Long Term Care: Planning for my Future Needs Our speakers are: - - PDF document

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Long Term Care: Planning for my Future Needs

Thursday, February 23, 2017 1:00 – 3:00 pm

You have two audio options:

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Long Term Care: Planning for my Future Needs

Our speakers are:

• Steve Shapiro, Medigap Insurance Counselor.
• Vicki Buchholz, Medigap Program Supervisor.

As insurance counselors, Steve and Vicki are advocates for consumers who seek insurance expertise through the Board on Aging and Long Term Care’s Medigap Helpline, a part of the Wisconsin SHIP program.

Medigap Helpline is a free insurance counseling service through the Board on Aging and Long Term Care with no cost and no relation to any insurance company.

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Long Term Care

Planning for Our Future Needs!

2/21/201 2/21/2017

Medigap Helpline Services WI Board on Aging & Long Term Care

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What is What is Long Term Care? Long Term Care? Delivery of services to Disabled and Aging persons.

• Population is Growing Older
• Life Expectancy is Increasing
• Social Structure (Family) has changed

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Types of LTC Care Types of LTC Care:

 Informal Care: Family or neighbor

VS.

 Formal Care: nurse or home health aide  Institutional Care: Nursing home

VS.

 Community Care: Care received in the

• community. ie: assisted living, adult

day or your home

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3 Types of 3 Types of Formal care care

1.

Skilled – 24 hour care needed (not received in the hospital)

2.

Intermediate – both intermittent skilled nursing care and help with activities of daily living are needed

3.

Custodial/Personal – non medical help with activities of daily living

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Informal care Informal care

 Typically from Family member or Neighbor  More than 43.5 million persons in U.S. will

be caregiver each year (Wisconsin had over 578,000 caregivers in 2015)

 Caregivers provide average 24.4 hours per

week in 2015. (60% also work outside of their home)

 Value estimated at $470 billion a year

(Wisconsin Value $7 billion in 2013)

 86% all Home Care by family caregivers.

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Where LTC can be received? received?

 At Home  Adult Day Care Facility (129 facilities) *  Residential Care Apartment Complex

(RCAC) (330 complexes) *

 Community Based Residential Facility

(CBRF) (1,571 licensed in State of WI) *

 Adult Family Home (1,969 Homes)*  Skilled Nursing Facility (Institutional Care)

(395 licensed in State of WI)*

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Costs of Long Term Care Costs of Long Term Care Services Services

The average costs*of care on a daily basis in the state of Wisconsin are listed below:

 Homemaker Services $129  Home Health Aide $133  Adult Day Care $66  Assisted Living Facility $126 ($3,780 mo.)  Nursing Home, Private Room $248 ($7.545 mo.)  Nursing Home, Semi-Private Room $238 ($7,237 mo.)

*This information came from the Genworth 2016 Cost of Care Survey.

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When is When is LTC needed? LTC needed?

When a person cannot perform their normal activities or safely take care of themselves or their home. Activities of Daily Living:

 Bathing, Eating, Dressing, Toileting,

Transferring, Continence

 Cognitive Impairment

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Who Pays for LTC? Who Pays for LTC?

Public Resources



Medical Assistance (Medicaid/T19)



Family Care (65 Wisconsin Counties)*



Community Options Program (COP)



Community Integration Program (CIP)

Spousal Impoverishment Protections

 Special financial provision with Medicaid regarding

income and assets that affect married couples applying for nursing home or home based community services.

 Community spouse income allowance is the lesser of:  $3,022.50 (2017) or  $2,670.00 plus excess shelter allowance (over

$801.00) (2016)

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IF the total countable assets of the couple are: Then the Community Spouse Asset Share is: $241,800 or more $120,900 Less than $241,800 but greater than $100,000 ½ of the total countable assets of the couple $100,000 or less $50,000

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Medicare vs. Medicare vs. Long Term Care insurance. Long Term Care insurance.

 Medicare is NOT LTC coverage  Medicare will cover up to 100 days of

Acute Care in a Skilled Nursing Facility after a qualified 3 day hospital stay- Medically Necessary only

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Who Pays for LTC? Who Pays for LTC? (cont)

(cont)

• Private Resources – Personal

Income, Assets or Resources

• Insurance Resources – Disability
• r Long Term Care Insurance
• “Informal” Resources

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Long Term Care Insurance

Do I need Long Term Care Insurance?

