Long Term Care • Financing LTC • Medicaid • Medicare • Asset Transfers • Look-Back Rules
Chapter 2 covers methods of financing long-term care. Medicare Part A covers skilled nursing facility care for up to 100 days — fully for the first 20, with a copay for days 21–100, and nothing beyond — but only after a qualifying 3-day hospital stay, with skilled care certified as medically necessary. Medicare does not cover custodial care.
Medicaid is more generous than Medicare for LTC, covering skilled and less intensive levels of care. To qualify, a single applicant must generally reduce countable assets below $2,000. The home is exempt unless equity exceeds $500,000 (or $750,000 in some states). The DRA imposes a 60-month look-back period; transfers below fair market value trigger a penalty period. The MMMNA protects the community spouse’s income. Life insurance policies may be accessed through surrender, loans, accelerated benefits, viatical settlements, or life settlements; viatical settlements involve a third-party sale, not the insurer. Only a home equity loan requires formal repayment.