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Posts Tagged ‘long term care’

On a clear Monday morning, the New York Times ran a good story about Medicare Advantage Plans. Medicare Advantage Plans are a type of home health care plan sold by private insurance companies. The plans are associated with Medicare. It seems that seniors across the country have been duped into signing away their Medicare benefits by enrolling in a Medicare Advantage Plan. There are some cases when the seniors did not understand how the Medicare Advantage Plans worked, and in others, they didn’t even know that the insurance agents had signed them up for the plan. The insurance companies that sell these plans have been accused of several bad practices, including:

Deceptive marketing strategies that don’t make a clear distinction between Medicare and Medicare Advantage  Targeting of uninformed seniors in low-income areas by pushy agents with hard-sell techniques, From outsourcing customer service to overseas call centers, whose employees have substandard knowledge of the complex Medicare system, Insurance agencies with Medicare Advantage Plans undergo a greater amount of scrutiny than they have in the past;and it seems to be helping at least a little. Kerry N. Weems, the acting administrator of the Centers for Medicare and Medicaid Services, says, “There are substantially fewer violations, and those violations are of substantially lower severity than in previous marketing periods.”

Medicare Advantage programs can help some consumers to finance their senior care, but these plans are not for everyone. There are factors to consider before signing up for any type of Medicare Advantage Plan. Here, a few of the most essential issues: Make sure your doctor(s) and local hospital are within the insurance company;s network of providers.  Also remember that Medigap policies become null and void once you are enrolled in a Medicare Advantage Plan. If you already have a Medigap policy, cancel it once coverage begins with a Medicare Advantage Plan to avoid paying twice.

Medicare Advantage plans vary greatly. You are giving up all rights to your existing Medicare policy, so always remember to pick a plan that will meet your future senior care needs as well as your current ones. Always read the fine print. This is an important decision;don;t rush it!  We live in a society where the buyer must beware. Call your parents tonight! Make sure that they know about the issues concerning Medicare Advantage. That phone call could be the one thing that saves them from making;or worse yet, being pushed into;a decision that isn;t right for them. You don;t even want to think about the alternative!

In a long-term care insurance (LTCI) policy, the elimination period is often referred to as the policy deductible. In many ways it is similar to the deductible used in major medical insurance policies. One significant difference is this: rather than a certain dollar amount that you will initially pay for your own care expenses, there is a specified number of days for which you will be responsible for your own homecare.

What are My Options?

Nowadays, there are only a few carriers that offer a zero day elimination period. The most common choices are 30, 60, 90, 180 and 365 days, although these periods can vary from one carrier to another. The choice of 180 or 365 days is most often made by those who have significant assets of their own. Selecting a much longer period can help them keep the expenses of LTCI very low. Even if one chooses a 90-day elimination period, the amount of funds put at risk is miniscule when compared to the asset protection afforded by the policy;s total pool of benefits.

What is a Reasonable Choice for an Elimination Period?

There are some popular financial authors who recommend setting it as low as possible, perhaps even at zero. It’s true that the shorter the elimination period, the less likely it is that you will have to pay out when the time comes for you to begin receiving care.   On the other hand, low elimination periods can have a dramatic effect on the premiums that you pay throughout the life of the policy. Usually some form of compromise is necessary for the sake of affordability. In making a decision about the elimination period, many policyholders keep in mind that insurance is often used as a way to avoid suffering catastrophic financial losses rather than insuring against every possible expense. Accepting a small portion of the risk involved can be an economical and reasonable choice for most people.

The Smartest Thing You Can Do

What’s right for most people, however, may not be right for you. In deciding on the best elimination period for your particular situation, it is important to check what the cost would be for the most expensive assisted care that you may have to receive, which is most often facility care. Once you have a good idea of the daily costs for facility care in your area, then you multiply the costs by various elimination period choices and determine the amount that you feel is affordable. When you decide on the elimination period that best fits your situation, earmark those funds for your care, and allow them to grow so that they keeps pace with inflation, at the very least.   Using a little financial common sense goes a long way toward making a wise decision about the LTCI elimination period.

