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    Caregiver Resources

    Financial Planning and Paying for Care

    Addressing the questions, 'how do I manage money for long-term needs' and 'how can I afford long-term services and supports'?

    Financial Planning – How do I manage money for long-term needs?

    As a caregiver, you can help the person you are caring for with financial planning. They will have more resources to age in a way that they choose at home or in the community. Here are tips for financial planning to discuss with the person you are caring for:

    • Calculate retirement income. Start by determining how much income the person you are caring for will have in retirement. Check Social Security benefits, pension plans, and retirement savings. Also, consider other income sources like rental properties or part-time work. Knowing the available financial resources helps with budgeting and decision-making.
    • Manage healthcare costs. Medical expenses can accumulate quickly, so it’s essential to plan ahead. Look into Medicare coverage and explore supplemental insurance options. Take advantage of benefits like Medicaid, VA programs, or state assistance programs. Review long-term care options, including home health care and assisted living coverage. Staying healthy and active can limit medical needs.
    • Create a budget. List all monthly income and expenses. Track spending and adjust as needed. Determine a plan to sustain savings to avoid running out of funds throughout the life span. Understand tax obligations on Social Security, retirement accounts, and investments. Use the Budget Worksheet to prepare a balanced monthly budget to track income, expenses, and set money aside for savings.
    • Build an emergency fund. Emergencies and unexpected costs can pop up anytime. These include medical emergencies, home repairs, or car maintenance. Save three to six months' worth of living expenses. Keep it in an account that you can access easily. This financial cushion can prevent relying on credit cards or loans.
    • Be aware of scams and fraud. Older adults are often targeted by financial scams such as fake investment opportunities and romance scams. These scams are getting more sophisticated. Sign up for Consumer Alerts or connect with your local Area Agency on Aging to learn more about scams and frauds targeting older adults. Keep an eye on financial accounts for any suspicious activity. Encourage the person you are caring for not to share personal information over the phone or online. Learn more about protecting yourself and your money.

    Paying for Care – How can I afford long-term services and supports?

    Most Americans underestimate the risk of developing a disability and needing long-term services and supports. Fewer than half of adults say they have ever had a serious conversation about who will care of them if they may need help with daily activities or how to pay for such care.

    Almost half of older adults say they are not confident they will have the financial resources to pay for the care they might need as they age. Experts estimate that the average older adult will incur $120,900 in future LTSS costs.

    Caregivers often sacrifice their own financial security and sustainability. In fact, 78% of caregivers incur routine out-of-pocket costs, which average more than $7,000 per year. This cost comes in the form of hospital bills, paying for equipment, and the cost of home or facility care. There are various resources and services that might help make care more affordable or manageable.

    • Use CareScout’s Cost of Care Calculator to get a more accurate estimate and projection of costs in your community. Identification of this tool does not imply endorsement; neither the Pennsylvania Department of Aging (PDA) nor its sister agencies endorse entities regulated by the state.
    • Insurance or coverage programs can play a significant role in covering long-term care costs, but cost coverage can vary a lot between policies and programs.
    • Medicare is a federal government health coverage program that helps pay some medical costs for people aged 65 and older, and for people under 65 with certain disabilities and serious health conditions. Call Medicare at 800-633-4227 or visit www.medicare.gov for more information about its programs and coverage options. Medicare will cover long-term care in some limited circumstances, such as when an older adult goes from the hospital to a nursing facility. Medicare’s coverage for this type of care will stop after 100 days, resulting in potentially significant out-of-pocket costs.
    • PA MEDI is a statewide service operated by PDA and is the known and trusted local resource for Medicare help. If you have additional questions or concerns, call the PA MEDI Helpline at 1-800-783-7067, Monday through Friday, 8 a.m. to 5 p.m.
    • Medicaid, known as Medical Assistance in Pennsylvania, pays for health care services for eligible older adults. This program covers the costs of medical care and some types of long-term care. People must meet income, asset, and other eligibility requirements to receive Medical Assistance.
    • HealthChoices is Pennsylvania's managed care programs for Medicaid / Medical Assistance recipients. Physical HealthChoices covers medical care. Community HealthChoices (CHC) covers medical care and long-term services and supports, including nursing facility care, personal assistance, transportation, and other home and community-based services. For individuals to qualify for CHC, they must also be evaluated and meet functional eligibility criteria. Both CHC and the Living Independence for the Elderly (LIFE) support people who are eligible for both Medicare and Medicaid  in Pennsylvania. LIFE is an integrated program that provides comprehensive medical care and supportive services for people 55 years of age and older. Review the general eligibility requirements for Medical Assistance or see if you qualify for any benefits. Apply for Medicaid LTSS through the Independent Enrollment Broker or call 1-877-550-4227 (TTY: 711).
    • Long-Term Care Insurance is one option that people may choose to provide financial protection for when they can no longer perform the most basic functions of daily activity. Coverage in Pennsylvania provides services in your home, a medical facility, or a combination of the two. These traditional long-term care policies work much like policies for auto or home insurance: You pay premiums, usually for as long as the policy is in effect and make claims for payment if you ever need the covered services.

    Medicare is a health insurance program for people aged 65 or older. Medicare offers different options for you to get health care coverage.

    Traditional Medicare includes Parts A and B.

