Long-term care refers to the type of care you may need if you are unable to care for yourself because of a prolonged illness, accident, disability or cognitive impairments. This type of care ranges from custodial care, personal care and Activities of Daily Living (ADLs) - bathing, dressing, transferring, toileting, continence (control of bodily functions), and eating, to skilled nursing care or skilled rehabilitation services.
Long-term care services can be provided in a variety of settings, including: Your home or a family member's home, assisted living facilities, personal care homes, Alzheimer's facilities & nursing homes. Long-term care may also include personal care management services to help evaluate your needs, coordinate and monitor the delivery of long term care services.
After the insured meets an initial elimination period, if any, benefit triggers include the requirement that the insured be unable to perform a certain number of ADL's (usually two) for 90 days or longer. Triggers include: transferring, toileting, maintaining continence, bathing, dressing, and eating. Another benefit trigger would be severe cognitive impairment (expected to last 90 days or longer). The triggers vary by company and product offered. However, tax-qualified plans must meet HR3103 guidelines which specify allowable benefit triggers in tax-qualified plans. Virtually all of LTC plans available today are tax-qualified plans.
Some policies pay up to a selected daily maximum amount to reimburse actual expenses incurred and continues until the pool of dollars, determined by the period of care selected, is exhausted. Other policies (non-tax qualified plans) will pay the full daily benefit amount that you elected, even if your benefit payment exceeds your actual expenses. Policies offering pooled benefits usually combine all levels of care regardless of the setting. In other words, if you have a plan with a 4 year benefit period which includes home care and you use 3 years of care at home and then need assisted living care, you would have 1 year remaining in total benefits.
Half of all women and a third of all men 65 or older are likely to need some type of long-term care.
For a couple turning 65, there is a 75% chance that one of them will eventually need long-term care.
40% of the people who need long term care are between ages 18-65.
Preserve personal and financial independence. Avoid depending on others for care. Avoid being a burden to children and spouse. Protect savings and assets that have taken years to accumulate. Guarantee affordability of services in your setting of choice. Avoid spending down to Welfare/Medicaid.
Preserve estate for heirs. Alleviate the physical, emotional and financial stress on family members and provide your family "Peace of mind".
Choose a company with a long historical record of excellent policyholder service. Select a company with a solid claim paying record, and low complaint ratio. Pick a company specializing in the Long-Term Care market which re-insures excess risk with top rated re-insurance carriers. Find a company which offers a suite of plans which allow flexibility in benefit design. Investigate company’s which gives the consumer the freedom to design a plan specifically for their unique situation. Choose a company which has made the commitment to the senior market and offer plans which are consumer friendly.
Pay out of your own income and/or savings. Set up a savings account to pay for long-term care expenses. Ask family/friends to take care of you for as long as possible. Ask family/friends to help you pay for your long-term care. Sell your existing assets (spend down) to qualify for government assistance (AHCCCS in Arizona), by "spending down" to welfare levels. Try doing a home equity conversion or reverse mortgage, or just do nothing and hope it does not happen to you.
While there are a variety of ways to pay for long-term care, it is important to think ahead about how you will fund the care you get. Generally, Medicare does not pay for long-term care. Medicare pays only for medically necessary skilled nursing facility or home health care. However, you must meet certain conditions for Medicare to pay for these types of care. Most long-term care is to assist people with support services such as activities of daily living like dressing, bathing, and using the bathroom. Medicare does not pay for this type of care called "custodial care". Custodial care (non-skilled care), is care that helps you with activities of daily living. It may also include care that most people do for themselves, for example; diabetes monitoring. Some Medicare Advantage Plans (formerly Medicare + Choice) may offer limited skilled nursing facility and home care (skilled care) coverage, if the care is medically necessary.
Medicaid (AHCCCS in Arizona) is a State and Federal Government program that pays for certain health services and nursing home care for people with low incomes and limited assets. In most states, Medicaid also pays for some long-term care services at home and in the community. Those who are eligible and what services are covered vary from state to state. Most often, eligibility is based on your income and personal resources. There's a good chance that you may need to pay for nursing home, assisted living, or home health care one day. In fact, more than half of the U.S. population will require long-term care at some point in their lives.
If you're concerned about being financially secure during your retirement years, you owe it to yourself and your loved ones to protect yourself against what could be the greatest threat to your financial security, the cost of long-term care.
Long-Term care insurance is not for everyone. The complexities involved in determining what, if any, type of plan is right for your situation, requires help from qualified LTC insurance specialists. John Rada & Associates can objectively review your situation and help you determine if LTC insurance is suitable and if appropriate, design a plan to meet your needs.
John Rada & Associates offer Medicare health insurance planning, Long-Term Care, Life insurance, and fixed Annuities.
For other insurance and professional services not available directly through our agency we refer you to specialists in your area to assist you with individual and group major medical insurance (for those people not eligible for Medicare), disability insurance, property and casualty insurance, legal, and accounting services. Please contact us directly for more information about our network of qualified professionals in your area available to assist you.
| • Medicare Health Ins. Planning | • Long-Term Care Planning |