Where Can I Receive Long-Term Care Services
Why Buy Long-Term Care Insurance
Paying For Long-Term Care
How Can I evaluate a Long-Term Care Company
LTC Glossary of Terms
| What is Long-Term Care | Top |
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Long-term care (LTC) refers to a variety of services designed to help people perform the functions of day-to-day living to help them remain independent.
Some long-term care is aimed at providing help with day-to-day activities for people with chronic illness, or cognitive impairment, such as dementia. Other long-term care services may be rehabilitative, helping someone regain function after a serious injury. Care is received in a variety of settings including nursing homes, alternate care facilities and a person's own home.
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| Who Should Consider Long-Term Care Insurance | Top |
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If you have assets to protect, but aren't wealthy enough to comfortably pay for long term care services out of your savings, you should be comparing long term care insurance policies now. It's especially important if there's a history of serious illness in your family.
It's also very important to apply while you still have your health. If you do not have a long term care policy when your health situation requires you to have one, most insurance companies will not issue you one. It might be too late. Most think that they will only require long-term care services when the get older. While it is true that many receive long-term care services at an older age, there are 40% of individuals under age 65 receive long-term care services*! So, it's not just for older individuals. Long-Term Care policies are usually guaranteed renewable, meaning once you qualify, you'll remain eligible as long as you pay your premiums. This is another good reason to plan ahead? The premium is based on your age at the time you purchase the insurance - and could be locked in for the life of your policy depending on whether the insurance company raises rates. If you have questions or would like more educational material on Long-Term Care, please call LeClair's LTC Team at 877-LeClair. *U.S. Office of Personnel Management, 2001 |
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| Where Can I Receive Long-Term Care Services | Top |
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When you opt for long-term care insurance, you opt for protection and choice. When the time comes that you may need care, you'll be able to receive it in several places--and some may be much more suitable than nursing homes. Given the right circumstances, most people today would prefer the freedom of receiving care in their own homes or through other types of extended community-based care.
Home Health Services - If you need ongoing care at home, these services--including nursing care, assistance with basic activities, physical and occupational therapy, and nutrition counseling -- may be the best solution. Adult Day Care Services - If your primary caregiver needs to go to work, this option will enable you to spend the day at a licensed location with planned activities and return home at night. Informal Care - This includes help with everyday activities, personal supervision from a skilled or unskilled provider such as a neighbor or friend, if you are cognitively impaired, and certain services to maintain the home environment. Assisted Living Facilities/Nursing Home Care - Another choice is care provided in a qualified assisted living facility or a nursing home. Alternate Care Facilities - This category includes other facilities which have emerged to meet the unique needs of individuals. Alzheimer's facilities, custodial care facilities and other alternatives to qualified nursing facilities are included here. |
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| Why Buy Long-Term Care Insurance | Top |
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Protect Your Assets
You work hard and save your money so that you can enjoy your retirement some day. Maybe you dream about the trips you might take or the fun you're going to have with all that time on your hands. Chances are, you're not thinking about the possibility of needing long-term care. Maybe you should.Long-term care is expensive. In 2004, the national average cost for home care per hour is $18 and the average daily rate for a private room in a nursing home was $192 ($70,080 annually)* Home care and nursing home care costs will continue to increase each year. Is that how you want to spend the savings you worked so hard to acquire? Long-term care insurance can help. It fills the gaps in coverage left by medical plans not intended to cover the cost of a home health aid or the expense associated with nursing home confinement. It provides benefits for long-term care services that are covered in a limited way by government programs like Medicare or Medicaid. Long-term care insurance is an affordable way to protect yourself and your family members from the financial burdens often associated with long-term care. Preserve Your Independence You're an independent person. You've always enjoyed good health. You may not think of yourself as a candidate for long-term care services, at least not until you're much older. But long-term care situations can happen at any point during your life, due to illness or an accident. Did you know that 40% of the 12 million people who are receiving long-term care are under age 65? That's 4.8 million people who probably didn't think they would need long-term care services either.**** What would you do if you could no longer manage to do everyday tasks without assistance? Could you depend on your spouse? What about other family members? If they work or live far away, your options become less clear. Long-term care insurance doesn't just pay benefits for care provided in a nursing home. A comprehensive long-term care insurance plan can pay for services that help you remain at home, like visits from a registered nurse or home health aid or home modifications that can help you manage on your own. Long-term care insurance offers coverage that will give you the flexibility you need to make decisions about the kind and site or care that works best for you. *The MetLife Market Survey of Nursing Home & Home Care Costs September 2004. MetLife Mature Market Institute ****U.S. Office of Personnel Management, 2001 |
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| Paying For Long-Term Care | Top |
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There are basically four ways of paying for LTC services.
