Health Insurance

Lots and lots of companies are now starting to offer long-term care insurance (LTCI) to their employees as part of an overall health care benefits package. And since buying group medical insurance is usually a way to get lower insurance rates, most people automatically assume that the same is true with LTCI policies. However, in most cases individual LTCI policies will be able to offer not only lower premiums, but also better benefits if they are examined in a true “apples to apples” comparison. Group LTCI can be a good answer for those who have severe health problems, as they may be able to qualify under the “simplified” underwriting procedures. The same lenient qualifications also drive up the cost of coverage for everyone else in the group.

This is one reason why individual LTCI policies actually cost less for relatively healthy applicants, the underwriting procedures in use effectively screen out most of those costly severe health cases. One of the ways that group LTCI companies hide or mask the increased cost of their policies is by not including an automatic inflation benefit as part of the premium. They typically tell you that they are providing a 5% compound inflation protection, but they do it as something called a “Future Purchase Option.” This actually means that they will come again every three years or so to make an offer based on an additional 5% compound increase in benefits. This is the least expensive way to buy LTCI initially because the inflation protection is not built into the premium. The problem is that it is the most expensive way to buy LTCI over the life of the policy because you are buying additional protection every three years at a later age. Moreover, you are paying for that additional protection at that later age instead of the age when you originally purchased the policy. So these kind of policies often wind up costing the policyholder twice as much or more over the life of the policy, as if they have just brought the automatic inflation protection built into the policy then. Another method that group policies use to lower premiums by providing less coverage is reducing the home care benefit to 50 to 75% of the daily benefit.

This may indeed lower costs, but it is not helping policyholders accomplish what they usually want most: to stay at homecare and remain as independent as possible for as long as they can. Of course, some group policies can be a very good value, but it is always a very good idea to individual policies using identical benefit features to make the comparison fair for long term care.

Becoming familiar with the foundational features and options of a good long-term care insurance (LTCI) policy requires taking enough time to educate yourself before making your final decision. This will help ensure that you get the policy that will best fit your particular needs. The very next step would be to find the right insurance provider that will be right for you. Since there are a number of LTCI carriers to choose from, here are a few suggestions for selecting a company that offers a quality product and is worthy of your trust in the many years ahead.

Among numerous companies that offer LTCI, there are a few that have an outstanding reputation. What I mean is that these companies have already distinguished themselves over a long period of time as financially solid, rate-stable carriers with an excellent customer service record. Unfortunately, we see so many stories in the media these days of other LTCI companies whose record in these areas is being seriously challenged. It’s been reported that some have appeared to excessively deny claims in order to make a profit. Others have had to request hefty premium increases due to a much higher number of claims than they had projected. While some of these stories may hold some facts, what we don’t hear is the good stuff: LTCI companies that really adhere to their claims of the customer being #1.

The June 18, 2007 issue of Newsweek magazine recommended the following four companies as being major carriers that can be worthy of your consideration: Genworth, John Hancock, MetLife, and Allianz Life. Of course, that does not mean that there aren’t other fine companies represented in the LTCI field, but the four carriers identified by Newsweek are among the oldest and financially strongest in the industry. They also have extremely favorable records of customer satisfaction.

Genworth, John Hancock, MetLife and Allianz Life are all fine choices if you are in excellent health. However, if you have health issues that are not serious enough to render you uninsurable, but will most likely disqualify you for ” preferred ” rates, the company you choose can have a significant impact on your premium. The reason for this is that each company has its own underwriting procedures that it uses for rating policyholders. These procedures can be different from one company to the next. For instance, one company will not issue a ” preferred ” rating to someone who uses even a single blood pressure medication while others will allow the use of up to four of these medications and still award the highest rate classification for long term care

Once you have more serious health conditions, the difference in the way individual carriers treat those issues can be even more dramatic. In other words, some health conditions that one carrier may decide to accept may be cause for rejection by another provider. This is where the help of a knowledgeable, experienced agent who can choose from several top companies in the LTCI field, can be a real asset in finding the company that is not only trustworthy and reliable, but also best fits your particular needs and home health care history.

This article, written by Jill Gilbert, originally appeared as ” Five Star is Progress” in McKnight’s Long Term Care News February 2009 edition. The Centers for Medicare & Medicaid Services recently released a new rating system to grade the 16,000 nursing homes in the United States that participate in Medicare or Medicaid. With the goal of streamlining the data already publicly available, the new system assigns nursing homes one-to-five-star ratings based on quality of care data, staffing information and health inspection surveys. The rating system falls short of its primary objective: helping families understand the qualitative data on facilities. The new rating system doesn’t add any new information, and it doesn’t account for patient or family satisfaction. The point is to help consumers compare nursing homes more easily. CMS says consumers should use the star ratings to narrow their choices, then review the deficiencies and citations in detail.

