Long-Term Care

Paying for long-term care is complex and confusing. It’s a good idea to get help from someone who knows what is available in your state. See “Who can I talk to about long-term care?” below. Or visit this page on Costs & Payment Options for Assisted Living & Home Care by State and click on your state to learn more about how to pay for long-term careServices for people who cannot do basic activities of daily living, like dressing or bathing. This includes medical and non-medical care. These services can be provided at home or in assisted living or nursing homes. Medicare and most health insurance plans do not pay for long-term care..

MedicareThe federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant).

Original Medicare does not cover most long-term care. While it will cover some medical services provided at home or in a facility, it will not cover any “custodial care,” meaning help with the activities of daily living or medical care that most people do for themselves (like put in eye drops). 

Medicare Advantage plans may cover long-term care. These plans vary widely. Visit this page on Medicare Advantage to learn more about what plans will pay for and how to choose a plan.

MedicaidA joint federal and state program that helps with medical costs for some people with limited income and resources.

Medicaid will cover many kinds of long-term care, although this coverage varies from state to state. 

In New Mexico, Medicaid Long-Term Care can provide nursing home and in-home care for low-income seniors. This coverage is only provided through state-contracted Managed CareA health care delivery system that combines health insurance, delivery of care, and administration. Managed Care Organizations (MCOs) are paid a set payment per member per month for these services. Organizations (MCOs) such as Molina, United Health, or Presbyterian, among others, and is not available for individuals enrolled in Medicaid Fee-for-Service. Centennial CareNew Mexico’s Medicaid Managed Care program since January 2014. Community Benefit (formerly CoLTS) covers many in-home care services for individuals who are eligible for nursing home care, but who can receive services at home or in an assisted livingA facility that provides care for seniors who want to stay independent but who need some help with activities of daily living, like bathing, dressing, eating, and moving around. facility. However, funding for this is limited and there is usually a waiting list. Visit this page on New Mexico Centennial Care Community Benefit to learn more.

If you are not eligible for Medicaid, you may be able to subtract your medical expenses from your income, called “spending down,” to become eligible and gain the long-term care coverage available through Medicaid. This process can be confusing and is not always possible, so it’s a good idea to get help. See “Who can I talk to about long-term care?” below.

Long-Term Care Insurance

This kind of supplemental health insuranceA type of insurance that pays for some or all of your medical expenses.
can be purchased just like any other private health insurance plan. Long-term care insurance reimburses you a daily amount for services to assist you with activities of daily living such as bathing, dressing, or meals. If you are older, in poor health, or are already receiving long-term care services, you may not qualify for some policies, or you may only qualify for limited or more expensive insurance.

To find out exactly what kind of insurance you qualify for and how much it will cost, you will need to apply for a plan. Applying for health insurance can be complicated and confusing, so consider getting in-person assistance. See “Who can I talk to about long-term care?” below.

Indian Health Service

IHS is authorized to provide long-term care to American Indians who need a nursing home level of care; however, IHS does not have dedicated funding to provide this care at IHS facilities. Typically, the IHS will help you to obtain Medicaid, Medicare, or some other form of private insurance to pay for the services you need. Talk to the Benefits Coordinator at your local IHS or Tribal clinic to learn more.