Some private insurance companies sell LTCI policies to offset the costs of long term care. LTCI, like all insurance policies, need premiums in order to help recipients avoid paying huge amounts later on in the event of an illness or a catastrophic event. Also take note that the premiums are based on the individual’s age at the time of the purchase and are usually locked in for the life of the policy. LTCI covers the following, depending on the policy you choose:

Care in a skilled nursing facility

Care in an assisted living facility

Home health care

Adult day care

Buying a LTCI policy gives the policy holder to select from the many options, such as the amount of the daily benefit, the number of years the policy will pay benefits, and, after the applicant qualifies for a policy, the number of days or months before the policy will begin paying benefits.  It’s very important to evaluate policies carefully to see which one offers the benefits you require with a premium that fits your budget. Policies differ in their benefits, contract conditions, deductibles and premiums.

It is also important to take into account the rising cost of home care. Be sure the LTCI policy provides inflation protection for benefits to increase as health care costs continue to rise. Policies are generally labeled according to the place in which benefits are paid.    Remember that homecare only policies only pay for care at home and in an adult day care or adult day health care facilities. Make sure the policy includes both types of day care.  Facility-only policies pay for care in a skilled nursing facility and in an assisted living facility.  Comprehensive policies pay for care in a skilled nursing facility, assisted living facility, adult day care or adult day health care facility, and at home.  Since the LTCI claims are always paid within many years after the purchase of the policy, it is imperative to check the following:  Financial strength of the company. The industry’s major rating services are A.M. Best , Duff and Phelps, Moody’s, Standard and Poor’s and Weiss Ratings .   Reputation and claims-paying history of the company.

You can contact the State Insurance Department for more information on specific private insurance companies. Check here for more listings information for each of the state’s insurance information. Applicant must be healthy at the time of application   Each insurance company has individual requirements and/or limitations   Not sure when is the right time to buy an LTCI policy? Or how to assess what you will need from a policy? Visit our Expert Column on Financing Long Term Care to find out more.

On Monday, the New York Times ran a very good story about Medicare Advantage Plans. Medicare Advantage Plans are a type of health plan sold by private insurance companies. The plans are associated with Medicare.  It seems that seniors across the country have been swindled into signing away their Medicare benefits by enrolling in a Medicare Advantage Plan. There were cases that the seniors did not have an idea how the Medicare Advantage Plans worked, and in others, did not even realize that the insurance agents had signed them up for the plan.

The insurance companies that sell these long term care plans have been accused of several bad practices, including:

Deceptive marketing strategies that does not make any clear difference between Medicare and Medicare Advantage  The targeting of uninformed seniors in the low-income areas by pushy agents with hard-sell techniques  Outsourcing customer service to overseas call centers, whose employees have substandard knowledge of the complex Medicare system.  Insurance agencies with Medicare Advantage Plans undergo a greater amount of scrutiny than they have in the past, and it seems to be effective and helping them a little. Kerry N. Weems, the acting administrator of the Centers for Medicare and Medicaid Services, says, ” There are substantially fewer violations, and those violations are of substantially lower severity than in previous marketing periods. “

Medicare Advantage programs can help some consumers to finance their long term care, but these plans are not for everyone. 1There are factors to consider before signing up for any type of Medicare Advantage Plan. Here are a few of the most essential issues:
Make sure your doctor(s) and local hospital are listed within insurance company’s network of providers.  Medigap policies become null and void once you are enrolled in a Medicare Advantage Plan. If you already have a Medigap policy, you will need to cancel it once the coverage begins with a Medicare Advantage Plan to avoid paying twice.

Remember that Medicare Advantage plans vary greatly. You are giving up all rights to your existing Medicare policy, so remember to pick a plan that will meet your future continuous care needs as well as your current ones.  Read the fine print. This is an important decision, so don’t be in a hurry!  We live in a society where the buyer must beware. If you want, call your parents tonight! Make sure that they know about the issues surrounding Medicare Advantage Plans. That phone call could be the one thing that saves them from making;or worse yet, being pushed into;a decision that isn;t right for them. You don;t even want to think about the alternative!

There are so many reasons why people do not like buying long term care insurance. Some of those reasons may be based on very sound decisions. For example, if you have made a good research into the cost of premiums from several of the financially sound major carriers and have discovered that the cost is much more than you can take, then long-term care insurance is not for you. However, if you are like most people, the real reason that you are hesitant to prepare for possible future long-term care costs actually has very little to do with reasoning or sound decisions. Your hesitation is most likely based on feelings and emotions. A lot of people continue to live in a state of denial about their possible need for long-term care services in the future.

