Letter from the Executive Director re: LTC Insurance


Long Term Care Insurance:   An Introduction

   "The average person does not fear death.  The greatest fear is of the dependence
      and disability that may occur in old age."
     ~author unknown

A large percentage of us will spend time in a nursing home.  Many more of us will require home care services on an extended basis.  Average costs for care across the U.S. is $40,000 per year.  The cost of nursing home care in New York State exceeds $60,000 ($75,000 in the metropolitan area).  It can cost even more for 24-hour care at home.

"...But I thought Medicare would pay for it...."
Medicare and Medicare supplement (Medigap) insurance are beneficial in protecting against the costs of acute medical care.  Rehabilitative care and acute skilled medical problems are covered, usually for a period of 100 days in a nursing (SNF) or rehabilitation facility.  However, most nursing home residents require custodial long term care which is covered only by private funds, LTC insurance and Medicaid.  Federal poverty guidelines for income and assets must be met to qualify for Medicaid.  Assets must be "spent down" to receive medicaid assistance.

What Is Long Term Care?
Long Term Care is a diverse system of services designed for people with chronic health conditions or cognitive disabilities who are no longer able to care for themselves independently.   Such services may be provided at home, in a nursing home or by any number of other service options.

Long Term Care (LTC) Insurance is a form of insurance available through private insurance companies as a means for individuals to protect themselves against the high costs of long term care.
The need for long term care arises when chronic physical or cognitive conditions affect a person's ability to remain independent in everyday life activities.  These activities of daily living (ADLs) include:
Bathing, Dressing, Eating, Transferring, Toileting and Continence.
Most LTC policies are triggered when you need assistance with at least two ADLs.

LTC Insurance typically covers:
Skilled Nursing Care
Custodial Care
Home Health Care
Adult Day Care
Respite Care
Continuing Care

The business of choosing a LTC insurance plan can be confusing at best.  There are a number of LTC policies on the market today.  Each has a distinguishing feature that sets it apart. Competition between companies makes policies improve simultaneously.

How Do I Shop for Long Term Care Insurance?
While every Long Term Care Insurance product has a 30 day "Free Look" period when you can change your mind and get a full refund, it is best to make a wise decision regarding one of the most important investments you will ever make.  This basic tool will guide you in making your own decisions regarding which policy may be best for you.  It is always a good idea to meet with a professional who is objective and understands your needs and priorities to assist you in making this decision.

Basic Checklist for Long Term Care Insurance:  Questions to Ask
(Highlighted  items will impact the total cost of your LTC policy)

What services are covered?

 Nursing Home             Assisted Living
Home Health Care       Day Care
Homemaker Services   Respite
Informal Caregivers
Alternate Care days in hospital
Other_________________________

What is the policy's daily benefit amount?
Nursing Home $_________________
Home Health Care _______________

How long will the benefits last?(3 years, 5 years, unlimited etc)
Nursing Home ________________
Home _________________________

Is there a maximum lifetime benefit?($200,000?  1,000,000 etc)
Nursing Home  $_______________
At home _______________________

What is the deductible/elimination period? (30, 60, 90, 365 days etc)
(How long must I wait before benefits begin, paying privately for the interim?)
Nursing Home ______________________
Home ______________________________

Is the policy guaranteed renewable?
(A guaranteed renewable policy cannot be canceled for any reason--such as infirmity, old age, disability-- as long as you pay your premiums and are truthful on the
application)
Yes     No

Is there an inflation adjustment feature?
(This feature ensures that your benefits will keep pace with rising costs of health care and inflation)
Simple      Compound     On Request    No inflation adjustment

Is there a non-forfeiture benefit?
(This benefit provides a cash value which is a percent of the sum of premiums paid by you if you decide to discontinue your coverage)
Yes    No   Death Benefit?

Is there a waiver of premium?
(This provision allows you to stop paying premiums when you are receiving benefits)
Yes      No
Finally:
How much does the policy cost?
$________________________

Other policy options      Additional Cost
____________________      _________________
_____________________      __________________
____________________      __________________

Talk with several companies to compare benefits and prices which can differ dramatically and be sure to only do business with stable, established companies and agents!

Insurance companies, of course, need to be able to measure the risk of providing you a policy.  Any chronic/progressive conditions can prohibit an insurance company from accepting you for LTC insurance coverage.  Some will offer you a policy, but at a much higher premium.  Be prepared for the underwriting process which often includes providing direct information from you medical records as well as a face-to-face interview with a company representative.  Be sure to answer all questions truthfully.  If you do not fully disclose your health status on the application, a company has the right to rescind or cancel your policy (and return your paid
premium).

For information on LTC insurance policies in New York State:
NYS Insurance Department 
http://www.ins.state.ny.us

(212) 602-0203
(800) 342-3736
Insurance Counseling
(800) 333-4114
CNY Elderplanning
(315)673-9876
(877) 243-4436

For information on LTC insurance policies in Arizona:
Arizona Insurance Department 
http://www.id.state.az.us/consumer.html
Phoenix (602) 912-8444
Tucson (520) 628-6370
Statewide (800) 325-2548
Insurance Counseling
(800) 333-4114
Elderplanning of Arizona
(877) 243-4436


Discuss with your insurance professional whether there is a partnership* plan in your state which may be the best type of plan for you.

For residents of NY state :  NYS would rather you not rely on Medicaid to fund your long term care expenses.  They have, therefore, designed a program which combines state government and insurance companies in a policy "partnership".  A certified Partnership policy allows you to shelter your assets despite your need for long term care.  Once the policy benefits are exhausted, the beneficiary can apply for Medicaid and still be able to protect remaining assets.  The
beneficiary, however, must be willing to contribute his or her income towards the cost of care.  A Partnership policy allows you full control over your assets and helps you to buy the kind of care you prefer for the time the policy is in effect.  Other states are in the process of developing partnership programs.
For more information on partnership programs visit: http://www.nyspltc.org/

Tax Incentives:
Because the state and federal governments are trying to preserve the Medicare and Medicaid system, they fully support the purchase of private long term care insurance.  The law provides incentives to purchasers of qualified * LTC insurance plans in the form of tax deductions.  If your itemized medical expenses are greater than 7.5% of your adjusted gross income, the following portion of your premium can be included:
For those up to age 40         $200
                           41-50         375
                           51-60         750
                           61-70       2000
                            70+         2500
*qualified means that the plan meets certain conditions outlined by the government

ELDERPLANNING:  We have no agenda but to find the best plan for you .
We represent over a dozen companies and are happy to meet with you at no charge to discuss your LTC plan.  To determine the costs and the benefits of the best plan for you, please call, email or write to us.   We are happy to guide you in choosing what is best for you.
E-mail us at: kate@elderplanning.com  or call us (315) 673-9876 or toll free (877) 243-4436 .



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