- LIFE (Term, Universal, Index and Whole)
- DISABILITY (Income Replacement)
- Health Insurance (Individual and Group)
- Accident Only (Hospital)
- Critical Illness (Cancer, Heart Attack, Etc)
- LONG-TERM CARE
- Medicare Supplements
- Medicare Part D

Friday, January 9, 2009

NBC - Long-Term Care Insurance


Thursday, October 25, 2007

LONG-TERM CARE INSURANCE OVERVIEW

Overview

Long-term care is the assistance provided when a person is unable to provide for himself or herself as the result of disability or a prolonged illness. It ranges from providing personal care at home, such as bathing and dressing, to skilled nursing services in a nursing home. Long-term care is offered through home care agencies, senior centers, adult day care centers, traditional nursing homes, and retirement communities that provide ongoing care.

Who Should Buy It?

Do you need long term care insurance?
A long-term care insurance policy is not for everyone , but does make sense as an affordable and worthwhile form of insurance for some. It depends on your age, health status, overall retirement objectives, income and wealth, and should not cause financial hardship or force you to forego other financial needs. Whether long-term care insurance is appropriate really requires a full financial analysis. These policies are only for people with significant assets they want to preserve for family members, to assure independence and not burden families members with nursing home bills.

Never buy a policy if:
- Paying the premiums will be a burden.
- If the only source of income is a minimum Social Security benefit or Supplemental Security Income (SSI).
- If paying utilities, food or medicine stretches a budget.
- If you have Alzheimer's or Parkinson's disease. No company will want to sell you a policy since they will face losses.

Although the need for long-term care can arise gradually as a person ages and needs more and more assistance with activities of daily living, for most a stroke or a heart attack will be the precipitating need. Those with acute illnesses may need nursing-home care for a matter of months, while others may need care for years.

Common exclusions
Do not expect any carrier to pay benefits for:
- Mental disease and nervous disorders, except some do cover Alzheimer's
- Addictions to drugs and alcohol
- Injuries and illnesses caused by war
- Treatment paid by the government
- Injuries that are self-inflicted, such as in suicide attempts

Odds of Needing Long-Term Care
Studies have shown that 43% of those who turned age 65 in 1990 will enter a nursing home at some time during their life. Of those who live to age 65, nearly 1 in 3 will spend three months or more in a nursing home and 1 in 4 will spend one year or more in a nursing home. Only 1 in 11 will spend five years or more in a nursing home.

Women outnumber men in nursing homes according to studies. Thirteen percent of women as compared to 4% of men, were projected to spend five or more years in a nursing home. And obviously the risk of needing nursing home care increases with age.
After assessing the odds, consumers must stringently analyze the reasons for a policy and the ability to pay for it for the balance of a person's life. It makes no sense to buy a policy unless it can be paid every year until death. Far too many policies are cancelled by policyholders on fixed incomes as they grow older and their premiums increase accordingly.

Here are the most commonly used types of policies and their generally accepted meaning.

Carriers can of course give special meaning to certain terms under their contracts, so it is important to always read the fine print. '

Skilled nursing care is needed for medical conditions that require care by specially trained, and usually state-licensed nurses or therapists. It is given either during or just after the severest level of an illness, and is usually required around the clock, 24 hours a day. Skilled care can be provided in a person's home with help from practical, as opposed to registered, nurses.

Intermediate nursing care is associated with stable conditions that require daily supervision, but not around the clock care. It is less specialized than skilled nursing care, often involves much personal care, and is supervised by registered nurses. Intermediate care is often needed for many months or years.

Custodial care is intended to assist with daily living, which includes bathing, eating, dressing, and other routine activities. Special training or medical skills are not required. It is provided by unskilled nursing assistants in nursing homes, day care centers, and at home. It is often called personal care.

The Cost of Long-term Care
Long-term care is expensive, depending on the severity of a disability, the degree of care needed and where it is to be provided. In 1991, the cost of a year in a nursing home averaged $30,000 across the United States. Skilled nursing care at home with two hour visits by a nurse three times a week over a year might cost about $12,500. Personal care at home from an aide three times a week for two hours would cost about $8,400 a year.

In major cities, the cost can be expected to reach $60,000 a year and as much as $100,000. With an average nursing home stay of 19 months, seniors living in major metropolitan areas, can expect to pay $100,000 on long-term care in addition to medical bills and prescriptions.

Who Pays for Long-term Care?
Combine Medicare, Medigap and long-term care insurance for best coverage
The answer is simple: it comes from your cash and your assets, your family's assets. For those without assets, it is paid by Medicaid programs administered by state government. More than half of nursing home bills are paid out-of-pocket by individuals and their families, and somewhat less than half are paid by state Medicaid programs.

Group insurance does not pay for most long-term care expenses, and Medicare does not offer long-term care as a benefit. Only in certain cases will Medicare cover the cost of some skilled nursing care in approved nursing homes or in your home, but there is no coverage for custodial or intermediate care or prolonged home health care.

