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Posts Tagged ‘adult care’

On Monday, the New York Times ran a great 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. There are some cases when the seniors did not 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:

Deceptive marketing strategies that don’t 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.”

Medicare Advantage programs can help some consumers to finance their senior care, but these plans are not for everyone. There are some factors that need to be considered before you sign 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.  Also remember that 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.

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!

Long-term care insurance (LTCI) policies are very different from most other kinds of insurance. As a result, even the foundational features of these policies require taking some time to understand before making your final decision. However, what about all the other choices and features which are not built into the policy and requires you to pay extra to get them? In my opinion, LTCI policies are best kept simple. If you have done your homework on setting up the foundational features of the policy, you have already done 90% of the work in most cases. It’s a good idea to explore those other options if you feel that you can afford to spend more on your care, but you should also examine whether they are truly going to be cost-effective in your case. One good way to do this is to narrow down your selection to the two to three carriers that you feel most comfortable with and get quotes on a straightforward policy setup with no extras or options added.

Next thing to do is to add on the choices that you are interested in one at a time and then get a new quote. This will tell you exactly how much extra you can expect to pay for these options. If you have all those figures, then it is much easier to decide if the choices you are considering are really worth pursuing further. Here is a list of some of the most popular options in LTCI or Long Term Care insurance policies:

1. Return of Premium – This will give you the option of allowing you to recieve back some or all of the premiums that you pay into the policy if you either decide to cancel the policy or if you die without using all of your benefits. This is often a very expensive option.

2. Survivorship – For this option, the benefits differ from one carrier to another, but typically it says that if the policy premiums have been paid for a specified period of time, often ten years, and one spouse dies, the surviving spouse’s policy is considered as paid up with no other premiums required.

3. Restoration of Benefits – This provision restores all of the benefits paid out for care if a policyholder fully recovers and does not suffer a relapse for a specified period of time (usually six months).

4. Waiver of Home Health Care Elimination Period – This option reduces the elimination period (the amount of days that you pay for your own care before the insurance company starts to pay) to zero. This only means that it starts to pay from the very first day of services made if the care is recieved at home. There are other options that can be considered when shopping for LTCI too, but in my experience the most common danger is getting bogged down in these extra features that do not really impact the quality of your future care nearly as much as the foundational features.

This is one reason why getting an experienced and knowledgable agent help you with the process can often reduce much of the confusion surrounding these options so that you can select the policy and features that suit you best.

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 always a specified number of days for which you will be responsible for your own homecare.

What are My Options?

These days very few carriers 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?

Some popular financial authors 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 negotiation is necessary for the very sake of affordability. In making a decision about the elimination period, a lot of policy holders remember that insurance is always 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

What’s right for most people, however, may not be right for you. In deciding on the best elimination period for your particular situation, it is important to check 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.

Some private insurance companies sell LTCI policies to offset the costs of long term care. LTCI, like all insurance policies, requires premiums to help recipients avoid paying large sums later on in the event of an illness or a catastrophic event. Premiums are based on the individual’s age at the time of purchase and are usually locked in for the life of the policy. LTCI covers the following, depending on the policy you choose:

Care in a skilled nursing facility

Care in an assisted living facility

Home health care

Adult day care

Buying a LTCI policy allows the policyholder to choose from many options, such as the amount of the daily benefit, the number of years the policy will pay benefits, and, once the applicant qualifies for a policy, the number of days or months before the policy will begin paying benefits.  It’s very important to evaluate policies carefully to see which one offers the benefits you require with a premium that fits your budget. Policies differ in their benefits, contract conditions, deductibles and premiums.

It is also important to take into account the rising cost of home care. Be sure the LTCI policy gives inflation protection for benefits to increase as health care costs continue to rise. Policies are generally labeled according to the place in which benefits are paid.    Remember that homecare only policies only pay for care at home and in an adult day care or adult day health care facilities. Make sure the policy includes both types of day care.  Meanwhile, facility only policies pay for care in a skilled nursing facility and in an assisted living facility.  Comprehensive policies pay for care in a skilled nursing facility, assisted living facility, adult day care or adult day health care facility, and at home.  Since LTCI claims are often paid many years after the purchase of the policy, it is imperative to check the following:  Financial strength of the company. The industry’s major rating services are A.M. Best , Duff and Phelps, Moody’s, Standard and Poor’s and Weiss Ratings .   Reputation and claims-paying history of the company.