This is often because they have always been relatively healthy; therefore, they find it hard to even picture themselves in a state where they may need assistance with activities of daily living. Or maybe their parents died all of a sudden or within a short period of time, so they figure that most likely, the same will happen to them. Or perhaps the denial is so strong that very little thought has gone into the matter at all. If that is the case, this subject is probably so depressing to most of these people that they have consciously chosen to delay any decision about purchasing long-term care insurance until later. And that time will never come. Why?  None of these thought processes are based on fact. We all know that good health can change overnight. In fact, almost everyone knows someone whose health situation changed dramatically within a very short period of time.

The risk increases with age, so the chances of it happening to any individual, including you and me, are very real.  Due to the advances in medical science in recent years, using your parent’s health history as a guide for your own does not work. It is obvious that more people are living longer and often need more care in the last years of life. And long-term care is extremely expensive. If you are among those who refuse to even think about their future health care facilities, ask yourself this: who will be left to make this decision for you?  Refusing to think about the subject does not make the possibility of needing long-term care any less real. It simply defers the decision to those you love the most.

They will often have to make decisions about your care at the last minute, when the choices are extremely limited, unpleasant and expensive. Our families will be well served if we all decide now to take responsibility for our own future health care needs and make sound decisions based on facts instead of unreasonable emotions.

Affordability is a key ingredient in any successful long-term care plan. Which is why the premium cost is often the most important elements to consumers who are considering the purchase of LTCI.  One of the most common questions I hear is: ” Will my premiums ever increase? ” The answer is this: there are lots of scenarios in which LTCI premiums could increase. I will try to explain one in this article and follow up with the second in a future article.  The first scenario involves a choice the policyholder makes regarding inflation protection. Most of the LTCI policies have automatic inflation protection built into the policy design from the very beginning; in such cases the premium is designed to stay level for the life of the policyholder. The benefits can increase each year, but the long term care insurance premium remains the same.

Inflation Protection: What You Need to Know

There are some insurance carriers that offer a different kind of inflation in which the policyholder starts out with no automatic inflation protection instead, benefit increases would be offered every three years or so. These increases can usually be accepted or declined by the policyholder. This means that your premium would increase every three years for the rest of your life or until you start receiving policy benefits.  The only problem with this inflation protection choice is that the policyholder is three years older when each offer of extra benefits is made. The expense of the added benefits is based on the later age, not on the age of the policyholder at the inception of the policy. This can result in a significant increase in premiums in later years. Some consumers simply drop these policies after a while, as they just can’t afford to continue paying long term care insurance premiums that are so much higher than the cost of the original premium.

Long-term Effects of Premium Increases

Group policies often offer this kind of inflation protection to stay competitive with individual LTCI policies. Before they start finalizing their decision, it is very important for consumers to understand the long-term effects that these premium increases can have. Unfortunately, there are lots of policyholders who did not understand the ramifications of this kind of inflation protection when they purchased their policy. They sometimes find themselves locked into a policy that is constantly increasing in price and have few options for switching to a more affordable LTCI product due to their age and/or home health care circumstances. It is actually true that automatic inflation protection increases that are built into the premium cost from the inception of the policy will initially be more expensive than a periodic increase offer. But in my opinion, in most circumstances, it is better to lock in your inflation protection costs at an early age, and know that your premiums will remain stable, than take the chance on an ever-increasing premium that may eventually be too much to afford.

For long-term care, health insurance is vital, and LTCI (or Long-Term Care Insurance) can be an effective tool for protecting your estate and assets from the high costs of senior care. The best long-term care insurance should cover many care solutions, and even if you don’t think you need it now, it’s best to purchase LTCI early on.  Though the average nursing homes length of stay is significantly higher than most people believe, 2.4 years according to a report conducted by the National Center for Health Statistics, less than 20% of long-term care is nursing home care. Home care, home health care, adult day care, assisted living facility care and others constitute the overwhelming majority of senior care services.  Generally, the people who are in need of care are the ones responsible for paying the costs. Long Term Care is usually not covered by your personal health insurance plan or by the policy you may currently have from a present or previous employer. Medicare is usually the one that pays for only a small percentage of skilled nursing costs, while Medicaid provides health care coverage to Americans with lower incomes and can pay almost half of all nursing home costs.

Though in the future you will need long-term care, no one can predict the kind of care that may be needed or what are the exact costs involved. With Long-Term Care Insurance, you can plan and budget for a known and quantifiable premium for a policy that can protect you from potentially large out-of-pocket expenses. It can be beneficial to learn about the different types of long-term care health insurance policies available to you in order to match the most appropriate policy to suit your needs.