However, there is a problem with this system as the ratings are sometimes misleading or unfair, essentially excluding some facilities from the consumer search to begin with. It is actually an oversimplification of a complex system that will give consumers only a small part of the picture. Looking ahead. Since it was implemented, the rating system has been under scrutiny from the nursing home industry, which is very much concerned about inaccurate representation of facilities, as well as consumer groups, who want reliable, understandable information which they don’t find in the current inspection data. But Rome wasn’t built in a day. The new rating system may not be perfect, but it is progress. We need to remember why CMS created the rating system in the first place: to make the inspection data less confusing and to help consumers make informed choices. Moving forward with innovative solutions is key in any industry, and essential for the skilled nursing industry. Voicing our concerns as providers and consumers will help CMS work out the kinks in the new system.

We need to remember why CMS created the rating system in the first place: to make the inspection data less confusing and to help consumers make informed choices. Moving forward with innovative solutions is key in any industry, and essential for the skilled nursing industry. Voicing our concerns as providers and consumers will help CMS work out the kinks in the new system.

The father of a dear friend of mine, Carol, died a few month ago. Last Friday night at our synagogue, she stood up to speak Kaddish, which was the communal prayer for the deceased, and I was taken aback by my visceral reaction at seeing my friend stand and speak those ancient words. The reality of her loss and her vulnerability, as well as my own, struck me full force. In that moment, I realized anew that what had happened to her will happen to me and to those I love. Loss is an intrinsic part of our lives. Each change of our loved ones along the way, illness, a change in mental capacity, a lessened ability to take care of oneself, is a loss to be acknowledged. When senior care managers are called in, the immediate work is to assess any immediate needs and set the necessary services into place. A sensitive care manager also assists the older person and their families and friends in acknowledging and also examine what the changes in their lives means to each one of them, and how they can best manage those changes. Senior care caregiving can raise some difficult questions.

Being aware of the following concerns can help you when the time comes:

Physical: am I physically able to care for my loved one? What sort of help can I give? When is it time to hire outside help?

Emotional: what emotions does this bring up for me? Do I need help in acknowledging the difficult (negative) emotions? Where should I turn to? S

Spiritual: what is the meaning of life? Does it mean something different to me now that my loved one is at the end of life? What will happen to me as I age?

Caregivers will benefit by addressing the physical, emotional and spiritual concerns of their own lives when helping their loved ones, as well as practical considerations such as the significant time commitment that homecare caregiving requires. A care manager can be available to discuss these concerns. She can sensitively demonstrate that grieving and working through loss is a lifelong task, not one that is simply relegated to after a physical death. Awareness of the small and not-so-small losses during our lives, and grieving those losses as they occur, makes for a fuller and richer life. If we open ourselves to the difficult and painful moments in our lives, we are then free to truly experience moments of pure joy and happiness as well.

This article, written by Jill Gilbert, originally appeared as “Assembling a Cast of Stars” in McKnight’s Long Term Care News October 2007 edition. There is actually no magic formula in making or creating your own dream team. But after talking with Jim Lee, administrator of Nineteenth Avenue Healthcare Facility in San Francisco, we learned some tried and true tactics that every facility can employ and you don’t need to break the bank to do them, either. It starts with hiring. We all know that due diligence always pays off when recruiting and doing background checks on potential employees, but Lee also values nontraditional assessments. One innovative example: He assembles a panel of residents and nursing homes staff to meet with job candidates so both sides can check and determine whether the candidate would fit with the culture and nature of the facility. Lee describes hiring as “very much a two-way process.” Also take note that support is also a two way street as Lee takes a humble approach to management. One way he does this is by turning the organization chart upside down. The top tier is the CNAs, dietary staff and homecare keepers, who Lee says have “the most opportunity to make a difference in the quality of (the residents’) lives.”

{In turn, it is management’s duty to ensure employees~In turn, it is the management’s obligation to make sure that the employees} have the best training and support to do their jobs optimally. This happy symbiosis fosters loyalty. Nineteenth Avenue boasts one CNA who has been on the job for 37 years, and there are lots of employees whose tenure ranges from 17 to 30 years. Social events are an excellent way to pay thanks to your staff. Not only does Nineteenth Avenue celebrate birthdays, company anniversaries and cultural holidays, but each monthly meeting concludes with a drawing for small cash prizes. Staffers who haven’t called in sick that month are eligible to win. In addition to the drawing, he spends less than $100 each month to buy small gifts for all attendees. The bottom line: Even small thank-you’s can be powerful.

