Health Insurance

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.

For seniors who are living on their own, mental health is always dependent on their capacity for self awareness and also their own willingness to seek appropriate senior care. For those living in nursing homes or other long-term care facilities, the situation is a little more tenuous. As the numbers show, depressive and behavioral disorders are prevalent in these settings. In addition to the usual stressful work associated with aging, such as loss of loved ones, physical deterioration, and fears related to death, seniors in long-term care facilities often struggle with increased isolation and debilitating physical ailments, which can always reproduce latent mental issues. Since residents of senior facilities are often in poor health and have decreased cognitive functioning, it’s not always easy to evaluate and treat these individuals.

How Medicare Helps Seniors with Depression

The Nursing Home Reform Act of 1987 have announced screenings for mental illness and the reduced use of chemical and physical restraints. As part of the Omnibus Budget Reconciliation Act (OBRA), this law mandated some pivotal changes in nursing home care, giving importance to the quality of life. In 1990, Congress responded by revising the Medicare laws, specifying the beneficiaries will recieve mental health care, should it be needed. Unfortunately, Medicare does not cover blanket screening procedures. This makes it impossible to discover hidden symptoms that residents sometimes hide to avoid stress and shame. In 2002, however, Medicare recognized the value of psychological services coinciding with the management of medical conditions. I translate this as such: Once you are already physically very ill, then your mental health is very important. If depression or mental illness is detected, and a doctor refers the resident to a psychiatrist, Then Medicare will take care of 50 percent of the approved amount. This is a hefty co-payment, especially in relation to the 80 percent Medicare covers for doctor’s office visits. I think it’s safe to say navigating through the Medicare system can be a little confusing.

Treating Depression in Long-term Care Facilities

A lot of organizations have risen to bridge the gap between mental health and long term care. VeriCare, for example, partners with skilled nursing and other residential facilities to make programs which are tailored to their resident’s needs. This company, founded shortly after the Nursing Home Reform Act, improves compliance with OBRA standards and provides behavioral and mental health services which is unavailable when it comes to most long term care settings. In searching for a nursing home facility, a process in which Gilbert Guide simplifies, it may be wiser to ask as to what mental health systems may have in place. With over 50 percent of nursing home residents exhibiting signs of depression and under 5 percent of those individuals receiving treatment, it’s crucial to plan ahead. I certainly wouldn’t choose a home for my grandmother if her physical health might be jeopardized. I’m even more hesitant to choose a place that doesn’t recognize her mental well being as equally important.

There are lots of caregivers who are placed in a role in which they are unprepared. Meeting with medical professionals can be intimidating, as we are living in a society that thinks doctors in white coats are seen beyond reproach and are sometimes unapproachable. But as all family caregivers know, it is their job to ensure that the family member’s needs are seen to, that person depends on their advocacy. Patients and senior care caregivers often feel that physicians and medical professionals are too busy to “hear” their concerns. Below are a few tips to make sure you get the most out of your doctor’s visits.

Before Your Appointment - Remember to be prepared and have detailed and important information for your doctor. For example, ” My father hasn’t been feeling well ” is not as easy for a doctor to assess as ” my father has had a fever for two days that was over 100°F. He also has had tingling sensations in his left leg for four hours. “

Always keep a list of all health concerns and then put them in order of importance. This list will help you bring up any home care issues, and keep both you and your physician focused on what matters to you.

During Your Appointment - Pay attention. The likelihood that you will retain everything that the doctor explains to you, especially if it isn’t good news, is slim. Help yourself recall the information your physician tells you by using the 3 R’s: record, write or rope in a relative or friend. Take notes during the conversation or directly after, when information is fresh in your mind. Taking a small tape or digital recorder with you can also be helpful. Having another set of ears listening may also help you decipher the full meaning of the information later on. Ask for clarification when a term or concept doesn’t make sense to you.

Specialists sometimes use a lot of medical jargon. Make sure you are effectively communicating. Doctors often are very busy people. Listen to what they are saying. Don’t waste anyone’s time, including your own, by rambling on in conversation. Make certain they know your feelings, a doctor can only guess until you say something. Both doctors and caregivers are in the business of helping people. Go in prepared to make sure you get the most out of the experience, and keep in mind that you came to provide long term care to another person.

In previous blog articles I have discussed the long-term care insurance partnership program that almost two thirds of the states have already put in place or are in the process of approving for their residents. This program is designed to encourage the purchase of LTCI by consumers so that the state can reduce its liability for paying for long term care costs in the near future. This is vital if current state Medicaid programs are going to remain solvent. The advantage to customers is that the state acts as the safety net for all of them in case their care exceeds the benefits of their LTCI policy, and they are guaranteed that long-term care costs will not be allowed to completely wipe out all of their assets. The question is what identifies a policy as being partnership qualified? There are several qualifications that were outlined in the federal Deficit Reduction Act of 2005, including the need to be federally tax-qualified and to contain the consumer protection provisions of the NAIC LTC Model Act and Model Regulation.