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INSURANCE INSURANCE

 Purchasing Insurance is based on

RISK. Cost of Paying for Services

VS

Cost of Premiums

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Can I Affor Can I Afford the LTC Premium - the LTC Premium - Now and in Now and in the Future? the Future?



NAIC & State Guideline: premium is not to exceed 7% of adjusted gross income



LTC insurance premiums are not guaranteed to stay the same in a policy



Contingent Non-Forfeiture Benefit protection

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Cost Analysis Cost Analysis

Example: Cost of Purchasing a LTC Policy Purchase age: 65 Premium Cost: $2000 a year Life Expectancy: age 85 Premium outlay over lifetime: $40,000 Policy Payable toward Services: $175 daily benefit X 30 days = $5,250 $5,250 X 12 months = $63,000 yr $63,000 X 2.5 year Average stay = $157,500.

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Why Consider Why Consider Purch Purchasing a sing a LTC Insur LTC Insurance nce Policy? Policy?

Some reasons may be:

 Living Longer  Rising Costs of Long Term Care Services  To help make Savings last longer  To help protect an estate for heirs  To help get a better quality of care  Not having a spouse or other family member

able to offer assistance or support

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Can I Can I Even Buy LTC Insura Even Buy LTC Insurance? nce?

An Insurance Company is allowed to ask “health questions” on an application for a Long Term Care Insurance Policy. This is called “Underwriting”. An Insurance Company CAN REFUSE to Issue Coverage based on results If a LTC policy is issued, the longest Preexisting Waiting Period allowed is 6 months.

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Wisconsin Long Term Care Wisconsin Long Term Care Insurance coverage Insurance coverage

 LTC policies issued in WI must provide

both Nursing Home and Home Health Care coverage

 LTC policies are designed to cover

chronic care not acute care

 The policy pays according to the

policy’s defined insured amount

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Options to Options to conside consider in in LTC insurance LTC insurance

 Daily Benefit Amount  Benefit Period  Elimination Period  Alternative Plan of

Care

 Renewability  Waiver of Premium  Assisted Living

• ptions

 Inflation Protection  Non Forfeiture

Benefit option

 Return of Premium  Spousal Options  Partnership Qualified  Many other options

to consider

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Filing a Claim Filing a Claim on your

• n your

LTC Policy LTC Policy

A claim can be filed toward your policy once meet the Benefit Triggers:

Activities of Daily Living: Bathing, Continence, Dressing, Eating, Toileting, Transferring Or Cognitive Impairment

Incidental Activities of Daily Living do not meet the criteria for policy to pay a claim (Cooking, cleaning, paying bills, yard work.)

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LTC Qualified Partner LTC Qualified Partnership hip Policy Policy

 Federally Tax-Qualified Policy  Requires Inflation Protection  Wisconsin Medicaid allows a person

who uses their qualified Partnership LTC policy to be able to disregard the equivalent value of assets to the benefits paid from the policy in qualifying for Medicaid benefits.

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Home Health Care Insurance Home Health Care Insurance

 Cover care received in the community.

That is, Home Health Care or other Community care.

 Home Health Care does not cover

Nursing Home stays.

 Home Health Care policies may or may

not pay for community based services such as Adult Day Care.

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Nursing Home Insur Nursing Home Insurance nce

 Cover only institutional (nursing home)

care.

 Nursing Home Insurance does not

provide coverage in your home.

 NH only coverage may or may not

provide care in assisted living facilities.

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Life Insurance Long Term Care Riders

 Another way to insure long-term care

expenses.

 Different from Long Term Care Policies  Monthly benefit typically a percentage of

the life insurance policy face amount.

 Payment of LTC benefits reduces the

death benefit amount of the life insurance policy.

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Annuity Long Term Care Riders

 Offered by some Life Insurance

Companies

 Allows you to use accumulated funds in

the annuity to pay for LTC expenses without applying surrender charges.

 Companies charge additional premiums

for this rider.

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For Additional Information: For Additional Information:

 Medigap Helpline: 1-800-242-1060  Wisconsin Office of the Commissioner

• f Insurance: 1-800-236-8517

 National Association of Insurance

Commissioners website: www.naic.org

 Local Aging & Disability Resource

Center.