1. Self-Insure
2. Medicaid
3. Medicare
For example, if a family member is involved in an accident that leaves the family member even partially paralyzed or if a family member develops Parkinson's Disease, some type of long-term care services would most likely be necessary to help the family member function on a daily basis. Back to top 2. Medicaid, a joint federal-state government program for low income individuals, will provide coverage for long-term care expenses if your income and assets are very low or after you have exhausted almost all of your own assets. It is an entitlement program based on strict income and asset guidelines. You may be required to spend your own money for care, living expenses and other "allowable" expenses before becoming eligible for Medicaid. This is referred to as the "spend-down" period. Even though every state has different eligibility criteria for this government program, assets and income are subject to review in order to determine your eligibility. Many people try to transfer all their assets immediately after it has been determined that they require long-term care assistance; however, this time period will not always meet the "look-back" period criteria. The look-back period is a 36 to 60-month period of time prior to a Medicaid application date. This means that certain assets that have been transferred for less than fair market value or simply "gifted" to others in this time period are still considered to be the care recipient's money, funds that the care recipient must use to pay for long-term care services. The look-back period for assets transferred to a trust is 60 months. When it comes to Medicaid eligibility, be sure to research your state's requirements. Back to top 3. Medicare is the federal medical insurance program for people age 65 or older, and disabled persons of any age receiving Social Security benefits for not less than 24 months. It was designed to pay some of the costs of certain health care services in order to provide recipients access to a basic level of health care. The majority of care provided in the U.S. today in connection with chronic long-term illnesses or conditions is personal or custodial care and may be rehabilitative in some cases. Medicare will generally not pay for personal or custodial care. However, Medicare will cover some long-term care expenses for a short period of time per Medicare benefit period if: * After a minimum three-day stay in a hospital, not including the day of release, you require a high level of care, as prescribed by a doctor, such as skilled nursing care or rehabilitation services. Medicare pays for the first 20 days of your stay in a skilled, Medicare approved nursing facility. * On the days 21st through 99 of your stay, you pay a daily co-pay amount determined yearly by the Centers for Medicare and Medicaid Services (CMS). Medigap policies may cover the daily co-pay amount. * After 100 days, Medicare will pay nothing for these services. The intent of Medicare Supplements policies (also known as "Medigap") is to provide coverage for Medicare co-payments and deductibles. The various types of policies, generally classified by the letters A-J in most states, are not primarily designed to cover long-term care expenses except for those described in number three. Admission to a nursing home is not enough to qualify for Medicare payment. The level and type of care determines whether short-term Medicare coverage for long-term care will be provided. Medicare does pay for short-term home health care, providing certain guidelines are met. Back to top 4. Long-Term Care Insurance This is insurance designed to help pay for the cost of long-term care services if you need them. It is not the same as medical insurance, which generally provides coverage for doctor visits and hospital stays. Depending on the type of policy and coverage selected, long-term care insurance can provide coverage for long-term care in many settings: your own home, nursing homes, adult day care, and assisted living facilities. Long-term care insurance can be issued on a group or an individual basis. If it is issued on a group basis, the group sponsor is the policyholder and is issued the policy. The insured will receive a certificate as evidence of coverage. If it is issued on an individual basis, the insured is the policyholder and is issued the policy. Often times, employees enrolling in a group plan can be guaranteed coverage without providing any medical history, on the condition that employees enroll during the initial enrollment period and are actively at work (not absent due to disability, leave or illness) on their effective date of coverage. Issuers of individual long-term care insurance policies require that you be underwritten before they approve a long-term care insurance policy. Back to top Source: Long-Term Care Insurance: The Essentials. 2004. MetLife Mature Market Institute |
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| How Can I evaluate a Long-Term Care Company | Top |
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Look for a company that achieves consistently high ratings from the leading insurance company rating agencies, such as Standard and Poor's (www.standardandpoors.com), Moody's (www.moodys.com), or A.M. Best (www.ambest.com). These ratings represent the overall financial stability of the insurance company.
