Macular Degeneration: Insurance & Long-Term Care

If you or a loved one has received a diagnosis of age-related macular degeneration (AMD), it’s important to begin planning for the future as soon as possible. Two key issues to consider are long-term care for your or your loved one’s housing and medical care needs and how to pay for it, usually through insurance.

Health Insurance Options

Because AMD is an eye disease, treatment for the condition is usually covered by major medical health insurance plans, not vision health insurance plans. Under the Affordable Care Act (ACA, also known as Obamacare), all qualified health plans must cover eye diseases such as AMD.

Options for private health insurance plans include:

Managed Care Health Insurance

Many people get their health insurance plans through their employers. They may also buy individual and family plans on their own. Both employer-based and individual plans have the following types:

• Health Maintenance Organizations (HMO) usually pay for care only within the network. You choose a primary care doctor who coordinates most of your care.
• Preferred Provider Organizations (PPO) usually pay more if you get care within the network. They still pay part of the cost if you go outside the network.
• Point of Service (POS) plans let you choose between an HMO or a PPO each time you need care.

Supplemental Health Insurance

Medigap is Medicare supplemental insurance, which is health insurance sold by private companies to supplement, or fill the “gaps,” in Medicare coverage. Medigap covers costs such as:

• Copayments
• Coinsurance
• Deductibles

Medigap insurance policies usually do not cover:

• Long-term care
• Vision or dental care
• Hearing aids or eyeglasses
• Private-duty nursing

Long-Term Care Insurance

Long-term care insurance helps pay for costs that Medicare and many private insurance policies don’t, including:

• Nursing homes
• Assisted living
• Home health care

Because different long-term care insurance plans may or may not cover costs associated with macular degeneration, it’s best to have a policy in place before the diagnosis. Learn more about long-term care coverage at https://longtermcare.acl.gov/ at the U.S. Department of Health and Human Services.

Loans and Personal Savings

Although long-term care and other facilities for seniors can cost thousands of dollars per month, many families pay for these costs through private funds. Some options for privately financing long-term care include:

• Life insurance policies: There are several ways to take loans from these policies that do not have to be repaid until death.
• Mortgages: A reverse mortgage allows homeowners to borrow money against the equity in their home.
• Personal assets: Options include:
  • Income from stocks and bonds
  • Sale of property
  • Savings and retirement accounts

Long-Term Housing for Seniors with Low Vision

Seniors with low vision, especially if they have other health problems, should think about long-term living arrangements that offer assistance. Some issues to consider include:

• When planning for the future, consider the possibility that vision loss may progress.
• Take into account the current and future levels of care that you or your loved one may need, as well as location and budget constraints.
• Carefully evaluate the complete financial situation to determine available resources. Although the cost will fluctuate depending on real estate market trends, location, and the level of services and amenities, long-term care is expensive.

Types of Housing

Independent Living or Retirement Communities

These communities are for seniors who are generally healthy and able to care for themselves.

Assisted Living Facilities

These facilities provide a home-like setting with accommodations with different levels of care, from independent living to continuing care.

Life Care Communities or Continuing Care Retirement Communities

These communities require a lifetime commitment. The person must be able to live independently at first and can then be transferred from an apartment to an affiliated nursing home.

Nursing Homes or Skilled Nursing Facilities

These facilities provide 24-hour, long-term care and must be licensed by the state and certified by Medicare and Medicaid. Thus they are subject to strict standards, inspections, and evaluations.

Resources for Insurance and Long-Term Care

See our page Low-Vision Helpful Resources where you can find contact information for organizations that can help you find senior housing and long-term care for yourself or a loved one. This list also has contact information to government agencies and low-vision organizations and companies that offer low-vision aids and audio and print materials.

Our fact sheet, Financial Aid, may help you find programs that offer financial assistance to help you pay for your medications.