The Hirshorn Company | CHCA Long Term Care

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 CHCA 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.”

How about the Federal LTC Insurance Program? [top]

The CHCA plans compete with the Federal LTC Insurance Plan in seven areas:

CHCA plans are priced substantially less for Preferred risks and less in most cases for Standard risks.
CHCA plans provide spousal discounts; the FLTCIP does not.
CHCA plans provide up to 100% Home Health Care benefit; the FLTCIP does not
CHCA plans provide simple, compound and no inflation options; the FLTCIP only offers compound or no inflation.
CHCA plans offer a discount plan for brothers, sisters, aunts, uncles and cousins; the FLTCIP does not.
CHCA plans pay for up to 100% of Adult Day Care; the FLTCIP does not.
CHCA 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.