Check out their record of rate increases. If the company has increased rates on a current block of business, they may have a history of under pricing products.
How long has the company been in the Long-Term Care Industry? The longer the company has been in the industry, the more experience they will have.
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| LTC Glossary of Terms | Top |
| A B C D E F G H I J K L M NOP Q R S T U V W X Y Z A activities of daily living (ADLs) - the basic activities of caring for oneself: eating, dressing, bathing, using the bathroom ("toileting"), moving back and forth from a bed to a chair ("transferring"), and remaining continent. Insurance companies use the inability to perform a specified number of ADLs to help determine eligibility for long-term care insurance benefits. adult day care - a place that provides a program of activities and services to individuals in need of long-term care. It is a helpful option for individuals living at home whose family caregivers work during the day and who require someone to be with them throughout the day. acute care - care provided by a doctor or other health care professional designed to treat or cure an illness, wound, or condition. Long-term care is not acute care. alternate plan of care - in certain circumstances, the care coordinators may authorize benefits for services that are not specifically covered under a plan. For example, services to make your home wheelchair-accessible may be approved. Alzheimer's disease - a progressive neurological disease that affects brain functions, including short-term memory loss, inability to reason, and the deterioration of language and the ability to care for oneself. Alzheimer's units - Special living units within skilled nursing facilities or assisted living facilities specifically providing care and services for those with Alzheimer's disease. assisted living facility (ALF) - a licensed residential facility that provides room, board and 24 hour personal care to individuals with long-term care needs. It is an important care option for individuals who are not able to manage at home but do not need the level of skilled care provided in a nursing home. automatic inflation option - a method of protecting the value of insurance over time. The increase choices are usually compound or simple inflation. Back to top B bed reservations - if you are in a nursing home, assisted living facility, or hospice facility, and you leave that facility, the policy will pay for actual charges you incur to hold a space to enable you to return to that facility. benefit - payment an insurance company makes for a service covered under the plan. benefit period -the length of time your insurance will last if you receive care every day at a cost equal to or more than your daily maximum benefit amount. If your care costs less, your insurance will last longer than the benefit period. The benefit period is used together with your daily maximum benefit amount calculate your lifetime maximum benefit. benefit trigger - a term used by insurance companies for the requirements you must meet in order to become eligible for benefits. Benefits would actually be payable after you meet the benefit trigger and satisfy the required waiting period. Triggers can vary, but there are usually two possible benefit triggers in LTC plans: (1) the inability to perform at least 2 out of 6 activities of daily living for an expected period of at least 90 days or (2) requiring substantial supervision due to a severe cognitive impairment. Back to top C care coordination services - services such as information, advice, and arranging of long-term care by a professional care coordinator. care management - Services provided by a professional, typically a nurse or social worker, to assess, coordinate, and monitor the overall medical, personal, and social services needed by an individual requiring long-term care. caregiver - a caregiver is the person who helps you accomplish the basic everyday activities you can no longer manage without assistance, due to illness, injury, or cognitive impairment. A caregiver could be a friend, neighbor, family member, certified home health aid or nurse. cognitive impairment - a deterioration or loss in intellectual capacity that results in impairment in some or all of the following: short and long-term memory, orientation to people, place, and time, deductive or abstract reasoning (including judgment), and ability to perform activities of daily living. community-based services - services, such as meals on wheels and adult day care, designed to help people remain independent and in their own homes. continence - an activity of daily living (ADL)- the ability of the body to control urination or bowel movements or both. custodial care - services aimed at maintaining your health and/or preventing deterioration in your functional status, provided