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The Biggest Health Care Cost Obamacare Won't Cover

Long-term care can get expensive fast, and it's not addressed by Obamacare. Here are 4 key facts you need to know.

Senior woman visiting with nurse in her home
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With the coming implementation of Obamacare, many Americans believe that all of our health-care needs will soon be taken care of. But the coverage mandated by the Patient Protection and Affordable Care Act doesn't address one critical type of health-care cost -- and could leaving you with a huge and expensive challenge to deal with on your own.

Many people don't realize that traditional forms of health-care insurance coverage don't typically pay for long-term care, and long-term care is increasingly becoming a key financial issue for the aging U.S. population. According to the RAND Corporation, 15 percent of those over age 70 have dementia, and dementia-care costs alone are expected to rise to $1 trillion annually by the year 2030.

To address the lack of knowledge about long-term care, the Department of Health and Human Services created a website with information on getting the care you need and protecting yourself from the financial impact of paying for that care.

Let's look at four key facts you need to know about long-term care.

1. Long-Term Care Isn't Just Nursing Home Coverage.

Decades ago, when people needed help with basic daily tasks like bathing or getting in and out of bed, they had relatively few options. If they couldn't get family members to take care of them, they often had to go to a nursing home to get the help they needed.

Now, though, a wide variety of different options are available. Home-care aides and other non-medical personnel can help you with many of your basic needs, letting you keep living in your home. Adult day services can give vital relief to family caregivers who can't provide 24-hour care. Moreover, a wide array of long-term care facilities, including assisted-living and continuing-care retirement communities, provide the services you need without the overkill of comprehensive nursing-home care.

2. Medicare Doesn't Usually Pay For Long-Term Care.

Medicare coverage is limited to very specific types of long-term care. To qualify, you must establish a need for skilled services or rehabilitative care. Even then, Medicare only pays for a maximum of 100 days of skilled-nursing care in nursing homes. Other types of covered care, including physical therapy and part-time skilled-nursing care, have their own limits on how long benefits will last.

Most private insurance options have the same coverage limitations as Medicare, leaving Medicaid as the biggest payer for long-term care services. But Medicaid is only available to those with low incomes and assets, making it a payer of last resort for many families.

3. Most People Have Multiple Options to Pay For Care.

In order to cover long-term care expenses through insurance, you'll need to buy a specialized long-term care insurance policy. Such policies provide comprehensive coverage of most types of long-term care needs, although they have different coverage limits and eligibility requirements.

Costs can vary greatly among different types of long-term care policies, so it's important to match up your financial resources with your anticipated needs.

But insurance isn't the only way to cover costs. Reverse mortgages can help provide funding for care, although most reverse mortgages require that you continue to live in your home and so don't work well if you need to relocate to receive out-of-home care. Various types of specialized trusts can also help, such as Medicaid disability trusts that can provide money for supplemental needs beyond what Medicaid benefits cover.

4. Planning In Advance Is the Best Way to Have Your Wishes Met.

Many families face the challenge of having to guess what family members would want after a tragic health event leaves them unable to express their wishes. Doing advance planning can help avoid the uncertainties and ensure that your wishes will be respected and followed.

A strong advance care plan includes a living will or advance health care directive that tells medical professionals what types of life-sustaining care you want or don't want, such as whether to resuscitate you if you stop breathing or your heart stops beating, or whether to use mechanical ventilators or tube-feeding.

You should also choose someone to act on your behalf under a health-care power of attorney, letting a trusted individual make decisions about the specific medical situation you face. Financial provisions like establishing a trust and a durable power of attorney can make it easier for others to care for your money matters as well.

You Can Get the Care You Need

Needing long-term care is a scary proposition for anyone. By taking steps in advance, though, you can handle your long-term medical challenges much better than if you let things go until you actually need care.

You can follow Motley Fool contributor Dan Caplinger on Twitter @DanCaplinger or on Google+.

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Harvey Larson

Paying for long term care is one of the financial issues that the federal government should closely look into right now. They should help in disseminating information about long term care and giving them additional financial help. There are still some who believe that Medicare provides long term care coverage, so instead of purchasing private insurance they resort to this. It does provide coverage but it is very limited and you need to qualify first before you can receive benefits. Some opt for this because long term care insurance cost is very expensive these days but this isn't the smartest thing to do. According to, the cost of ltc insurance can go as high as $7,000 in a year and this can still go up in the next few years. It comes with a high price tag but this is still the cheaper choice compared to paying for long term care straight from your pocket. If you want to protect your assets while receiving care, then you should purchase coverage early.

