1 / 39

LeClair Insurance

Background on company

mariahs
Télécharger la présentation

LeClair Insurance

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Ensuring Care for the Long-Term • The Issue of the Future is Now the Issue of Today • 2011

  2. Topics for today’s discussion Long-Term Care • What is Long Term Care (LTC) and why is it needed? • Myths about LTC • How does Long Term Care Insurance (LTCI) work and what’s right for me?

  3. What is Long-Term Care? • Long-Term Care is needed when we are “caught between” being… • …not actually ill or injured enough to remain hospitalized… • …yet not able to care for ourselves without some level of assistance.

  4. Do I have to be in a nursing home? No!! • Where are long-term care services commonly provided? • The home!! • Adult day-care centers • Assisted living facilities • Hospice home-care programs or facilities • Nursing homes (last resort)

  5. Why LTC Insurance? Reasons why the issue of LTC is more urgent than in the past The Good News We are Living Longer! The Bad News • America is getting older • Fewer informal caregivers • The risk is REAL • Cost is increasing 5

  6. First -The Aging of America • The longer we live, the more likely we will need LTC services. • 71% of those 65+ will need LTC services at home or in a nursing home. • 48% will spend time in a nursing home • LTC is not only an issue for the elderly. Advances in Medical Technology have saved and prolonged lives. • 1/3 of stroke victims are under age 65! Examples:Michael J. Fox & Mohammad Ali both have Parkinson’s, Christopher Reeve was paralyzed at age 46.

  7. Second -Fewer informal caregivers

  8. Third - The Risk is Real • Compare the Risk • Lifetime odds: • Total Loss from Fire: 1 in 1200 • Major Auto Accident: 1 in 240 • Hospitalization: 1 in 15 • (over $30,000) • Long Term Care: 1 in 2 NOTE: You insure other risks, yet LTC has greater odds.

  9. Fourth - Skyrocketing Cost!! Nursing home care:costs average $55,480 annually in 2010, for a semi-private room. $63,601 for a private room Assisted-living facilities: $43,020 annually in 2010 Home health care:$48,048 annual costs (40 hours per week).

  10. Myths about LTC • Myth #1 • “It won’t happen to me”

  11. What can cause someone to needLong Term Care? • Almost every family in America today has someone who has needed Long Term Care services. Why? • An Accident • A Chronic or Disabling Illness (Cancer, Parkinson’s Disease, Stroke, etc.) • Cognitive Impairment • Normal Aging

  12. Have you known a friend or familymember who needed care? • What was it like? • Were they prepared for the emotional drain and financial cost associated with needing long-term care services? • How did it impact their family - financially and emotionally? • How did paying for long-term care services out of their pocket impact their own retirement savings? • Were they able to stay at home? If so, who coordinated/provided their care?

  13. How can Long-Term Care Insurance help? • It Can Help You To: • Preserve and protect hard-earned retirement income and assets; • Give you the flexibility to choose where and how you receive care; • Assure high-quality care at a reasonable price; and • Provide financial and emotional support for you and your family members.

  14. Myths about LTC Myth #2:“I’m already covered”

  15. Long-Term Personal/Custodial Care is NOT routinely covered by other insurance • Medicare • Medicaid • Traditional Health • Insurance • Disability Income • Insurance

  16. Who will pay for this care?Understanding Medicare • Medicare pays health care costs for seniors. • Part A: Hospital type costs • Part B: Doctor type costs (2009 Premium = $110.50 / month) • Medicare pays claims “by diagnosis” • Short Stay = hospital makes money • Long Stay = hospital loses money • Results in people getting out of hospital “quicker & sicker”

  17. Know the difference between Skilled Care & Non-skilled Care • Skilled care is when recovery is expected and progress is being made by patient. • Only 0.5% of services received by nursing home patients is skilled. • Examples of non-skilled care: • Meal preparation • Paying Bills • Transferring • Getting to the bathroom • Bathing • Dressing • Eating • Taking medications

  18. Will Medicarepay for Nursing Home care? • Limited funds are available provided all criteria is met: • Skilled care must be required • A prior 3-day hospital stay for the same condition, not including day of discharge, is required (within 30 days) • The nursing home must be Medicare certified • The patient must be recovering • * 99.5% of care in NH is non-skilled • * 60% enter NH with no prior hospital stay

  19. If all criteria are met, then payment is made as follows: Days 1 – 20:Pays up to 100% of Medicare approved amount Days 21 – 100:You pay the deductible of $133.50 per day, Medicare pays remainder(Your Medicare supplement policy will pay the $133.50 deductible) Days 100+:Neither Medicare, nor Medicare policies, will pay How much willMedicarepay forNursing Home Care?