Long-term care insurance is a good financial protection vehicle for anyone who has enough assets to protect and can comfortably afford the premiums. It can help ensure that all of the time and effort you have spent on acquiring a sufficient retirement income is not lost due to the rising costs of long-term care. There are several specific advantages for couples purchasing long-term care insurance. Consider this: most often, the healthier spouse acts as the primary caregiver. Without long-term care insurance, the healthy spouse often takes on the bulk of care giving duties, simply to try to avoid paying the high costs associated with either in-home care or institutional care. Eventually, this can leave the caregiver almost as ill as his or her spouse. Long-term care insurance helps provide the necessary funds so that the healthy spouse can make sure that quality care is provided for the ill spouse while not endangering his or her own wealth even further.

Couples can even save money on the purchase of long-term care insurance, as all major carriers will discount the cost of a policy by thirty to forty percent when both spouses are on the same policy. This can result in significant cost savings for married couples. The good news is that even those who may not be married but have lived in with someone else with whom they are in a committed relationship for a year may also receive the same discount for long-term care insurance. If one spouse is approved for a policy but the other has significant health issues that preclude him or her from qualifying for long-term care insurance, this does not mean that the couple should decline coverage for the healthy spouse. Long-term care insurance is still an advantage for this couple because no one knows which spouse will need long-term care first.

Once there is a major health reversal for the previously healthy spouse, the one who had health issues originally would be in an even more disadvantaged position as a caregiver. Should this be the case long term care insurance will provide the funds needed for quality care without further damaging the health of the spouse who was declined for the long-term care insurance policy. It would not be reasonable to forego health insurance for one spouse simply because the other cannot qualify for a major medical plan. The same is true for long-term care insurance. It may be disappointing that both cannot be covered, but the financial risks for each of them are still prevalent and should not be ignored.

There are so many reasons as to why people chose not to buy long-term care insurance. Some of those reasons may be based on very sound decisions. For instance, if you have made a thorough investigation into the cost of premiums from several of the financially sound major carriers and have found that the cost is more than you can reasonably bear, then long-term care insurance is not for you. But if you are like most people, the real reason that you are hesitant to prepare for possible future long-term care costs has very little to do with reasoning or sound decisions. Your hesitation is most likely based on feelings and emotions. Many people live in a state of denial about their possible need for assisted care services in the future. This is often because they have always been relatively healthy; therefore, they find it hard to even picture themselves in a state where they may need assistance with activities of daily living.

Or perhaps their parents died suddenly or within a short period of time, so they figure that most likely, the same will happen to them. Or perhaps the denial is so strong that very little thought has gone into the matter at all. If that is the case, this subject is probably so depressing to most of these people that they have consciously chosen to delay any decision about purchasing long-term care insurance until later. Only problem is, that time will never come. Why? None of these thought processes are based on fact. We all know that good health can change overnight. And also, I knew someone whose health situation changed greatly within a short period of time. This risk obviously increases with age, so the chances of it happening to any individual, including you and me, are very real. Due to the advances in medical science in recent years, using the health history of your parents as an exact guide for your own future home health care doesn’t work.

It is obvious that more people are living longer and often need more care in the last years of life. And long-term care is extremely expensive. If ever you are one who refuse to think about their future health care needs, ask yourself this: who will be left to make this decision for you? If you refuse to think about the subject, it does not make the possibility of needing long term care any less real. It simply defers the decision to those you love the most. They will often have to make decisions about your care at the last minute, when the choices are extremely limited, unpleasant and expensive. Our families will be well served if we all decide now to take responsibility for our own future health care needs and make sound decisions based on facts instead of unreasonable emotions.

Most people are already aware of the gaps within the original Medicare plan. For one, there’s no ” stop loss ” feature. Most health insurance policies will pay 100 percent toward certain medical services after you meet your deductible, for example, you might have to pay $1,500 per year before your benefits will kick in. If you have Original Medicare and need hospital care or must enter a nursing home, this applies to you. Many of these individuals buy Medicare Supplemental[spin] (Medigap) Insurance policies to fill in the gaps within their existing coverage, which might include co-payments or deductibles. [spin]Medicare Advantage Plans cover all the same services Original Medicare covers, and potentially some it doesn’t.

These plans are offered in some parts of the country through private long term care insurance companies, but are still part of the Medicare program. If you are planning to switch to a Medicare Advantage Plan, now’s the perfect time. Open enrollment for Medicare Advantage extends from January 1st through March 31st. You are eligible for a Medicare Advantage Plan if you currently have Medicare Part A or Part B. However, you will have to see doctors and use hospitals within the plan much like you would with an HMO. If you’d like to switch plans, always remember that you cannot drop Medicare prescription drug coverage. If your existing plan has prescription drug coverage, then your new one needs to have it as well.

For more information on the plans available in your area, visit Medicare’s web site or call 1-800-633-4227. Your new plan should be effective on the first of the month after your request is received. Are you still not sure of what Medicare plans cover? Gilbert Guide lists all of the major types of insurance as well as what they cover. For a detailed explanation, check out Gilbert Guide’s Medicare Explained or Senior Care Reimbursement Overview, which will show you where each type of insurance pays benefits.