October 03 2013 at 5:48 AM Report abuse rate up rate down Reply

Long term care insurance can provide an invaluable benefit during a time of crisis, but the key is to buy the right amount at the right time. Buying when you are young and healthy will help you save significantly on premiums over time and you have a better chance to qualify, as it's no secret medical conditions are more likely to develop as we age, and as you pointed out, many people wait until it's too late to qualify. You can get a side-by-side comparison of the top rated companies and policies at

LTC Tree

September 25 2013 at 5:06 AM Report abuse rate up rate down Reply

For those of you who want to get rid of the ACA and go back to the old system, then you are ok with insurance companies denying coverage for your pre-existing condition, or dropping you like a hot potato when you get really sick, even if you've paid their outrageous premiums for the last 20 + years. Or with uninsured people dropping into the emergency room and racking up $50k in charges, skipping out on paying them and sticking those of us who have insurance with the bill. You're ok with that, yes? Sticking with the old system that is crumbling around us, and makes us the highest cost nation in the world in health costs, and the laughing stock of all civilized nations which have figured out how to do it at a fraction of the cost, and get better health outcomes!

September 20 2013 at 5:28 PM Report abuse -1 rate up rate down Reply
1 reply to chris1011's comment

omg--obuMMa zombies simply CANNOT DEAL WITH ONE FREEEEKIN FACT,never mind THEM trying to TELL INFORMED FOLK about the bs called in the ACA.

there's NOT 1 DAMN thing about CARE--it's all about the costs,those LEFT OUT,those that still CANNOT AFFORD THIS CRAP on and on.

i see over on huffing_ho the same crap on the ER visits--uuuh hellOOOOOOO morons,what bunch has succeeded in fking UP OUR EMERGENCY CARE SYSTEM ?

uninsured ? why WOULD ANYONE WITHOUT INSURANCE GO TO THE EMERGENCY ROOM ,unless it were a TRUE EMERGENCY ??? LM@O ! freeeeeeeeeekin illegals and their progeny ARE ******* us dry via welfare and MEDICIAD and emergency medicaid.
THEY have THE RIGHT TO GO TO ANY CLINICS or OFFICES LOCATED within the hospital campus BUT NOOOOOOOOOOO they have to go to the emergency room and under another federal law THEY MUST BE REGISTERED AND SEEN even IF IT IS APPLICABLE FOR THEM TO TAKE THEIR BUTTS to THE CLINICS or an office.

thank the diMlibs[rOgressives for that one and the BILLIONS WASTED ON THEM ANNUALLY in every freeekin state.

get rid of this crap and then they DEFINITELY COULD take care of every LEGIT/AMERICAN man,woman and child .

sick of this sheiss.

September 20 2013 at 9:07 PM Report abuse rate up rate down Reply

not addressed because it is in medicare and medicade

September 20 2013 at 2:39 AM Report abuse rate up rate down Reply

There will be alot of thing Obamacare wont cover. The real fun has yet to start. There is a reason major insurance companies are bailing on the plan. America needs to wake up !

September 19 2013 at 11:54 PM Report abuse +3 rate up rate down Reply

TexasKitty needs nine lives to learn the real facts. Just check the Whitehouse webpage for honest information. Obamacare is wonderful already. Don't get litterboxed by TexasKitty! My office visits were around $300.00, now I pay $25.00. My meds are $11.00. I love the free visit each year as well. You'll all see I'm being very forthcoming with the facts. Happy Health to all.

September 19 2013 at 11:38 PM Report abuse +1 rate up rate down Reply
1 reply to Ginger's comment

The individual health insurance policies that are the heart of Obamacare don't go into effect until 2014. Whatever is paying your bills now, it isn't really Obamacare.

September 20 2013 at 1:39 AM Report abuse rate up rate down Reply

Obama Reid and Pelosi could care less. They wrote the law to exempt themselves. Pelosi and husband are rich beyond measure. She has a vineyard valued at 26 million, but taxed at 6 millon. He has 17.2 million shares of starkist.

September 19 2013 at 11:32 PM Report abuse +1 rate up rate down Reply

Now we hear Obamacare will cost America 1.8 trillions, how in the world will America be able to afford that. It's not. When you hear about the poor don't have insurance, yes, they do, it's called WELFARE and MEDICAID. If you want to see a huge mess, just wait for Obamacare to arrive. OMG" A train wreck, an abomination all done by 51 democrats who didn't even bother to read the 2,700 pages and about the 1,000 + pages of regulations, it's like fine print, nothing good is ever seen in fine prints. The entire Obamacare is written in "Fine Print."

September 19 2013 at 10:59 PM Report abuse -2 rate up rate down Reply

Long term care costs at least $6,000 per month in all states. You need long term care insurance. It is expensive, costing the two of us $300 per month.

September 19 2013 at 10:41 PM Report abuse +1 rate up rate down Reply
1 reply to betty_brock's comment

By the way, it goes up every year.

September 19 2013 at 10:42 PM Report abuse +1 rate up rate down Reply

I have my future planned out for me. I will commit a major crime when I need to be placed in a assisted living facility. I know I can't afford this, so I will be placed in prison, where I will get three hots an a cot, also medical. See, my future has been planned. Now what kind of crime can a old man do to get placed in jail. Will the police throw me on the ground and beat me and kick me? I guess thats part of doing the crime. I hope it won"t hurt, I can't stand pain. See you old timers in jail. LOL

September 19 2013 at 10:09 PM Report abuse +3 rate up rate down Reply
1 reply to Curtis's comment

That's one way to take care of the problem. ha.

September 19 2013 at 11:14 PM Report abuse +1 rate up rate down Reply