FAQ's
Private Long-Term Care Insurance Policies
Links to FAQ's on this page
What is it? | Why Me? | Who Pays?
Costs | Insurance | Coverage | Eligibility
Medicare & Medicaid
Original Medicare | Part A, Part B | Replacement card | Premiums
Prescriptions | Medicaid | Bills | Claims | Plans
Recommendations | Medicare + Choice | Medigap | HMOs
Re-enrolling | State Health Insurance Assistance
http://www.medicare.gov/
Also see our Viatical Settlements FAQ page
What is long term health care?
How does it differ from other kinds of health care?
Long term health care is the variety of services necessary for someone who requires some form of daily, ongoing assistance. This may include such things as housekeeping, financial management, bathing, dressing, transferring from a bed or chair, as well as assistance with meal preparation, feeding and toileting. While people often think of this as care for elders, there are many physical and mental conditions that require long term care at younger ages as well.
Why might I need long term health care?
Studies published in the New England Journal of Medicine and other publications, indicate that for individuals over 65, there is a 43% chance of needing some form of long term care. For married couples this means a risk of more than 80 percent that one spouse will need such care at some point. For most retirees this is the largest threat to the income and assets they have accumulated over a lifetime. Compare this risk to that of a house fire (1 in1200) or an auto accident (1in 240).
Won't Medicare, Medicare Supplement Policies such as Medex, or my retiree health benefits, pay for most of my long term care costs?
NO! These programs pay only for hospitalization and a brief period of post hospital recovery, usually less than 60 days. According to the most optimistic estimates, Medicare paid for less than 9% of the total long term care bill last year. Congress is expected to further curtail such benefits as home health care paid for by the Medicare program. Unless you have already purchased a private long term policy, less than 3% of nursing home care and a minimum amount of home care is paid for by your current health care insurance.
What are the costs associated with Long Term Care?
Last year, the average cost of a semi-private room in the North-eastern US was between $165.00 and $185 per day. A private room is likely to run more than $200.00 per day. The Massachusetts Rate Setting Commission recently approved hourly rates for a home health aide at $18.00 to $22.00 per hour.
How much should I expect to pay for a Long Term Care insurance policy?
The cost of obtaining insurance coverage of long term care will depend on several things; your age on the date you applied for coverage; your health, the amount of long term care you want to insure; and the optional benefits you select such as inflation protection.
The typical policy for someone 60 years of age, including inflation protection, is $100 per month. Rates and benefits can vary significantly depending upon the company you obtain your coverage from. (For this and other reasons, it is important to compare policies from several companies before you decide.) The same policy would be nearly twice as expensive for a 70 year old and only half as much for a fifty year old. If you want this protection, the longer you wait, the greater the risk that you'll need it and the more expensive it becomes.
How do I decide whether this coverage is appropriate for me? If I do need Long Term Care insurance, how do I select the policy that is best suited for my needs?
Contact an Independent Long Term Care insurance specialist. An independent broker can focus on your needs-not the insurance company's. Insist that your first meeting with a broker be an informational meeting. Don't succumb to sales pressure to make a hasty decision. You may want to have another family member present-or perhaps an attorney or accountant- to ask questions and to help you in the decision making process.
Does my health affect my ability to obtain Long Term Care insurance?
YES! You must be in good health "for your age". Insurance companies frequently insure applicants that have had previous health problems including cancer, and heart disease. Generally the insurance company will obtain a report on your medical history. Chronic conditions such as Alzheimer's, Parkinson's, Lou Gherig's disease and severe rheumatoid arthritis will make it unlikely that you will be approved for Long Term Care insurance.
Medicare & Medicaid (USA)
The following 20 questions and answers are the most frequently asked questions by callers to the Medicare + Choice toll free line. These are also available at the US Government's site at http://www.medicare.gov
1. How does the Original Medicare Plan work?
The Original Medicare Plan is the traditional fee-for-service system that covers your health care needs.
The Original Medicare Plan has two parts:
- Part A for hospital services and
- Part B for physician services.
But not everybody is eligible for both parts. Medicare pays its share of the bill and you pay the balance. You may choose to go to any doctor, hospital, or other health care provider, like a home health agency, which accepts Medicare payment.
2. How do I know whether or not I'm eligible for both Part A and Part B?
You should contact your local Social Security Office. The staff there can tell you if you are eligible for Part A and Part B.
3. How can I get a replacement Medicare card?
You should contact your local Social Security Office to get a replacement card.
4. I can't afford my Medicare premiums. What can I do?
If your income is limited, your State may help you pay your Medicare costs, such as your premiums and deductibles. Check the "Who to Contact" section of the Medicare web site for the phone number of your State medical assistance office. They can help you determine if you qualify for help.
5. What coverage is available for prescription drugs?
Generally, Original Medicare does not cover prescriptions. There are certain limited exceptions, like some cancer drugs. However, some Medicare health plans do cover drugs. In addition if you are in the Original Medicare plan, Medigap or other supplemental insurance plans may cover prescription drugs.
6. What is Medicaid and who does it cover?
Medicaid is a health insurance program for certain low-income people. It covers children, the aged, blind, disabled, and people who are eligible to receive other federal assistance. In some cases, Medicaid will help pay for Medicare premiums, deductibles, and coinsurance. For more information, you can contact your State medical assistance office.
7. If I have Medicare and Medicaid, who should process my bills first?
Your bill should always be sent to Medicare first. Medicare pays first. The part of the bill that Medicare does not pay will then be sent to your State Medicaid program for additional payment.
8. Will I be responsible for sending my claim to Medicaid?
No, under the Original Medicare Plan your claims are sent to your state Medicaid program for you. Sometimes your provider (hospital or physician) will send the claim to Medicaid after they receive the notification of what Medicare paid. Other times the contractor that pays your Medicare claim will send it to Medicaid.