Majority of the policies sold today already have those provisions. However, there is one requirement that contributes more than almost any other to qualifying a LTCI policy for the partnership program. It needs to have the age-appropriate inflation protection benefit. These requirements are as follows: Those age 60 or younger must have ” compound annual inflation protection. ” Those at least 61 but younger than 76 must have ” some level of inflation protection. ” Those by the age of 76 or older must be offered an inflation protection option but they are not required to purchase that option. Why is inflation protection given such prominence in partnership-qualified policies? The answer is that if partnership-qualified policies don’t have inflation protection, the purpose of a partnership program may be defeated. This is because the whole point of the partnership program is to help relieve the financial burden of long-term care costs from the state Medicaid systems.

If a consumer buys a LTCI policy but does not allow it to keep pace with the rising costs of assisted care, the insufficient benefits will most likely to force the policyholder to turn to Medicaid anyway. With very few assets left, the state will have to pick up the rest of the bill for this individual and the original intent of the program is defeated. A very important lesson that can be learned is that inflation protection is a vital component of any LTCI policy;whether partnership-qualified or not.

For most of us, life is one juggling act where family, home, work and play are a few of the many things that we try to balance. But what if you could get some of these pieces to fall into sync with each other? A number of recent articles I have read pointed out how Vermont seems to be doing exactly this for its citizens. In 2005 the state known for its maple syrup, Ben & Jerry’s and forward thinking began to implement Care for Choices, a new plan for Medicaid-eligible seniors who need assistance. The choice in this case is twofold: the elder can stay at home and the assistance is given by a family member, friend or neighbor who is paid by the state to provide homecare care for the individual. (In the past I have written articles as to how the internet can help in managing family caregiver duties. In this case it’s the state, at least in Vermont, that is offering its own helping hand by paying family senior care caregivers whose finances or time is strained when trying to balance both work and family.) So why is Vermont doing this anyway? Well, the reasoning is fairly simple; the state simply needs to be proactive. According to the May update from the Vermont Department of Disabilities, Aging & Independent Living, ” the state’s fastest growing age group is…65 to 74, [which is] projected to grow 62% during the period 2005–2015. ” The report stated that in 1996, Vermont spent 88% of its public long term care dollars on nursing homes facility care leaving 12% for home and community-based services.

Today, the figures are 68% and 32% respectively, giving Vermonters greater choice in their long term care options. And it isn’t just Vermonters who benefit, the state does too, withe caregivers being paid an hourly rate about $10, with an eight-hour day costing $80, whereas skilled nursing facilities cost the state on average about $122 a day. But there are still a few unanswered questions, is this keeping those seniors who do not require skilled care out of nursing facilities? Even worse yet, keeping those who need skilled care inside their homes with caregivers not able to provide them with all the care they needed? How many people not requiring skilled care have been made to move into a facility preemptively? And will this really make a financial difference to the state? These are the types of queries that only time will be able to answer. What we do know so far is that the numbers of seniors who are eligible for Medicaid in skilled nursing facilities has dipped and rates of homecare have increased since the Care for Choices plan first came into action. And every person’s scenario will be different. However, in my opinion, every time the state steps in to ensure that a senior’s needs and desires are met should be applauded. I’m sure many Vermonters welcome the opportunity to aid seniors with household chores, getting dressed or even rides to a doctor’s appointment. Knowing that the state will compensate you for your work could take financial pressure off of many family caregivers. And whether this proves the best option for a particular person comes down to personality, compatibility and needs;similar to the process of choosing the right facility for yourself or a loved one. And no one can argue that choosing is better than being told.

No one likes to pay insurance premiums of any kind and long-term care insurance is no exception. We pay these premiums because the alternative leaves our retirement income and investment assets exposed to high risk if long-term care becomes necessary and, of course, we have to pay for the care ourselves. It is no secret that the cost of nursing facility care can quickly drain a retirement nest egg and force a retiree into financial ruin. By getting a long term care insurance or LTCI, a policyholder is accepting a small loss each year in the form of premiums paid. This small loss helps making sure that he or she will not be wiped out financially by unmanageable long-term care costs in the future. People who are unfamiliar with long-term care insurance often wonder how long the premiums will need to be paid. The answer is that there are three choices for the premium payment period usually offered by insurance carriers.

The most popular choice so far is a “lifetime” payment period that requires the payment of premiums until death or until the policy is activated. There are people who oppose to paying these premiums for a long time. In response to that objection I usually ask prospective clients to consider other forms of insurance that they most likely own. For instance, would they expect to only pay premiums for health or major medical insurance for a short time, or do they plan on paying those premiums for life? Wouldn’t they expect to pay auto insurance premiums for as long as they drive? Isn’t it reasonable to pay homeowners insurance premiums for as long as they own a home? As long as the financial risk is present, the payment of insurance premiums is prudent. Since the risk of needing long-term care is present for as long as we live, the premiums for long-term care insurance can be expected for the remainder of our life.

The second and third options for payment of long-term care premiums allow the policyholder to condense all of those expected premium payments into a shorter time period. For those under fifty-five years of age, a “pay to age sixty-five” option may make sense. For others a “ten-year pay” option may be a good choice. Because the expected premium payments over a lifetime are simply condensed into a shorter time frame, the cost of these premiums is much higher. So therefore, these choices usually makes sense for policy holders who can take advantage of tax deductions that help them reduce the overall cost of their long-term care insurance..