Types of Long-Term Care Health Insurance Policies: Some of the most commone type is indemnity which pays a maximum fixed benefit. A benefit amount is chosen at the time the policy is issued and actual expenses, up to a fixed predetermined dollar amount, are reimbursed as they are incurred. Integrated policies that pool benefits are becoming more popular today. The provisions which allow for a total dollar amount that may be used for various long-term care services with expense limits on a daily, weekly or monthly basis.

Because of the rapid increase in long term costs, most long-term care health insurance policies are now offerring inflation adjustments to help offset high anticipated future costs. Take note that long term care insurance policies only take effect when an individual is unable to perform activities of daily living or becomes cognitively impaired from dementia or related illnesses. Home care services such as physical therapy, skilled and unskilled nursing care and home health aide support provided by licensed agencies are generally covered as are intermediate, custodial and skilled care services provided in licensed nursing facilities. It should be noted that if any conditions are preexisting, benefits are often denied if care is needed within six months of the policy’s issue date for that condition.

What to Consider When Selecting the Best Long-Term Care Insurance: There are now over 100 Long-term Care Insurance products on the market today. Before selecting a long-term care health insurance provider and policy, please consider the following: Verify that the insurance agent is licensed to sell long-term care health insurance in your state and review ratings to ensure that the insurance provider is financially secure since you will likely need the policy for years to come.  Determine exactly which services are covered, e.g., skilled nursing home care, unskilled nursing facility care, home health care, adult day care, etc. in order to select the best when it comes to long term care insurance policy.  Examine the length of time benefits are provided for the various types of services covered; look for maximum lifetime benefit amounts.

Identify the length of time before pre-existing conditions are covered. Find out how long you must wait before benefits begin for services.  Inquire regarding coverage of Alzheimer’s and other related illnesses, the best long-term care insurance provider should allow for this. Review any premium provision waivers.  Analyze cost requirements to make sure your ability to make policy payments during retirement years.  As with all complex and important decisions, you should talk to friends and relatives to obtain recommendations on the best long-term care insurance and share experiences regarding various policies, review all paperwork, with the consultation of your attorney if needed, to ensure that you understand policy provisions and discuss economic implications with your financial advisor.

Let’s say you got sick and your regular health insurance can’t cover all your expenses, then what should you do? Below are three good options along with some pointers and explanations. If any of these types of supplemental policies have had positive (or negative) effects for you and your loved ones, we;d love to hear your story. Snapshot: Long-term Disability Insurance (LTDI) is for individuals who are working and younger than 65.   Some financial planners propose that LTDI is your best bet because it will protect your income if you are unable to work for a period of time. LTDI is also sometimes referred to as income protection insurance.

With this kind of policy you must be unable to perform your normal occupational duties in your work environment. These policies are created for people who are actively working;although those in risky jobs may find that they are undesirable to insurance companies. If a covered disability occurs, then a specified monthly benefit is paid to you for a finite period of time (typically no more than two years).

Here’s a snapshot: Long-term Care Insurance (LTCI) should be purchased in your fifties or as soon after retirement as possible it;ll pay out a monthly benefit for the type of care your policy allows. LTCI is geared toward the senior market. There are actually three types of policies: each of which is based on where benefits will be paid: either in a facility, at home or both. This type of insurance stems from the idea that as you age you may need assistance with anything from the activities of daily living (e.g., dressing or bathing) to skilled nursing care;and that in-home caregivers and care facilities are not affordable for many of us. In addition to that, many worry about draining their personal financial resources, resulting in an inability to leave an inheritance for their loved ones, or even support themselves at all.

For more information on when to buy LTCI, check out Is Long-term Care Insurance Worth It?  Again, here is another snapshot: Critical care insurance pays a single huge amount and then terminates, but your particular life-threatening condition must be must be enumerated in your policy. With critical care insurance, you are also paid a large amount after you have been diagnosed with a critical illness. The idea is that auxiliary expenses tend to pile up just when the diagnosis occurs even if a person is insured in adult day care.

With a critical care insurance plan, the beneficiary can decide where his/her benefits will do the most good, whether it goes toward skilled nursing care in a home health care, or lost wages for family caregivers, or other expenses of daily living that are difficult to meet when one is financially disabled. As the policy only pays once, it has some advantages and disadvantages;while you are responsible for managing the funds sufficiently, a large payment can ensure that debt isn;t allowed to accrue.