on an extended basis. Long-term care includes custodial care. Back to top D daily benefit amount - A specified, maximum, daily, dollar amount payable on a covered period of care. Policies usually offer a range of choices in ten-dollar increments. Your choice should take into account the local costs of care, how much you could pay for care out of your own resources (without dipping into savings), and how much money or care you could count on from your family. Back to top E eligible group - individuals who are eligible to apply for long-term care insurance coverage under an employer sponsored plan. elimination period - the time between becoming eligible for benefits and when your long-term care insurance actually begins paying those benefits. It helps keep premiums affordable: the longer the waiting period, the lower the premiums. Most plans require only one qualification period per insured. If an insured recovers form an ailment and later goes back into claim, that insured does not need to wait through another elimination period. exclusions - specific conditions or circumstances for which your insurance will not provide benefits. Back to top F formal care - care which is provided by a home health aide or homemaker arranged or supervised by a home care agency, or provided by a nurse or therapist. free look period - a protection which allows you to cancel coverage within 30 days after you receive your benefit booklet and receive a complete refund of any premium you paid. full underwriting - the type of underwriting that you would undergo if you applied for an individual policy in the private market. This means that you would have to answer numerous health-related questions It may also include a review of medical records and/or an interview with a nurse. future purchase option - an inflation protection feature that allows you to periodically purchase additional coverage without proof of good health. Back to top G guaranteed acceptance - During the initial enrollment period on employer sponsored group plans, all actively at work employees may enroll in the plan without answering any health questions. guaranteed renewable - a feature of tax-qualified long-term care insurance plans, whereby an insurance company cannot cancel or fail to renew coverage because of a change in a person's health or age. As long as premiums are paid and benefits have not been exhausted, coverage will continue. When a plan is guaranteed renewable, premiums may be changed on a group basis only. Back to top H hands-on assistance - when you require physical help by another person without whom you would not be able to perform the activities of daily living. Some insurance companies measure the inability to perform activities of daily living based on the need for hands-on assistance only. Health Insurance Portability and Accountability Act (HIPAA) - Federal health insurance legislation passed in 1996 that specifies conditions under which certain long-term care insurance policies qualify for tax advantages. home care - services provided at home which may include nursing care; occupational, physical, respiratory or speech therapy; personal care; and homemaker services. home health aides - individuals who provide care to older adults or people with disabilities at home. Training or certification may vary for home health aides, but typical services they provide include assistance with activities of daily living, managing medications, and some household tasks. homemaker services Assistance given in managing and maintaining household activities that allows you to remain safely in your home when you can not manage those activities on your own. May include meal preparation, laundry, cleaning, chores, etc. hospice care - care for those individuals who have been diagnosed with a terminal illness is covered at home if the services meet the certain requirements of the plan. Back to top I inflation protection - a feature or option of long-term care insurance coverage that increases the value of benefits over time to keep pace with increasing costs of care. informal care - care provided by an unlicensed caregiver whose services are not arranged and supervised by a home care agency. Back to top L lapse - termination of insurance coverage when premium is not paid. lifetime maximum benefit - this is the maximum amount of benefits that your insurance coverage could pay. The maximum lifetime benefit can also be referred to as a "pool of money". Your maximum lifetime benefit is calculated by multiplying your daily maximum benefit amount times the number of days in the benefit period you selected. long-term care (LTC) - personal care and other related services provided on an extended basis to people who need help with activities of daily living or who need supervision due to a severe cognitive impairment. It can be provided at home, in a nursing home, assisted living