MANAGED CARE PLANS AND SUPPLEMENTAL INSURANCES
9. What plans are available in my area?
The Original Medicare plan, the traditional fee-for-service system, is available nationally and Medicare managed care plans are available in many parts of the country. You can search for plans in your area using the Medicare Compare database on this web site.
10. If I like the coverage I have under Original Medicare, do I need to make a change?
If you are happy with the Original Medicare plan , you don't need to do anything. You will continue to receive Medicare benefits the same way as you do now.
11. What plan is best for me? Can you recommend a plan?
Medicare can't recommend a plan to you. However, a comparison of plans in your area is available on this site or by calling 1-800-318-2596. Any decision about your health care is an important one. You may want to talk with people you trust about which plan would best meet your needs.
12. What are the plans/choices available under Medicare + Choice?
Medicare + Choice expands your options. The Original Medicare Plan and Medicare HMOs are available now. The Original Medicare Plan, the fee-for-service arrangement, is available to everyone. Also, Medicare HMOs are available in many parts of the country.
Beginning in 1999, Preferred Provider Organizations and Provider Sponsored Organizations, and other insurance options like Private-Fee-For-Service Plans and Medicare Medical Savings Accounts, might become available in your area. This site will contain additional information on these options when they become available.
No matter which option you choose, you are still in the Medicare program and will receive all of the Medicare covered services.
13. Does Medicare + Choice replace Original Medicare?
No. Medicare +Choice expands the Medicare health plan options to include a broader range of plans. Currently, the types of Medicare + Choice plans that are available are the Original Medicare Plan and Medicare HMOs. The Original Medicare Plan, the fee-for-service arrangement, is available to all Medicare beneficiaries; and Medicare HMOs are available in many parts of the country. If you choose the Original Medicare Plan, you may want to consider a supplemental insurance plan, or Medigap insurance.
No matter what option you choose, you are still in the Medicare program and will receive all the Medicare covered services.
14. What impact do these new plans have on my Medigap/supplemental insurance?
If you stay in Original Medicare, there is no effect. If you choose to join a managed care plan, you may keep your coverage, but you may not need to. Medicare managed care plans will often cover the same type of services that the Medigap/supplemental policy covers.
If you are trying a managed care plan for the first time, you have a 12-month protection from the time you enroll to change you mind. If you go back to Original Medicare with 12 months, you can get your Medigap plan back as well, as long as it is still being sold.
15. If I don't need Medigap insurance anymore, what should I do to stop it?
To drop your Medigap insurance, contact the insurance company. You should be aware that when you drop your Medigap policy, there is no guarantee that you will be able to pick it back up at the same price if you want it back.
16. Why are HMOs terminating their contracts with Medicare?
Each year, HMOs have to make a choice to continue their contracts, adjust premiums and benefits, or not to renew their contracts. Some HMOs have made business decisions to terminate their Medicare contracts in certain areas.
17. If the HMO I am in now decided not to participate in 1999, what should I do?
You will need to make a decision. Your decision will depend upon what health plan options are available in your area. No matter what you choose, you are still in the Medicare program and will receive all Medicare covered services.
The Original Medicare Plan, the fee-for-service arrangement, is available to all Medicare beneficiaries nationwide; and Medicare managed care plans are available in many parts of the country. Depending upon where you live, a Medicare managed care plan may be available in your area.
In order to enroll in other Medicare + Choice health plan options, you must have Medicare Parts A and B but you must not have End Stage Renal Disease.
18. How do I re-enroll in Original Medicare if I want to leave the plan I have chosen?
You will automatically return to Original Medicare if you leave your plan. You do not need to re-enroll. You may leave your plan by calling the Social Security office, or notifying the plan that you wish to leave and asking to disenroll from your Medicare managed care plan.
19. If I leave my plan, when will my benefits change back to Original Medicare?
It usually takes about a month for this change to occur. Once your plan receives your request to leave, you will automatically return to Original Medicare on the first day of the next month.
Remember, if you change to another managed care plan, that plan will tell you when your new benefits are effective. Usually this will occur on the first day of the next month after your enrollment form is received.
20. What is the State Health Insurance Assistance Program?
The State Health Insurance Assistance Program offers free insurance counseling services to Medicare beneficiaries. Their counselors can help you understand health plan options under Medicare. They can also answer your questions on private insurance to supplement Medicare, and help you with questions on your Medicare bills or statements.
Also see our Viatical Settlements FAQ page
If you have further questions, please take advantage of our free consultation service - this allows you to determine whether Long Term Care insurance is appropriate for your own personal retirement plan, at no cost or obligation.
Simply give us a call at 781-461-9637 or send us your questions via our Feedback page - we are independent Long Term Care specialists.
Our goal is to help you determine if you need and are qualified for this protection, and only then to assist you in selecting the company, the amount and type of coverage best suited for your particular needs.
Informed Eldercare Decisions, Inc., provides the following services:
- Health, social & functional assessments to determine the services best suited for each individual.
- Care Planning and care management: arranging & monitoring home & community care, assisted living, nursing care facilities & other services.
- Support for family caregivers who live far from their parents or siblings.
- Advisory services to guardians and conservators.
- Counseling and assistance with methods of financing the high cost of long term care including: Long Term Care Insurance, Reverse Mortgages, Life Settlements and other long-term care financing strategies.
Informed Eldercare Decisions, Inc. is a private company dedicated to helping people make the best choices for long term elder care of their relatives. We are Experts in Long Term Care insurance and Elder Care planning.
450 Washington Street, Suite 108, Dedham, MA 02026-0428, USA
Phone 781-461-9637
Fax 781-461-9638
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