  20. Will Medicare pay for home visits? • Funds are available for Home Health Care if all the • following criteria are met: 1.Skilled care must be delivered 2. Patient must be improving 3. Visits are from 1 to 4 hours (no 8 hr. shifts, no more than 4 hrs., 7 visits per week) 4. Patient must be housebound 5. Physician must certify on a regular basis that skilled care is still needed & patient improving 6. Must be a certified Home Health Care Agency

  21. What is Medicaid? “Medicaid is a joint federal and state program that provides medical assistance for certain individuals with low incomes and limited assets.” Must be impoverished – allowed only $2000 - $3000 in assets! Who will pay for this care…What about Medicaid?

  22. Medicaid is no picnic • Home Health Care is rarely an option • Waiting lists • No Assisted Living facilities • No frills facilities • Can be many miles from family • Loss of control of your own lifestyle • Start out private pay & run out of money • Usually no options other than nursing home • Can split spouses (bed shortages in many states) • No control over choice of home: County placement

  23. Transferring Assets to Qualify for MedicaidIs it really a good idea? • Criminal Offense if done to falsely impoverish oneself • Divorce • Miss-use of Funds • College Financial Assistance • Change in Look-back periods (60 mo.) – most states have increased the look-back! • Lose Control • Financial Difficulties • Lawsuits • Early Death of Child

  24. Who will pay for this care?Will my major medical policy cover Long-Term Care? • No. • Major Medical insurance is designed to cover health care services provided to us for accidents and illness… from which we expect recovery. • Major Medical Insurance generally does not provide custodial services to us while we recover, whether short term or long term. • Disability Income

  25. Myth #3:“My family will take care of me” Myths about LTC

  26. Sociological changes haveimpacted caregiving • Families No Longer Reside in Same Community • Working Women; Sandwich Generation • Divorce • Delayed Childbirth

  27. Today’s working caregivers • 60% of male caregivers and 41% of female caregivers are working full-time. • Many caregivers fulfill multiple roles. • Most caregivers are married or living with a partner (62%); • Most caregivers work and manage caregiving responsibilities at the same time (59%); and • The great majority of caregivers (83%) are helping relatives.

  28. Myth #4:“I can’t afford Long-Term Care Insurance” Myths about LTC

  29. How can Long-Term Care Insurance help? • It Can Help You To: • Protect your savings and assets • Preserve your independence • Provide choice on where you receive care

  30. How does LTCI work and what’s right for me? • What • should • I do?

  31. Policies begin paying for LTC services when you can no longer perform your own activities of daily living (ADL’s), because you are either physically or cognitively unable to (called benefit triggers). How does LTC Insurance work?

  32. Unable to perform two or more of the following ADL’s: Bathing Dressing Transferring Toileting Eating Continence B. Cognitive Impairment Loss of “thinking or reasoning” ability due to organic disease -- Includes Senile Dementia and Alzheimer’s Diagnosed by clinical evidence/standard tests Benefit Triggers Either…

  33. Are we suitable candidates for this insurance? • Is our health relatively good? • 2) Do we have assets over $50,000, not including our home? Ask yourself these questions . . .

  34. Five questions to ask yourself • Where would you like to receive care? • At home or in an Assisted Living Facility* or Nursing Home?** 2) How would you like to receive your benefits? • Daily or monthly reimbursement, or cash payment? * In California, this type of facility is licensed as a Residential Care Facility. ** In California this type of facility is licensed as a Nursing Facility.

  35. Five questions to ask yourself (continued) 3) How much coverage is right for you – considering the cost of care in your area? • What Maximum Nursing Home* Daily Benefit Amount (“DBA”)? • What percentage of your DBA for Assisted Living** and Home and Community Based Care? * In California, this type of facility is licensed as a Nursing Facility. ** In California, this type of facility is licensed as a Residential Care Facility.

  36. Five questions to ask yourself (continued) 4) How long would you like your benefits to last? • Number of days you receive your maximum DBA. • The Benefit Period you select is used to calculate your “Total Lifetime Benefit” - the total amount of benefit dollars available under your policy. • 5) How long can you wait before benefits are paid? • The Elimination Period is the period of time you are responsible for paying the cost of your care services. Example: $150 DBA x 365 x 5 years = $273,750 Total Lifetime Benefit

  37. Discounts Available* • Spousal Discount • Spouse** or Domestic Partner • Both apply and are approved • Marital Discount • Spouse** or Domestic Partner • Both do not have to apply or if one spouse/partner is declined • Residential • Two people living in the same household • Preferred Health Discount*** • Multi-Life Discount * Not all discounts may be available in all states or in conjunction with one another. ** Spouse may include, where permitted by law, domestic partners and civil union partners. *** Does not apply to Multi-Life Simplified Underwriting.

  38. Ask yourself thisCritical Question Can you think of anything other than the cost of Long-Term Care that could wipe out most of what you own, that you haven’t already protected?

  39. So what is the Answer?LTC Insurance • I know the risk is real • I can transfer that risk to the insurance company • I protect my assets and income from being drained • I protect my legacy • I maintain control of my life & choices • I will not be a burden to my family • Tax benefits are available

More Related