    • Part A helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care.
    • Part B helps cover services from doctors and other health care providers in the home and in doctor’s offices. Part B also helps cover the cost of wheelchairs, walkers, hospital beds, and other equipment. Part B helps cover services that prevent or detect health conditions early like screenings, shots or vaccines, and annual wellness visits.

    Part C is more commonly known as Medicare Advantage. These plans are alternatives to traditional Medicare purchased from private companies. Generally, Medicare Advantage includes Part A, Part B, usually Part D, and usually offers some extra benefits. There may be restrictions for selecting doctors.

    Part D helps cover the cost of prescription drugs. Part D is not included in traditional Medicare.

    Medigap is supplemental insurance that is purchased to help pay for your share of costs in traditional Medicaid. If you have a Medicare Advantage Plan, also known as Medicare Part C, you cannot purchase a Medigap policy. Medigap policies generally don’t cover long-term care.

    There are several opportunities to enroll in Medicare. The initial Medicare enrollment period begins three months before a person turns 65 and ends three months after.  You may be subject to penalties if you did not enroll during your initial enrollment period. There are also special situations that may qualify you to enroll outside of the normally designated times. Current Medicare enrollees are able to make changes to their plan between October 15 and December 7 every year. Current Medicare Advantage enrollees can make changes to their plans between January 1 and March 31.

    PA MEDI is a statewide service operated by the Pennsylvania Department of Aging and is the known and trusted local resource for Medicare help. If you have additional questions or concerns, call the PA MEDI Helpline at 1-800-783-7067, Monday through Friday, 8 a.m. to 5 p.m.

    Medicare generally does not cover costs for ongoing long-term services and supports that help people live independently in the community. Some services for homebound older adults may be covered under Medicare’s home health care benefit, such as home health aides and in-home physical therapy.

    Medicaid, also known as Medical Assistance (MA), is a health insurance program. It helps people with low income and resources afford medical care and treatment. The program varies from state to state. Pennsylvania’s Medicaid program helps:

    • Children
    • Pregnant women
    • Parents
    • Older adults
    • People with disabilities
    • Other adults who qualify for federal income support

    Medical Assistance recipients in Pennsylvania receive services through the HealthChoices managed care program. Managed care includes a network of organizations and providers. They coordinate care for physical and behavioral health. This also covers long-term services and supports. Learn more about Behavioral Health Managed Care in Pennsylvania.

    For qualifying older adults and individuals with physical disabilities, Pennsylvania’s Community HealthChoices (CHC) program covers long-term care services including nursing facility care, personal assistance, transportation, and other home and community-based services.

    Medicaid long-term services and supports for individuals with intellectual disability and autism are administered through the Pennsylvania Office of Developmental Programs (ODP).

    Medical Assistance has specific eligibility requirements including limits to income and other financial resources and assets, identity verification, US citizenship and PA residency, and household composition. Apply online through COMPASS, in-person at your local County Assistance Office, or by phone at1-866-550-4355. COMPASS is a fast and easy way to access benefits. You can also see if you qualify for many health and human service programs.

    To receive Medicaid long-term services and support in Pennsylvania, individuals must also be evaluated and meet functional ability criteria. Learn more and apply for Medicaid LTSS through the PA Independent Enrollment Broker or call 1-877-550-4227 (TTY: 711).

    If you are not eligible or lost your Medicaid/Medical Assistance coverage, you may be able to get low-cost or even no-cost health coverage through Pennie™, Pennsylvania’s official health and dental insurance marketplace.

    The Act 150 program provides personal assistance services to eligible adults aged 18 through 59 who have physical disabilities and are capable of hiring their own attendants, managing their own financial and legal affairs, and directing their own care.

    There are many other public benefit programs available to older adults and children, even if the person you are caring for is not eligible for MA. Use the National Council on Aging’s BenefitsCheckUp to explore public benefits near you and screen for eligibility.

    Health Coverage

    • Pennie™ is Pennsylvania’s official health insurance marketplace and the only place to get financial savings to help lower the cost of coverage and care.

    Prescription Coverage

    • The Pharmaceutical Assistance Contract for the Elderly (PACE) Program helps qualified residents, aged 65 and up, get prescriptions at a lower cost. PACE and PACENET work with Medicare Part D and other drug plans like those from retiree plans, employers, Medicare Advantage, and Veterans’ Benefits, to reduce the out-of-pocket costs.
    • The PACE Clearinghouse assists those 18 and older with prescription costs and other services like food, housing, transportation, and help finding employment.

    Long-Term Services and Supports

    • Aging Services provided by Area Agencies on Aging to help older adults stay happy and healthy at home and in their communities, including support with health, wellness, nutrition, protection from abuse, Medicare, prescription medication, and more.
    • The OPTIONS program provides assistance to Pennsylvania residents, aged 60 and older who would like to remain in their home. OPTIONS offers adult day services, care management, in-home meals, personal care services, and other supplemental services. There are no income requirements to participate in the program. However, depending on an individual's income, they may be required to contribute towards the cost of their services based on a sliding co-payment scale.
    • The Caregiver Support Program (CSP) provides resources and assistance to individuals who assume the primary responsibility for the care of another. CSP aims to reduce caregiver stress by focusing on the caregiver’s well-being. The program provides respite care, support services, and financial reimbursement.

    Food Assistance

    Utilities and Housing Costs