Long Term Care: Planning for my Future Needs Thursday, February 23, 2017 1:00 – 3:00 pm You have two audio options: • you can use your computer to receive the audio • you can join by Wisline: 855‐947‐8255; Passcode: 7099 369# 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. 1
Long Term Care Planning for Our Future Needs! Medigap Helpline Services WI Board on Aging & Long Term Care 2/21/201 2/21/2017 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 4 2
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 5 3 Types of Formal care 3 Types of care Skilled – 24 hour care needed (not 1. received in the hospital) Intermediate – both intermittent 2. skilled nursing care and help with activities of daily living are needed Custodial/Personal – non medical 3. help with activities of daily living 6 3
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. 7 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)* 8 4
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. 9 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 10 5
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) 11 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) IF the total countable assets of the Then the Community Spouse Asset couple are: Share is: $241,800 or more $120,900 Less than $241,800 but ½ of the total countable assets of the greater than $100,000 couple $100,000 or less $50,000 12 6
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 13 Who Pays for LTC? Who Pays for LTC? (cont) (cont) Private Resources – Personal Income, Assets or Resources Insurance Resources – Disability or Long Term Care Insurance “Informal” Resources 14 7
Long Term Care Insurance Do I need Long Term Care Insurance? INSURANCE INSURANCE Purchasing Insurance is based on RISK. Cost of Paying for Services VS Cost of Premiums 16 8
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 17 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. 18 9
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 19 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. 20 10
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 21 Options to Options to conside consider in in LTC insurance LTC insurance Daily Benefit Amount Inflation Protection Benefit Period Non Forfeiture Benefit option Elimination Period Return of Premium Alternative Plan of Spousal Options Care Renewability Partnership Qualified Waiver of Premium Many other options to consider Assisted Living options 22 11
Filing a Claim Filing a Claim on your on 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.) 23 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. 24 12
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. 25 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. 26 13
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. 27 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. 28 14
For Additional Information: For Additional Information: Medigap Helpline: 1-800-242-1060 Wisconsin Office of the Commissioner of Insurance: 1-800-236-8517 National Association of Insurance Commissioners website: www.naic.org Local Aging & Disability Resource Center. 29 15
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