Grand Plans: April 24, 2025

A semi-monthly newsletter from Grand Plans designed to normalize and celebrate our glorious geri-destiny through information, stories, real talk conversation, smart planning and shared experience.

Things I’m prattling on about today

I hate to be a Debbie Downer, but all this talk about Medicaid cuts is making me nervous both for my own future and the 73 million adults who will be over the age of 65 in five, short years. Of that group, 70 percent will need some kind of long-term care, a resource that can cost between $5,600 and $10,000+ a month for assisted living or nursing home arrangements or more than $30/hour for private in-home care, according to Genworth. Translation: most of us will need some form of expensive long-term care after the age of 65. And in case you need a reminder, there are only THREE ways to fund long-term care costs:

1) Out of your own pocket

2) Via a generous long-term care insurance policy or

3) With Medicaid, a joint federal and state program that provides health coverage to low-income individuals and families -- a program that may be on the DOGE chopping block, for Pete’s sake.

Medicare does not pay for long term care.

Your private health insurance does not cover long term care.

Only you, your long-term care insurance plan or Medicaid pay for long term care. And that third option may not be available to you in its current form.

Wah whaaaah.

And before you start thinking Medicaid doesn't apply to you or your peeps, think again. A lot of people qualify for and depend on it, including people you know, love and may be supporting one day. In 2020, KFF estimated "that 4.2 million people used Medicaid long-term services and supports (LTSS) delivered in home and community settings and 1.6 million used LTSS delivered in institutional settings."

Now is the time to start sharpening your Grand Plans for long-term care funding options one and two. How are you going to pay for your care if spending down assets and financial resources for Medicaid care qualification is no longer an option, or has different parameters? How will you receive or pay for long term care when it's all on you or your long-term care insurance? How can you make sure you have enough to thrive in your personal vision of senior living?

In the absence of an easy answer or perfect plan, there are three actionable steps to mitigate a one-day long-term care crisis if Medicaid isn't part of the equation:

1. Talk to a certified financial advisor and figure out exactly what you need to make or invest or save now to achieve a financially manageable senior lifestyle that includes formal caregiving services such as skilled nursing, assisted living or professional in-home care. Get real on the costs of these services and utilize your financial advisor's guidance on how to pay for it all.

2. Talk to a long-term care insurance agent to see if there is a plan suitable for your unique financial situation.

3. Talk to your adult children, family and friends about plans for informal care if you are unable to meet the costs of formal caregiving services as you age. If you need or want to depend on your own family for care, which is culturally the norm for millions of families around the world, that is a super fantastic plan -- the superist! Just make sure you're having honest conversations with the folks who will be involved and are aligning expectations for this most important Grand Plan.

Hopefully, this Medicaid crisis will not befall us and we can continue to study ways to utilize Medicaid in our long-term Grand Planning efforts. It is legitimate thinking and makes a lot of sense given the current landscape of long-term care costs. But don't be caught without a Plan B or C, if -- poof! -- Medicaid is no longer an option. In this increasingly crazy and exhaustingly expensive world, it behooves all of us to get real about Grand Planning. And the best way to do that is to talk seriously (immediately) with financial advisors, long-term care insurance professionals and the family/friends who may be our one-day personal caregivers to see just what exactly our options are for the future. This is Debbie Downer, signing off!

News you can use

OK, so what is Medicaid again? According to Medicaid.org, “Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. Medicaid is administered by states, according to federal requirements. The program is funded jointly by states and the federal government.” Visit Medicaid.gov and read up on this important government resource.

Got it. So what is the difference between Medicaid and Medicare? According to the U.S. Department of Health and Human Services, Medicare is “federal health insurance for people 65 or older, and some people under 65 with certain disabilities or conditions. A federal agency called the Centers for Medicare & Medicaid Services runs Medicare. Because it’s a federal program, Medicare has set standards for costs and coverage. This means a person’s Medicare coverage will be the same no matter what state they live in. Medicare-related bills are paid from two trust funds held by the U.S. Treasury. Different sources (including payroll taxes and funds that Congress authorizes) fund the trust funds. People with Medicare pay part of the costs through things like monthly premiums for medical and drug coverage, deductibles and coinsurance.” Read more on the difference between Medicaid and Medicare here.

NBC News shared a piece on how Medicaid cuts could impact everyday Americans.

Get ready to talk about it all at these upcoming events and classes. I am very excited to begin this work with the St. John’s Cathedral’s new Center for Wellbeing. This offering is part of the Capstone service-learning requirement for my masters in Gerontology work, but I have high hopes this will be a long-term relationship at the center. CFW is a wonderful community resource doing some really interesting programming. Check it out! And come see me at the book launch May 18:

Shelf life

Grand Plans 2.0: How to Mitigate Geri-Drama in 20 Easy Steps and its accompanying workbook, the Grand Planner 2.0, are both published and out on the interwebs for you to order and enjoy! Click links to purchase on Amazon and look for copies in your local bookstores.

Some golden gedunk and goods

Get yourself another few copies of Grand Plans: How to Mitigate Geri-Drama in 20 Easy Steps and the Grand Planner for all the people who like getting gifts in your life! Visit www.mygrandplans.com for links to purchase on Amazon.

And… Check out our Grand Plans merch in our Etsy storefront.