Contact your State Insurance Department for information on specific private insurance companies. Check here for more listings information for each of the state’s insurance information. Applicant must be healthy at the time of application   Each insurance company has individual requirements and/or limitations   Not sure when is the right time to buy an LTCI policy? Or how to assess what you will need from a policy? Visit our Expert Column on Financing Long Term Care to find out more.

It’s no surprise that with age, seniors often experience increased limitations, the loss of certain abilities and require more assistance with the activities of daily living. It is equally unsurprising that one;s finances  largely influence the types of services and long-term care available to that individual. An experienced financial planner for the elderly can provide the seniors and their families with invaluable advice on money issues and more,  to help seniors find the appropriate solution to their particular situation. Some of the questions a financial  planner can address include:  What type of long-term care can I afford? Will I outlive my assets? How much are all my assets worth? Can I make my assets create more income to meet growing expenses? What do I sell first? What are all my options? What is the cost of selling different assets? Do I have to sell my own house? Are there other financing alternatives? What impact will this have on my spouse and dependents? Is it too late to do any estate planning? What about inheritance issues?

Listening to Your Needs – Financial planners can assist you in understanding and evaluating your decisions,  which will help you avoid confusion, frustration, major errors and family dissension. Financial decisions are more  than about just money, I know from experience how difficult it is for everyone involved. Making major financial  decisions can be even more daunting when you don;t have the detailed knowledge, time, experience or ability. What are the potential impacts and benefits of making one decision over another? So what are the requirements to execute such decisions? Financial planning for senior care begins with acknowledging and considering all present and  possible future situations you might encounter. This can be very difficult as it requires both forward thinking as  well as transitional realism. By ” transitional realism, ” I mean about being realistic about your changing needs, and the impact of those needs on your life as well as the lives of  your loved ones. When evaluating your needs, a financial planner should consider:

Personal care, do you need assistance with activities of daily living? Services, what types of long-term care services do you require? Are there any specific concerns with regards to safety? Transportation;are there physical or financial considerations? Priorities, what are your desires and limitations? Interpersonal relationships;how will financial decisions affect your loved ones? Following is a list that comprises the elements you should consider in identifying  and evaluating your needs. You may want to think about these things before talking to a financial planner to ensure  the time you spend in conversation is well spent. If you happen to have questions about any of these elements, a financial planner  who works with the elderly will be well versed in all of these issues and should be able to address any concerns.  Financial needs Insurance coverage and limitations Income sourcesExpenses (present and future) Assets availabilityReal estate needs Human resources: home health care, personal and quality-of-life issues After you have indentified all of your needs, think about the resources that you will need, and  the ones that you already have at your disposal.

This can help you in developing a plan of action.  Make a list of the following  resources that you might need: Public resources like prepared food services, community activities, religious and charitable assistance/support, etc.Private resources, including family members and/or homecare caregivers. Planning can make a huge difference in finding the best solutions. Knowing all of your needs and resources is paramount before making any major financial changes. Financial decisions should be holistic in nature, therefore recognizing that everyone, seniors and caregivers, all have   different needs and resources, unique to their particular situation. Making financial decisions based only   on your present situation, without full consideration of everything, can have disastrous results.

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 health inspection surveys, staffing information and quality of care data. 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 also does not account for family or patient satisfaction. The point is to help consumers compare nursing homes more easily. CMS advises consumers to use the star ratings to narrow their options, then review the deficiencies and citations in detail.

But the problem with this is that the ratings are sometimes unfair or misleading, essentially excluding some facilities from the consumer search to begin with. It’s an oversimplification of a very complex system that gives consumers only part of the picture. Looking ahead. Since it was implemented, the rating system has been under scrutiny from the nursing home industry, which is concerned about inaccurate representation of facilities, as well as consumer groups, who want understandable, reliable 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.