confusing for residents and their families to understand. The basic distinction is:

Medicare is an insurance program;

Medicaid is a government assistance program.

Both programs are administered by the government agencies and both CAN pay for long term care.

Medicare

Medicare is an insurance program administered by the federal government. You must qualify for Medicare by having paid into the program throughout your life through payroll taxes and by reaching age 65. (You can qualify before 65, if you meet certain criteria). By the time you are eligible for Medicare, you have already paid for it, so Medicare is a prepaid Health Insurance Program.

Medicare Part A -- refers to the basic set of benefits.

Medicare Part B -- adds additional coverage, but requires additional premiums.

Medicare Part D -- a prescription drug benefit for Medicare beneficiaries. Medicare Part D web site

Deductibles apply. More information on Medicare is available from your local Social Security Office and the Official U.S. Government Site for Medicare Information

Handbook: 7 Steps to Understanding Medicare's new prescription drug program Handbook

Handbook: Medicare and You 2006 (English Version)

Handbook: Medicare and You 2006 (Spanish Version)

Below are links on how to avoid Medicare Scam:

Medicare Fraud Reporting Process for Washington State Consumers

Medicare Beneficiaries Warned About Drug Card Scams

Senior Citizen Cautioned To Protect Identity In Medicare Drug Plan Offers

Medicare Beneficiaries Urged To Be On The Look-Out For Phone Scams

Tips For Medicare Discount Card, from Internet Fraud Watch

LTC Ombudsman Advice:

Medicare under Managed Care Programs is widely available today. Beneficiaries are often enticed into these programs with extra benefits above what traditional Medicare provides. What a beneficiary gives up is the right to choose their service providers, but more importantly, they may be giving up their entitlement to the full Medicare benefit because the Managed Care Contracts act as an incentive to providers to provide less care.

Medicaid

Medicaid is a program available in all states and is funded by federal and state dollars. It, too, provides healthcare benefits, but to qualify, you must meet certain income and asset criteria which are generally very low. It provides benefits to all who qualify regardless of their age. It is an important benefit for residents in long term care. If a potential resident does not have income or assets that can pay for long term care, Medicaid can assist. If a resident spends all their savings paying for long term care, Medicaid can continue payment to the facility. Provisions are made for a spouse or dependent children.