Health Insurance

A level of frustration is inherent in Alzheimer’s and dementia , not just for the person who has it, but also for that person’s caregiver(s). Until recently, caregivers were advised to “correct” a dementia patient in regard to actions not considered “normal”. Today a gentler approach has superseded this wisdom. For example, a dementia care patient, forgetting that he is retired, may begin to dress for work. So nowadays, caregivers are always told to ” go along ” with the patient’s sake, help them pick out a tie or what-have-you, and then slowly move the discussion to other matters until the fact that he must go to work slips his mind. I have one friend who is a licensed CNA, and an in-home caregiver with over a decade’s worth of experience providing long-term care to dementia patients.

Rita’s voice appeals its rythmic Irish phrasing and accent, her laughter and graying red curls burst forth from her small frame in spurts of abundance. I had the chance to talk to her about her own personal care philosophy. When I mentioned the above situation, she responded, “You have to let them get dressed for work. You have to let me them go through their moments.” Her philosophy is definitively one of diversion, but she says she came across this naturally, and told me, “The man I look after now is a person. There are times when he’s going through something or having a moment, but he’s always a person.” She then stressed the importance of eye contact as she finds dementia patients are ” in their own world and they are clinging onto ideas, it is often hard to distract them from that so you need to make sure they really see you.” She went on to explain, ” It can be difficult because they are so strong-willed.” I asked how her patient was that evening. She said, ” He is absolutely wonderful. I’m holding hands with him right now,” and I could hear her mouth breaking into a smile even over the phone line. This vacillating between great joy and stress seems par for the course for many homecare aides. Caregiving is truly an interdisciplinary field where science, the mind and the heart have to combine for any real success to occur.

Rita’s patient is medicated and his aides overlap at different points in the day to help him with walking. One aide walks in front of his walker and the other on the back. Once during this exercise, a family member was talking about an issue in the family business, and although normally the man would be completely engulfed in the act of walking, he exclaimed in a jovial manner, ” Well, it’s my dough anyways! ” to everyone’s amusement. I also asked Rita how she deals with a job that can be rewarding, but can sometimes be quite tiresome, both physically and emotionally. She mentioned attending social events, in her opinion, nothing relieves stress as much as a good party with friends. She also made mention that even her patient was able to attend the odd family occasion, but big crowds stress him as do unfamiliar faces. I inquired as to whether he remembered her, after all, she works there five days a week. ” Oh now, I began working here too late. He doesn’t know my name, but, you know what, he is always happy to see me and calls me a nice lady. “

There are actually so many opinions about LTCI or long term care insurance which are mainly based on anecdotal evidence. Once a year, the American Association for Long-Term Care Insurance publishes a LTCI Sourcebook that cuts through the fog of opinion by helping to establish the facts. The 2009 version of this publication just became available and here are some of the results of the data gathered from a large sampling of the leading long-term care insurers for those who only have a single long-term care insurance policy:

The number of claimants and policyholders paid in claims: 8.25 million Americans currently have long-term care insurance and last year 8.5 billion dollars were paid in claims to 180,000 policyholders.

Age of claimants: Of the new claims opened during 2008, 61% of claimants were age eighty or older, 30% were between seventy and seventy-nine and only 9% were under the age of seventy.

Sales by issue age: It was found that 24% of long-term care insurance buyers were between the age of forty-five and fifty-four. 53% were between fifty-five and sixty-four. 15% were between the age of sixty-five and seventy-four.

Sales by daily benefit amount: Only 6% have bought policies with a daily benefit between $50 and $99, while 31.5% were between $100 and $149, 35% were between $150 and $199, and 27% bought more than $200.

Sales by elimination period: The overwhelming favorite elimination period chosen was ninety days, with almost 83% of buyers choosing it.

Sales with the use of benefit period: Benefit period choices by long-term care insurance consumers were as follows: 2 years, 7%; 3 years, 30%; 4 years, 15%; 5 years, 24%; 6–10 years, 11%; and Lifetime/Unlimited, 13%.

Sales by benefit increase mode: 40% chose 5% compound interest, 16% chose simple interest, 13% chose a Future Purchase Option, 7% chose CPI (consumer price index), 14% chose none, and 10% chose other forms of inflation protection benefits.

Care settings paid for: 42% of long-term care insurance claims paid were to policyholders receiving home care, 30.5% to those in a nursing home, and 27.5% to those in an assisted living facility.

There are still many other interesting facts that was revealed by this important gathering of data that I will include in the next articles. The information presented here should be helpful to anyone who is seriously considering the purchase of long-term care insurance.

