Health Care Collaboration

There are different types Long Term Care Insurance Policies. “Indemnity” or “Expense Incurred” policies are most common. When you buy an expense incurred policy, you choose the benefit amount. Regardless of what you spend an “indemnity” or “per diem” policy pays up to a fixed benefit amount. An “indemnity” or “per diem” policy reimburses for the actual expenses for services received up to a fixed dollar amount per day, week, or month.

“Integrated Policies” or policies with “Pooled Benefits” pay a total dollar amount which may be used for different kinds of long term care services used. There is usually a daily, weekly, or monthly dollar limit for long term care expenses covered by this kind of policy. For example you buy a policy with a maximum benefit amount of $300,000 of pooled benefits. You will have, with this policy a maximum daily benefit of $300 that would last for 1,000 days if you spend the maximum daily amount on care. If your care costs less than the maximum daily amount of $300 you will receive benefits for more than 1,000 days.

Long Care Insurance Policies can be divided into three broad categories according to where benefits are paid – Home Care Only, Nursing Home and Residential Care Facility Only and Comprehensive. Care in your own home or a community setting is covered by Home Care Only policies. This kind of policy pays for expenses rising out of home health, adult day health care, hospice, respite care, personal care and homemaker services.

Nursing Home and Residential Care Facility Only policies cover care in a nursing home or any place that provides assisted living care as long as this place is licensed as a Residential Care Facility for the Elderly (RCFE). The benefit of this kind of policy is not the payment for room and board in these facilities. The policy benefits include coverage of all long term care services you receive in either of these facilities up to the policy’s maximum daily benefit amount.

Care for patients with cognitive impairment (dementia) from Alzheimer is provided in small neighborhood homes also called board and care facilities, retirement homes and specialized community facilities which are part of the RCFE. This kind of policy provides for assisted living benefits equallingl to atleast 70% of the nursing home care benefit.

Expenses rising out of care in a nursing home, assisted living facility, home care and community care (adult day care) are covered by Comprehensive Long Term Care Insurance Policies. Before benefits can be paid LTC Comprehensive policies sold by different companies require different criteria to be met. When two activities of daily living (such as bathing, using the bathroom, dressing eating etc.) can not be performed or you have a cognitive condition that requires supervision, Comprehensive Long Term Care Insurance Policiy will pay you the benefits. The criteria required for the benefits remain as described above whether care is provided in a nursing home, at your own home or in an assisted living facility.

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The type of Long Term Care Insurance Policy chosen, daily benefit amount to be paid, your age, number of years the policy will pay benefits, choice of inflation protection and the number of days after you qualify for the benefits before the company will start to pay benefits are factors which influence your Long Term Care Insurance Policy Premium. If you have a pre-existing condition, your premiums may be higher if some companies agree to insure you. All of the above factors influence your LTCI policy premium.

Various LTCI companies calculate the cost of benefits you choose in a varying manner. This reason alone can make a significant difference between premiums for similar benefits. For instance, a company calculates the premium based on every $10 of the daily benefit you choose. If for each $10 of daily benefit the company charged $95, the premium would be $950 per year for a daily benefit of $100. With a similar package of benefits costing $150 with another company, the premium would rise to $1500.

The type and amount of inflation protection chosen will also influence your LTCI policy premium. The makes the cost nearly double for those in 40s and 50s and not expecting to need care for several years. As you age your ability to change LTCI policy diminishes but probability of developing health conditions which make you ineligible to apply for new benefits increases.

You may see an increase in your LTCI premiums over the years. A personal worksheet which explains the rate increases the company has had since 1990 is provided to you by your agent when you buy a LTCI policy. For rate increases for every company that sells go to the California Department of Insurance website. LTC insurance companies found it difficult to increase future premiums when California passed legislation in 2000.

When it became mandatory in 2006 for all companies filing for premium increases over a certain amount to offer a choice, policy holders got to choose between stop paying their premium and keep the benefits equal to the total amount of premiums already paid. The sum of premiums that has already been paid will finance only a small amount of care. If you were unable to pay because of a premium increase, you will not lose all your benefits.

Lower premiums can be negotiated with your company by reducing some of your policy benefits. If you need to lower your premium or you have received a premium increase notice contact your local Health Insurance Counseling and Advocacy Program (HICAP) office.

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Costs rising out of long term care services are paid by Long Term Care Insurance. Help needed to carry out daily activities like eating, bathing, dressing and using the bathroom etc. when you have a physical disability or cognitive impairment such as dementia caused by Alzheimer’s disease is called Long Term Care. Traditional health insurance, Medicare or Medicaid do not pay for such care. This kind of care is not received in a hospital nor is it intended to cure you. You may need this kind of care for the rest of your life and can receive it in your own home, a nursing home or assisted living facilities.

The Federal Health Insurance program is called Medicare and aims to provide health care services for people 65 or older. It also covers those who have certain disabilities under the age of 65, and those dealing with permanent kidney failure requiring dialysis or a transplant. People suffering from ALS or Lou Gehrig’s disease are also covered by Medicare. Medicare pays only for short term skilled care like inpatient hospital stays, inpatient skilled nursing facility stays, hospice care and home health care. Out patient medical services such as doctor visits, diagnostic tests and preventive care, prescription drugs are covered by Medicare. Medicare provides for specialized care in hospital and only for a limited time.

