How about the Federal LTC Insurance Program?
How about Medicaid?
How about Medicare?
Do I really need it?
Are other family members eligible?
What is the normal length of stay in a nursing home?
Do rates go up?
Why buy coverage now?
Is Home Care cost included?
Is Alzheimer’s covered?
When does the insurance pay?
What is an Activity of Daily Living?
What is Medical necessity?
How about the Federal LTC Insurance Program?
The AFSA plans compete with the Federal
LTC Insurance Plan in seven areas:
- AFSA plans are priced substantially
less for Preferred risks and
less in most cases for Standard risks.
- AFSA plans provide spousal
discounts; the FLTCIP does not.
- AFSA plans provide up to 100%
Home Health Care benefit; the FLTCIP does
not
- AFSA plans provide
simple, compound and no inflation options;
the FLTCIP only offers compound or no inflation.
- AFSA plans offer a discount plan for
brothers, sisters, aunts, uncles and cousins;
the FLTCIP does not.
- AFSA plans pay for up to 100% of Adult
Day Care; the FLTCIP does not.
- AFSA plans have an Indemnity option with
payment directly to the insured rather than the healthcare provider:
the FLTCIP does
not. A comparison of the plans’ features is available.
How about Medicaid? [top]
To get Medicaid
help, you must meet federal and state guidelines for income and
assets. Many people start paying for nursing home
care out of their own funds and “spend down” their
financial resources until they are eligible for Medicaid. Medicaid
may then
pay part or all of their nursing home costs. You may have to spend
down or use up most of your assets on your health care before Medicaid
is able to help. Some assets and income can be protected for a
spouse who remains at home. Medicaid pays for nearly half of the
people
in nursing homes. Medicaid also pays for some home and community–based
services.
State laws differ about how much money and assets you can keep and
be eligible for Medicaid. (Some assets, such as your home, may not
count when deciding if you are eligible for Medicaid.) Contact your
state Medicaid office, office on aging, or state department of social
services to learn about the rules in your state.
How about Medicare? [top]
Medicare’s skilled nursing facility (SNF)
benefit does not cover most nursing home care. Medicare will pay
the cost of some
skilled care in an approved nursing home or in your home but only
in some situations. The SNF benefit only covers you if a medical
professional says you need daily skilled care after you have been
in the hospital for at least three days. You should not rely on
Medicare to pay for your long-term care needs.
Medicare does not cover homemaker services. Medicare does not pay
for home health aides to give you personal care unless you are
home-bound and are also getting skilled care such as nursing or
therapy. The
personal care must also relate to the treatment of an illness or
injury and you can only get a limited amount of care in any week.
Medicare supplement insurance is private insurance that helps pay
for some of the gaps in Medicare coverage, such as hospital deductibles
and excess physician’s charges above what Medicare approves.
Medicare supplement policies do not cover long-term care costs. However,
four Medicare supplement policies – Plans D, G, I and J – do
pay up to $1,600 per year for services to people recovering at
home from an illness injury, or surgery. The benefit will pay for
short-term,
at home help with activities of daily living. You must qualify
for Medicare-covered home health services before this Medicare
supplement
benefit is available.
Do I really need it? [top]
Why people Do
Buy LTC Insurance:
- Maintain their independence
- Avoid being a burden
- Guarantee affordable service
- Choice of location
- Protect their assets
- Leave an inheritance
- Avoid depending upon Medicaid
Why People Do
Not Buy LTC Insurance:
- They think it will not happen to them
- They
think it is too expensive
- 73% believe Medicare will pay
- 45% would consider
transferring assets
- 33% would depend on their children
- Self-insure
- Procrastination
Are other family members
eligible? [top]
All AFSA members are eligible.
Spouses, parents, parents-in-law, grandparents, grandparents-in-law,
children, sisters, brothers, cousins,
aunts, and uncles are also eligible, depending on the insurance
company.
What is the normal length
of stay in a nursing home? [top]
The average
length of stay in a nursing home is 2.8 years.
9% of people reside in nursing homes for over 5 years.
40% of all people in nursing homes are under 65.
Do rates go up? [top]
While it is possible for premiums to go up,
they cannot go up individually. They can only go up for an individual
company for a specific product in each
State. Most of The Hirshorn Company carriers have never had a
rate increase.
Why buy coverage now? [top]
Coverage will never be less expensive than
right now.
The earlier you purchase Long Term Care Insurance, the better protected
you will be.
Long Term Care Insurance depends on meeting health qualification.
Procrastination not only increases rates, it opens up to the possibility
of catastrophic loss – witness Christopher Reeve.
Is Home Care cost included? [top]
Home Care cost is usually included in the policies we sell. Some
companies offer home health
care protection at 50%, 75%, 100%, or 130% of the daily benefit.
Is Alzheimer’s covered? [top]
Yes… not only Alzheimer’s
but also most forms of dementia and cognitive impairment are covered.
When does the insurance pay? [top]
The insurance company will pay when
the insured is unable to perform two activities of daily living
(ADL’s) or is cognitively impaired.
A third way for an individual to go on claim is called medical
necessity, which is defined as “your doctor saying it is
medically necessary for you to need substantial care”.
What is an Activity of
Daily Living? [top]
Activities of Daily Living
are:
- Bathing
- Continence
- Dressing
- Eating
- Toileting
- Transferring
The inability to perform two of the six activities
of daily living (ADL) will allow the insurance company to pay
the insured
under the terms of the policy.
What is Medical Necessity? [top]
Medical Necessity is a kind of overriding
trigger that allows the policyholder’s own doctor to “trump” the
needs test of Cognitive Impairment or Activities of Daily Living
based
upon extenuating medical circumstances that are not addressed by
the other two triggers. The insured’s doctor can prescribe
care as medically necessary for any number of reasons, so long
as that care is “appropriate to the diagnosis, widely accepted
by the practicing peer group, and based upon scientific criteria
that is not experimental, investigative or randomized.” |