On a clear Monday morning, the New York Times ran a good story about Medicare Advantage Plans. Medicare Advantage Plans are a type of home health care plan sold by private insurance companies. These plans are actually associated with Medicare. It seems that seniors across the country have been duped into signing away their Medicare benefits by enrolling in a Medicare Advantage Plan. In some cases, the seniors didn’t understand how the Medicare Advantage Plans worked, and in others, they didn’t even know that the insurance agents had signed them up for the plan. The insurance companies that sell these plans have been accused of several bad practices, including:

There are deceptive marketing strategies that do not make a clear distinction between Medicare and Medicare Advantage Targeting of uninformed seniors in low-income areas by pushy agents with hard-sell techniques, Outsourcing customer service to overseas call centers, whose employees have substandard knowledge of the complex Medicare system, Insurance agencies such as Medicare Advantage Plans undergo greater scrutiny than they have in the past;and it seems to be helping at least a little. Kerry N. Weems, the acting administrator of the Centers for Medicare and Medicaid Services, says, “There are substantially fewer violations, and those violations are of substantially lower severity than in previous marketing periods.”

It is true that Medicare Advantage programs can help some customers to finance their senior care, but these plans are not for everyone. There are factors to consider before signing up for any type of Medicare Advantage Plan. Here, a few of the most essential issues: Make sure your doctor(s) and local hospital are within the insurance company’s network of providers. Medigap policies become null and void once you are enrolled in a Medicare Advantage Plan. If you already have a Medigap policy, cancel it once coverage begins with a Medicare Advantage Plan to avoid paying twice.

Some Medicare Advantage plans vary greatly. You are giving up all rights to your existing Medicare policy, so pick a plan that will meet your future senior care needs as well as your current ones. Always read the fine print. This is an important decision, don’t rush it! We live in a society where the buyer must beware. Call your parents tonight! Make sure that they know about the issues concerning Medicare Advantage. That phone call could be the one thing that saves them from making, or worse yet, being pushed into a decision that isn’t right for them. You don’t even want to think about the alternative!

A close family friend recently phoned me to ask, “So I am thinking about long-term care insurance, what exactly should I be looking for and where do I start? ” And my answer was, ” Are you confused?” “Yes.” “Well, that’s how most people start.” We both laughed, but the point remains that picking a long-term care insurance plan can be very confusing. Some of the other postings on this particular subject I have covered the benefits of buying a policy especially in the early years of retirement. But what should you be looking at when you are shopping around for an LTCI policy? and how do the policies actually work?

1. Check out what will be covered. LTCI policies vary and may cover home health care, homecare, adult day care (and health care), assisted living, skilled nursing care, hospice care or some combination of these, but one must look closely and see what is being covered. Your best bet is to get a policy which covers most, if not all, of these possibilities.

2. How benefits will be paid out. Most of the policies pay by a daily benefit. Sometimes the daily benefit is calculated using a monthly average. This is an advantage when working with nurses, aides or homecare might work sporadic hours if, for example, a family caregiver is available. Secondly, benefits are paid on either an indemnity or reimbursement plan. So benefits are either a lump sum payment regardless of what the charge is OR (in the case of reimbursement) the insurance carrier will only pay the actual charges for care even if the charge is lower than the maximum daily. There are times when the unused funds are carried over.

3. When your coverage will begin. Many policies spell out how many activities of daily living (like dressing or bathing) you must need assistance with before your coverage begins. There is also a waiting period, which usually runs from 0-90 days, but sometimes is longer. So you need to consider what you can afford to cover before your benefits kick in.

4. How long will your benefits last. How long do your benefits need to last;a few years? 10 years? Although this is somewhat of an unknown, you need to take into consideration if you are predisposed to a chronic illness and what kind of funds you may have at your disposal.

5. What will your benefits be “worth” once they are paid out to you. Not only should you look at how they are paid out but what is exactly paid out in regard to inflation. Many policies offer some sort of inflation protection. Considering long-term health care costs only seem to be rising, this protection translates into having a financial cushion protecting your assets.

6. Which resources can help you make the best decision. There are three resources you need to use to make the best decision: ratings companies, a reliable agent and yourself. Always make sure that you select a company which has been in business and is highly rated by A.M. Best, Moody;s, Standard & Poor;s, or Weiss. Looking for professional assistance with long-term care insurance and which policy might meet your needs? Get a free long-term care insurance consultation and quote. Finding an agent is tricky. Many people are “referred” by carriers or internet searches. This is akin to mushroom-picking by memory, it is not in your best interest. Look for an agent that sells a variety of products, but specializes in LTCI.

Also, if the agent’s commission rates are standardized, then it is not financially gainful for him or her to up-sell you. And although most of these decisions can and should be aided by professionals, it is always your job to be vigilant. Use common sense along with the help of professionals. It can be hard to determine what your long term care needs are. A good place to start is by looking at what many consider the baseline;that is, what the federal government offers to its employees via the Federal Long-Term Care Insurance Program.