Federal Funds supplement a state based program called Medicaid. In California the Medicaid Program is called Medi-Cal. The poor and impoverished are provided health services by Medicaid according to the state’s guidelines. One must meet the state’s poverty criteria in order to be eligible for Medicaid. Usually this means you need to expend all but $2000 of your assets. Medicaid, a welfare program kicks in only after a person’s assets are gone!

Medigap is a form of private supplemental health insurance policy which increases the amount of health insurance for eligible Medicare recipients. Medigap is provided by private health insurance companies such as Humana, Blue Cross and Blue Shield etc. The 12 standardized Medigap Policies have the same benefits regardless of which private company sells it to you. A part or all of Medicare’s coinsurance and deductibles are paid by Medigap policies. A few Medigap policies cover health care costs which are not covered by Medicare like emergency medical care in foreign countries.

In conclusion, Long Term Care Insurance pays for costs resulting from Long Term Care. To protect your assets and to safe guard yourself and your family in case you need long term care, invest in a Long Term Care Insurance policy.

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Children born in the US between 1946 and 1964 are known as the Baby Boom Generation. The 76 million baby boomers represent approximately 28% of the population. 40% of this generation will live to be 90. 70% of people above the age of 65 will need some kind of Long Term Care Services at some point in their lives.

When this generation reaches retirement at 2030 the elderly population will be double what it is today. The oldest baby boomer will turn 65 in 2010 and the youngest by 2030. The youngest baby boomer turns 85 by 2050 when the need for long term care is felt the most. 30% of Baby Boomers believe that they have long term care coverage. Unfortunately, those who can afford to purchase a policy have not done so yet.

A big portion of seniors needing long term care in the future consists of baby boomers not planning for this need today which will lead to financial drain on the government. 43% of nursing home care costs for seniors come from Medicaid. In the future Medicare and Medicaid will be taking more out of the system when fewer workers in the workforce will be contributing (tax).

Informal home care is less of an option for the baby boom generation than it was for their parents because of today’s life style. Some of the demographic changes which have made informal home care more difficult are smaller family size, work related mobility, increase in divorce rates and increase in people choosing to remain single.

Baby boomers need to realize the possibility of needing some kind of long term care at some point in their life. For financial peace of mind in old age retirement planning should include long term care as a key component. Buying long term care insurance at an earlier age will be cheaper than later by not denying that “this can never happen to me”. By not assuming that the government or family to meet your long term care needs will help you choose a policy that best fits you. Choose a long term care insurance policy with the maximum coverage for peace of mind and to avoid being a burden to your family.

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People with chronic illness or disabilities use Long Term Care services. It can be defined as help needed with daily activities such as eating, bathing, using the bathroom, dressing, moving from bed to chair etc. This kind of help is not skilled care and Medicare only pays for skilled care. Help received in your own home, in a nursing home or in an assisted living centre is not paid by Medicare. Only after a person’s assets are gone does Medicaid kick in.

Long Term Care Insurance pays for costs resulting from long term care. As life expectancy increases so does the need for help with daily activities. Baby boomers by 2030, will reach the age of 65 and 40% of them will live to be 90. 70% of people over the age of 65 will become to depend on help with their daily activities. At anytime accidents and injuries can happen to anybody forcing them to become dependent on these kind of services.

40% of people receiving these services are working age adults between 18 and 64 years. Buying early a long term health care insurance locks in rates which you can not receive at a later age and guarantees you coverage when you need it the most. You cannot buy this kind of insurance at a time of crisis or only at the time you need it.

Most times children or family want to help. But very often children have their own young ones to take care of or are unable to quit their jobs and relocate to help their aged parents. Maximum coverage long term care health insurance provides you the financial freedom to choose the kind of care you want and where you want to receive it.

Many desire to leave their life savings to their family instead of spending it on hospital and nursing home bills. Long Term Care Insurance not only protects your assets but should you overcome the need for help with daily living activities you will still have your savings to enjoy when you recover.

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Begin by reviewing your current financial condition, your savings and assets, and consider the kind of Long Term Care you want before you buy long term care insurance policy. Look for a financially sound Long Term Care Insurance Company with a good rating so that the company is still around when you want to receive your benefits say in 20 years. Read the long term care insurance reviews and claims process and know how many filed claims have been paid by the company.

The maximum daily benefit of your Long Term Care Insurance policy and the cost of long term care services in your area affect your long term care insurance quotes. Keeping inflation in mind seek a Long Term Care Insurance policy that factors in the inflation rate in its premium. If you don’t keep inflation in mind while buying Long Term Care Insurance policy, you will be left with too little money too late.

Become familiar with non-cancel and guaranteed renewable Long Term Care Insurance policies so that your policy is not canceled just when you need it the most. A Long Term Care Insurance policy which provides coverage if you become unemployed and works along with your Social Security is preferred.

Consider a Long Term Care Insurance policy with coverage when unemployed, works with your Social Security and comes with non-cancel and guaranteed renewable features. Some Long Term Care Insurance policies have an option to choose a 10 year or paid up by age 65 payment plan and the freedom to choose the benefit payout – either reimbursement or indemnity. Long Term Care Insurance policies allows you to apply for additional coverage without providing proof of medical insurability once a year for a specified number of years. Look into Long Term Care Insurance policies which allow you to receive benefits if you experience an income loss from a partial or a total disability.

To have the ability to go where you want to go instead of having to go where you are taken and to maintain your financial independence and dignity, find a Long Term Care Insurance policy that offers the maximum coverage. Long Term Care Insurance not only protects your assets but should you overcome the need of long term care, you still will have your savings to enjoy when you recover.

Maria Smith likes to write about general insurance and long term care insurance.