CCRCs are living communities for seniors. Most have three levels of residence: independent living, assisted living and skilled nursing. Each level of residence is tied to the level of care that the resident requires. The primary concept behind a CCRC is that it offers a wider spectrum of care, so that once a senior moves into the community, he or she will be able to receive the appropriate care as his or her needs change. Many CCRCs support aging in place.

My latest article was all about coping strategies for caregivers, a topic I believe can never be exhausted. Therefore, I will continue the topic. This month I’m presenting several important strategies with a philosophical bent. For you to be able to make the most out of these strategies, take the time to think about what’s really important to you.

1. Open Your Hearts - It is important to be “tuned in to” our loved ones when we are with them. This should also include telephone conversations. During those times, always remember that the greatest gift that we can give is ourselves. We cannot turn back the clock and we cannot affect miracle cures. We can be emotionally available for the people we love who are ailing or frightened. Nurturing an open, honest and caring relationship is a tremendous gift to your loved one under senior care.

2. Take Care of Yourself - Alyce Rudden is a wonderful and caring nursing home social worker who told me, ” When we do this work, there must be other things in our lives.” I always thought of her wise words always. When your visit with a loved one comes to a close or you hang up the telephone, immediately do something for yourself. Have that cappuccino, take a walk in the park, or just take a moment to quietly breathe. Pursue activities that bring joy and pleasure. You need them now more then ever. Time spent on yourself will reap dividends in the capacity to “recharge” you for your loved one under assisted care.

3. Live Life Fully - Now there’s a tall order! However, I do believe that this is the most important order. Following the tragedy of September 11th, I spent a year speaking with groups of seniors in NYC. When I asked one group if they did anything differently following that day, one woman said, ” I hug my family before I leave the house every morning. We can’t know how long any one of us has to live. ” I will never ever forget that wise response. Don’t sweat the small stuff. Keep your priorities in order. Stop procrastinating. And when there is a choice of now or later, strongly consider now.

4. Finish Unfinished Business - Families can sometimes be messy and complicated. In some families, the adult ” children, ” who may be 50 or 60 years old, reunite when a parent becomes ill and then soon behave like five or ten year old children. Squabbles may ensue and statements like, ” Dad always liked you best, ” or ” You’re only interested in the money ” are common. The very best gift that a family can give themselves, and future generations, is to discuss and resolve longstanding resentments and disappointments, and come together in the anticipated loss of the loved one.

Families should come to terms with what was good as well as with what was not. Some families may wish to avail themselves of professional help to do this work. This is a lot to think about. So ruminate away, and please feel free to be in touch with any comments or questions.

In a long-term care insurance (LTCI) policy, the elimination period is always referred to as the policy deductible. In many ways it is similar to the deductible used in major medical insurance policies. One major difference is this: rather than a certain dollar amount that you will initially pay for your own care expenses, there is a specified number of days for which you will be responsible for your own homecare.

What are My Options?

Nowadays, there are only a few carriers that offer a zero day elimination period. The most common choices are 30, 60, 90, 180 and 365 days, however, these periods can differ from one carrier to another carrier. The choice of 180 or 365 days is most often made by those who have significant assets of their own. Selecting a much longer period can help them keep the expenses of LTCI very low. Even if one chooses a 90-day elimination period, the amount of funds put at risk is miniscule when compared to the asset protection afforded by the policy’s total pool of benefits.

What is a Reasonable Choice for an Elimination Period?

There are some popular financial authors who recommend setting it as low as possible, perhaps even at zero. It’s true that the shorter the elimination period, the less likely it is that you will have to pay out when the time comes for you to begin receiving care. On the other hand, low elimination periods can have a dramatic effect on the premiums that you pay throughout the life of the policy. Usually some form of compromise is necessary for the sake of affordability. In making a decision about the elimination period, many policyholders keep in mind that insurance is often used as a way to avoid suffering catastrophic financial losses rather than insuring against every possible expense. Accepting a small portion of the risk involved can be an economical and reasonable choice for most people.

The Smartest Thing You Can Do

Please keep in mind that what is right for most people might not be right for you. In deciding on the best elimination period for your particular situation, it is prudent to consider what the cost would be for the most expensive assisted care that you may have to receive, which is most often facility care. Once you have a good idea of the daily costs for facility care in your area, multiply the costs by the various elimination period choices and determine the amount that you feel is affordable. When you decide on the elimination period that best fits your situation, earmark those funds for your care, and allow them to grow so that they keeps pace with inflation, at the very least. Using a little financial common sense goes a long way toward making a wise decision about the LTCI elimination period.