S HIBA Long-Term Care Overview

1. SHIBA Long-Term Care Overview SHIBA Statewide Health Insurance Benefits Advisors A free, unbiased service sponsored by the: Dec. 2013

2. SHIBA mission statement SHIBA provides free, unbiased information about health care coverage and access to help improve the lives of all Washington state residents. We cultivate community commitment through partnership, service, and volunteering. Dec. 2013

3. Long-term care overview • What does “long-term care”mean to you? Dec. 2013

4. Why talk about long-term care? • Many people live longer now than in the past. • More people will likely need long-term care help than in the past. • Long-term care is expensive! • The options for where people get long-term care have changed in the past 50 years • We want you to have the facts and make informed choices. Dec. 2013

5. What do we mean when we talk about “long-term care?” • Medical and non-medical support services needed by people with prolonged illness or disability • Often help people with cognitive impairment • Help people perform activities of daily living (ADLs) or independent activities of daily living (IDLs), or both. Dec. 2013

6. Activities of Daily Living (ADL) Examples • Bathing • Dressing • Eating • Using the toilet • Transferring (getting out of bed) • Continence (bladder/bowel control) Dec. 2013

7. Independent Activities of Daily Living (IADL)Examples • Grocery shopping • Laundry • Preparing meals • Housework • Taking or managing medication • Transportation Dec. 2013

8. Cognitive impairmentExamples • Alzheimer’s disease • Dementia • Mental illness • Developmental disabilities Dec. 2013

9. What types of care might long-term care include? • Skilled or medical care: Medical or nursing care by a health professional • Personal/custodial care: Help with ADLs and IADLs • Supervisory care: Monitoring/supervision to prevent harm for people with cognitive impairment Dec. 2013

10. Where does long-term care happen? • Informal settings: • At home • Care from family or friends • Unpaid caregivers • Often used when people don’t need skilled care Dec. 2013

11. Where does long-term care happen? • Formal settings: • Licensed home care services – by professional staff • Community services – such as adult day care • Residential care – including nursing homes, assisted living facilities, group homes, etc. Dec. 2013

12. Does private health insurance pay for long-term care? • Usually not • Health insurance pays for care that cures, usually for acute (temporary) needs only • Most long-term care needs are chronic (long-term) • Most long-term care needs are for ADLs and IADLs – not medical care Dec. 2013

13. Does Medicare pay for long-term care? • Not really, coverage is very limited Dec. 2013

14. What long-term care does Medicare pay for? • Nursing home (skilled nursing facility) if: • Doctor says medically necessary (doctor certified) • Patient has already stayed three nights in hospital for same condition • Must be “INPATIENT” in the hospital – “Observation Stays” don’t count!! • Facility is Medicare-certified Dec. 2013

15. What long-term care does Medicare pay for? • Home Health Care (skilled care in home) • This includes skilled nursing care, OT, PT or Speech Therapy services • Can be covered if: • Doctor says patient needs skilled care on part-time basis (medically necessary) • Patient is homebound • Agency providing care is Medicare-certified Dec. 2013

16. Medicare also pays for hospice care • End-of-life pain relief and symptom management • For terminally ill patients • Medicare Part A covers most of the costs of hospice care • Very little out-of-pocket csts Dec. 2013

17. What Medicare does NOT pay for • 24-hour care in home • Meals delivered to home • Homemaker services (shopping, cleaning, laundry) • Non-skilled personal care services for ADLs or IADLs (bathing, eating, dressing, supervisory care) Dec. 2013

18. What are my options to pay for long-term care? • Do nothing – if you choose not to plan for LTC • Rely on state or federal programs to take care of you & your estate • Make financial plans • Buy long-term care insurance You may use one or more of these options Dec. 2013

19. Doing nothing may be an option for some people • Prefer day-to-day living over long-term planning • Do not believe they will have a need for long-term care • Have reasons related to family, culture, or personal beliefs for not planning Dec. 2013

