Differences in Medicare and ALTCS

Question: Why do I need to even consider Arizona Long Term Care System when I have Medicare? After paying into the Medicare system for my entire career, shouldn’t Medicare cover my medical expenses? I don’t understand why I need to apply for ALTCS when I am already insured.

Answer: The simple answer to this question is that Medicare only covers acute care and ALTCS covers the costs of long-term care.

Medicare is important and necessary, but it is oftentimes not enough, particularly given that the costs of long-term care can very easily exceed $6,000 per month. And because Medicare will not cover this cost, it can be exceedingly important to pursue ALTCS if you require long-term care.

In the interest of providing further clarity on this question, Medicare will cover up to 100 days of skilled nursing care, but only if that care is acute, or rehabilitative, in nature.

In some instances, people have long-term care insurance to cover long-term care, but the vast majority of folks do not have this type of coverage.

Here, unless the individual qualifies for ALTCS, he or she will have to pay out-of- pocket for care — Medicare will not cover skilled nursing care once the acute coverage lapses.

Most people in this situation have never contemplated ALTCS, but it is never too late to prepare for the application process. In fact, most of the time people do not prepare for the application process until they are confronted with a crisis, but many times, it is possible to qualify for the program with only minimal delay.

Richard White is an elder law attorney at JacksonWhite Attorneys at Law. For more information on Elder Law at JacksonWhite, please visit www.ArizonaSeniorLaw.com.