Beware of the Hard Sell

Buying tips
Seniors fear losing physical independence and becoming financially dependent. They buy long-term care insurance coverage to avoid becoming a burden to family or friends. The fear of nursing homes makes them especially vulnerable to high pressure sales tactics focusing upon the risk of losing assets and reassuring promises of protection.

Loneliness clearly magnifies seniors' concerns and their vulnerabilities as consumers. One-third of those who are older than 65 live alone, and the ratio of women to men is two to one. When people are isolated, their beliefs are readily influenced by those who fill the loneliness of their lives.

The most common slimy sales tactic is known as "turning, turn to earn, or churning, " in which sales agents return once a year to pitch a "new and improved" insurance policy. By convincing a buyer to cancel a good policy a sales agent subjects a customer to higher premiums and new waiting periods for the sake of earning a new commission.

Supplying information to the insurance company can be a delicate process. The assistance of an insurance agent or advisor is almost always a huge help during this process. Fortunately, having help picking and getting a policy costs you nothing, and can save you a lot.

Are you ready to get started?
CORBIN LINDSEY
(425) 280-9169
corbin@lindseyadvisors.com

Long-Term Care - Glossary of Terms

Activities of Daily Living (ADLs): Everyday actions performed by individuals such as dressing, eating, bathing, toileting, continence and transferring. Most insurance policies covering long term care services base your qualification for benefits on your inability to perform a certain number of ADLs.

Adult Day Care: Group supervision for elderly persons, including social and recreational services and in some cases health services, in a community facility.

Alternate Level of Care Benefits: Care in a hospital inpatient setting for those persons waiting to be placed in a nursing home or while arrangements are being made for home care.

Assisted Living Facility: A residential facility providing ongoing care and related services for persons needing assistance in the activities of daily living.

Co-payment or Coinsurance: The amount you must pay for each medical service, outpatient hospital service or hospital stay.

Custodial Care: Non-medical care that meets your personal needs. For example, custodial care includes help eating, bathing, toileting, taking medication or walking.

Cognitive Impairment: Deterioration in intellectual activity such as thinking, reasoning or remembering.

Daily Benefit Amount: The amount your insurance policy will cover for each day of services provided. Some policies pay a flat daily benefit amount, while others will pay reasonable and customary charges up to the daily benefit amount.

Deductible: The amount you must pay for health care before Medicare or private medical insurance begins to pay.

Dementia: Impairment of intellectual faculties due to a disorder of the brain.

Elimination or Waiting Period: The elimination or waiting period is the number of days you must receive long term care services before benefits will be paid under the policy. During the elimination or waiting period you will have to privately pay for the care you receive. A new elimination or waiting period may be imposed for each period of care. Shorter periods increase the cost of coverage.

Free Look Period: The time period after receipt of the policy during which a policyholder can cancel and get a full refund.

Functional Impairment: The need for assistance to carry out a specific number of activities of daily living.

Guaranteed Renewable: Guaranteed renewable means that you have the right to continue the policy as long as the premiums are paid on a timely basis. An insurer cannot terminate the policy if your health declines. The insurer also cannot make any change in any provision of the policy while the insurance is in force without your agreement. An insurer cannot change the premium charged for the policy unless it is approved by the State Insurance Department, and unless it applies to all members of a class covered by the policy.

Home Care (personal care): Assistance with personal hygiene, dressing or feeding, nutritional or support functions and health-related tasks.

Home Health Care: Health services received in your home, including skilled nursing care, speech, physical or occupational therapy or home health aide services.

Hospice Care: A program of care and treatment, either in a hospice facility or in the home, for persons who are terminally ill and have a life expectancy of six months or less.

Inflation Protection Benefit: Increases the daily benefit amount and policy maximums over time to help keep pace with inflation and increased expenses.

Maximum Policy Benefit: The period of time or dollar amount limit for which long term care benefits will be paid under the policy.

Medicaid: A governmental program for low-income individuals and families.

Medicare: A federal program providing hospital and medical insurance to people aged 65 or older and to certain ill or disabled persons.

Medicare Supplement Insurance: Private insurance designed to fill in some of the major gaps in Medicare coverage.

Non-forfeiture Benefit: A benefit designed to ensure that if an insurance policy is lapsed after a specific number of years, some of the benefits from the policy will be retained.

Period of Care: A specified number of days of care either in a nursing home or while receiving home care services without a break in the services for a specified number of days.

Preexisting Condition: A medical condition for which medical advice was given or treatment was recommended by, or received from, a licensed health care provider within six months before the effective date of coverage.

Respite Care: Services to provide family members a rest or vacation from caregiving responsibilities.

Skilled Nursing Care: A level of care that must be given or supervised by registered nurses.

Waiting Period: The number of days you must be in a nursing facility or the number of days of home health care you must receive before long term care benefits will be paid under the policy. During the waiting period, you must privately pay for the nursing facility stay or home health care services.

Waiver of Premium: After a policyholder has received benefits for the specific number of days stated in the policy, no further premiums will be due until they leave the nursing home.