20. Points to think about if you do nothing • May increase the chance you won’t have control over health or financial decisions made on your behalf later in life. Dec. 2013

21. Rely on federal programs • Department of Veterans Affairs (VA) may be an option for people who: • Are a military veteran • Are or were married to a military veteran Dec. 2013

22. Points to think about with the VA • Some veterans and spouses may qualify for both federal and state programs • These programs may work together to help pay for long-term care • Not all veterans or spouses qualify – check with the VA to make sure Dec. 2013

23. Rely on state programs • Medicaid/State Dept. of Social & Health Services (DSHS) may be an option for people who: • Meet income and asset limits • Meet a DSHS category (such as aged, blind, or have a disability Dec. 2013

24. Points to think about with Medicaid/State DSHS • It may cover Medicare’s gaps. • It may require you to spend down assets impoverish yourself to qualify. • If you transfer assets to others to qualify, it may require you to meet legal time limits. • It may affect your choice of providers and locations of care. • The state may try to recover funds from your estate after your death (estate recovery). • I’ll talk about the Long-Term Care Partnership Program in a minute Dec. 2013

25. Making financial plans may be an option for some people • Are unlikely to qualify for Medicaid • Are not interested in or qualified for long-term care insurance • Are willing and able to do some financial planning with appropriate professionals • Own (or are close to owning) your home outright Dec. 2013

26. Points to think about with making financial plans • May or may not keep pace with long-term care cost inflation. • May or may not be protected if you have financial emergencies. • Using home equity (for example, in a reverse mortgage) may affect inheritance available for heirs. Dec. 2013

27. Buying long-term care insurance may be an option for some people • Can afford the premium • Are healthy enough to qualify • Won’t qualify for Medicaid • Or can buy a Long-Term Care Partnership Program plan • Want to ensure control over assets Dec. 2013

28. Points to think about with buying long-term care insurance • The Office of the Insurance Commissioner (OIC) requires insurers to provide certain consumer protections. • Insurers may raise premium rates on classes of policy holders. • Insurance may cover only some needs. • Plan coverage may/may not keep pace with inflation and changes in the medical and long-term care field. • Plan premiums may/may not be affordable. Dec. 2013

29. Points to think about with ALL options • Some facilities may have waiting lists. Have a back-up plan. • Changing life events may affect your plans. • Think about discussing your planning with others, such as family members and friends. • Check into local resources: • Your county’s Senior Information & Assistance Program • Local senior resource guide for your county Dec. 2013

30. Washington state Long-Term Care Partnership Program Offers you Medicaid asset protection on a dollar-for-dollar basis • Protects most assets – up to the amount of benefits paid under the policy Can protect you against inflation, depending upon your age when you buy the policy • Best protection if you buy it before age 61 Can protect your assets in different states • National reciprocity agreement Dec. 2013

31. Washington state Long-Term Care Partnership Program More information and list of companies that sell these plans at: www.insurance.wa.gov Type “Long Term Care Partnership” into the search box. Dec. 2013

32. What’s your plan for long-term care? • Here are some examples: • Deborah exercises, eats right, and stays healthy. • Donald bought long-term care insurance. • Delmar moved into an apartment attached to his daughter’s garage. • Denise set aside enough money for three years in a nursing home. • Dave lives one day at a time and enjoys the moment. Dec. 2013

33. Protect yourself from fraud • Review your insurer's explanation of benefits statement. • Only give your insurance/Medicare identification information to those who provide you with medical services. • If you suspect fraud, call the Insurance Consumer Hotline at 1-800-562-6900. Dec. 2013

34. How to contact us 1-800-562-6900 TDD: 360-586-0241 TDD Relay: 1-800-833-6384 www.insurance.wa.gov Dec. 2013

35. Need help with other insurance questions? • Homeowner • Auto • Life • Annuities • Health • And more! Call our Insurance Consumer Hotline 1-800-562-6900 www.insurance.wa.gov The Office of the Insurance Commissioner can also help you with all types of insurance, such as: Dec. 2013