facility, or an adult day care center. long-term care insurance - insurance that helps defray the costs of assistance with the activities of daily living or the costs of supervision due to a severe cognitive impairment and allows you to receive the type of care you need in the setting that's right for you. Back to top M Medicaid (Medi-Cal in California) - the joint Federal-state program that pays for health care services for individuals who meet their state's poverty guidelines. Medicare - a Federal health care program for most adults age 65 and older and certain disabled individuals. It pays for long-term care under limited circumstances and for limited periods of time. Medicare Supplement Insurance (Medigap) - private insurance to help pay hospital and medical costs Medicare does not cover. It pays for long-term car under limited circumstances and for limited periods of time Back to top N nonforfeiture - a feature that provides some value in the event coverage is cancelled. nursing home - a licensed facility that provides 24-hour-a-day room and board, nursing care and personal care services. Nursing homes also provide medical care, therapy, and other health related services. Back to top P personal care - care to help you meet personal needs such as bathing, dressing and eating. plan of care - a plan prescribed by a licensed health care practitioner that identifies ways of meeting your need for long-term care services. pool of money - see Maximum Lifetime Benefit. portable coverage - Once you have long-term care insurance coverage, you can keep it, even if you are no longer a member of the eligible group, as long as you continue to pay the required premium and have not exhausted your maximum lifetime benefit. premium - the money paid to an insurance company for coverage. Most companies offer a handful of ways you can pay premium (monthly, quarterly, semi-annual and annual). Often times there are accelerated premium payment options (10-Pay, Paid up at 65, Double Pay first year, Reduced pay at 65, etc…) Back to top R reduced paid-up benefit - a provision that allows an insured to stop premium payment and retain a portion of his or her benefits. respite services - services by a substitute provider, from a few hours to a few days, to give time off to the regular caregiver. return of premium at death - a provision that allows for the return of a portion of the insured's premium, less any benefits paid or payable. Back to top S simplified underwriting - in this type of underwriting, the long-term care insurance application has a reduced amount of health-related questions designed to determine who may be immediately eligible for benefits, or eligible for benefits within a short period of time. spend down - depletion of income and assets to meet eligibility requirements for Medicaid (Medi-Cal in California). spousal benefits - options offered by some long-term care insurance programs to spouses. The options may include allowing spouses who both qualify for the insurance to pay premiums that are less than if each person had purchased individual coverage and/or allowing spouses to use each other's benefits. standby assistance - when you require the presence of another person, within arms reach of you, to help you perform the activities of daily living. Some insurance companies measure the inability to perform activities of daily living based on the need for standby assistance, rather than or in addition to hands-on assistance. substantial assistance - hands-on or standby help required to perform activities of daily living. substantial supervision - continual monitoring of a cognitively impaired person. Back to top T tax-qualified - conforming to Federal standards that enable the enrollee in a long-term care insurance plan to receive Federal tax advantages. third-party notification - Gives you the option of having the "premium overdue" notice sent to a third party as a precaution to insure that the policy does not unintentionally lapse. toileting - an activity of daily living -- getting to and from the toilet, getting on and off the toilet, and performing associated personal hygiene related tasks. transferring - an activity of daily living -- the ability to move in or out of a bed, chair or wheelchair. Back to top U underwriting - the process of reviewing an individual's health status to determine eligibility for coverage under a long-term care insurance plan. Back to top W waiver of premium - a provision of most long-term care insurance plans that allows you to stop paying premiums while you are receiving benefits. Back to top |
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| Helpful LTC Marketing Tools and Links | Top |
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www.MatureMarketInstitute.com The Official Site for People with Medicare: www.Medicare.gov |
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