For those who are not familiar with the term, underwriting means the acceptance of risk in return for payment. In long term care insurance, this happens once an applicant becomes a policyholder, paying the insurance company in accepting the risk involved that may require them to pay out claims on the applicant’s behalf. A lot of people often wonder what the application process and the underwriting process for long-term care insurance are about and how all of it works. I’ll discuss all of that in this article. Why is underwriting necessary? The answer to this question has to do with how insurance functions.

Think of this kind of insurance as a pool of money into which different parties and events have made deposits. These funds can then be used to pay for the financial losses of individual depositors who have had to make a claim due to unforeseen circumstances. In the case of long-term continuous care, the funds could be used to pay for custodial care for the individual policyholders who may have developed a need for this type of care.

One primary objective of underwriting is to spread the risk among the pool of policyholders as equitably as possible in such a manner that is also profitable for the insurance company. The premiums in which each of the policyholder needs to pay are directly affected by how much money the insurance carrier expects to have to pay out for claims. This means that the insurance company has to manage the risk that it will have to pay money out of that central pool of funds. The more money they have to pay out, the higher the cost of the insurance for everyone. Risk management involves analyzing the potential risks for each applicant (and the associated costs of those risks) in order to set premium rates for policyholders and mitigate the potential financial losses for the insurer.

How are long-term care insurance premiums calculated? To manage the payout risk, each insurance carrier employs underwriting procedures to make sure that applicants with high-risk medical histories are not allowed into the insurance pool, which would thereby drive up the cost for everyone else. Obviously, while the risk involved is taken by the insurer directly informs the premium rates that policyholders must pay, there are different levels of risk which are reflected the different premium rates. This is actually how a long term care insurance company determines the premium rate that you will pay, which I will discuss further in a future article.  What underwriting procedures are employed? One of the first thing of underwriting that all carriers use is the application form where the applicant lists his or her relevant personal health history and authorizes the insurance company to examine their medical records.

Often the carrier will schedule a phone health interview that lasts for about fifteen to twenty minutes. One of the main purposes of this telephone call is to assure the carrier that the applicant should not have any cognitive problems that would become evident in the way the phone conversation is conducted.  Afterward the carrier will often request a copy of the medical records from the applicant’s primary care physician to verify that person;s overall health. If the applicant has been treated by a specialist for any serious illness in recent years, a copy of those medical records may be requested as well.  This is then where the whole process can sometimes bog down for a few weeks if the doctor’s office does not process the record request quickly. However, once the carrier receives the medical records, a final underwriting decision usually follows very quickly.

Long term care insurance is a good financial protection vehicle for anyone who has enough assets to protect and can comfortably afford the premiums. It can help ensure that all of the time and effort you have spent on getting enough retirement income is not lost due to the rising costs of long-term care. There are so many specific advantages for couples purchasing long-term care insurance. Consider this: most often, the healthier spouse acts as the primary caregiver.

If long-term care insurance did not exist, the healthy spouse often takes on the bulk of caregiving duties, just to try avoiding the expensive costs associated with either in home care or institutional care. In the long run, this will leave the caregiver almost as ill as his or her spouse. Long-term care insurance helps provide the necessary funds so that the healthy spouse can make sure that quality care is provided for the ill spouse while not further endangering his or her own health.

Will We Save Money? Couples can even save money on the purchase of long-term care insurance, as all major carriers will discount the cost of a policy by thirty to forty percent when both spouses are on the same policy. This can result in significant cost savings for married couples. The great news is that even those who are still single but have lived with someone else with whom they are in a committed relationship for more than a year may also receive the same discount for long-term care insurance.

What Should We Do If One of Us is Declined? If one spouse is approved for a policy but the other has significant health issues that preclude him or her from qualifying for long-term care insurance, this does not mean that the couple should decline coverage for the healthy spouse. Long-term care insurance is still an advantage for this couple because no one knows which spouse will need long-term care first. If there is or was a major reversal of health for the previously healthy spouse, the one who had health issues originally would be in an even more disadvantaged position as a caregiver.

The fact is, long-term care insurance would provide the funds needed for great quality care without damaging the health of the other spouse who was declined for the long-term care insurance policy. It is no longer reasonable to forego health insurance for one spouse simply because the other cannot qualify for a major medical plan. This is also true for  continuous care insurance. It may be disappointing that both cannot be covered, but the financial risks for each of them are still prevalent and should not be ignored.