Insurance FAQs

Answers to Common Health and Life Insurance Questions

Frequently Asked Health Insurance Questions

Medicare Advantage Plans, such as a Medicare Managed Care Plan, a Medicare Preferred Provider Organization, or a Medicare Private Fee-for-Service Plan, are health care choices in some areas of the country. In most plans, you can only go to doctors, specialists, or hospitals on the plan’s list.

Medicare health plans must cover all Medicare Part A and Part B health care, including home health care. If you belong to a Medicare Advantage Plan, you may only be able to choose a home health agency that works with your plan.

Call your plan if you have questions about the plan’s home health care rules, coverage, appeal rights, and your costs (quality of care ?) If you get services from a doctor or a home health agency that doesn’t work with your Medicare Advantage Plan, your plan and Medicare won’t pay the bill.

For more information about the Medicare Advantage plans available in your area, please contact us.

Long-term care is the care you need when you are no longer able to care for yourself. It is personal care, such as help with bathing, eating or dressing required over a lengthy period of time.

It can range from simple assistance in your own home to assistance required in a residential care facility, or it can be highly skilled care in a nursing facility.

Cognitive impairments such as Alzheimer’s and other diseases may also trigger the need for long term care, even though physically the person appears to be fine.

Typically long term care is not covered by health insurance, HMO’s, Medicare or supplemental policies. These are for short-term not long term care.

Anyone concerned about providing for their potential future needs and looking to protect their life savings and assets for themselves, their family and heirs. The number one problem is that people don’t think they need it, or maybe they’ll need it sometime in the future, but not now, not today. They get up, they dress, and on their way to work they get rear-ended and need months or a lifetime of care. Then they learn that their health insurance or Medicare only covers the first few weeks. Reality has a way of overcoming denial.

Long-term care can be caused by such things as motor vehicle accidents, falls, sports injuries, strokes, heart attacks, surgery, illness, old age and frailty. Healthy, active people of any age can suddenly find themselves in the situation where their lives are changed.

We all have experienced a change of health. We go to bed feeling fine and wake up sick. Most of the time it’s a minor illness. Changes of health are sudden, we’re fine then we’re not.

At any given time in America, 40 percent of all those on long term care are not elderly but between the ages of 18 and 64. If you are not insured today but plan on insuring later I recommend you do it two months before your health changes.

The uninsured are exposed to a huge financial risk. Americans don’t save enough and they don’t insure enough. One way or another Americans are going to pay for their long term care — savings or insurance. Over 56 percent of adults who receive long term care will pay out-of-pocket, 39 percent will be on Medicaid (welfare). Many of the 56 percent will spend-down their savings and then go on Medicaid.

Purchasing long term care insurance while young keeps the cost down over time while avoiding becoming uninsurable later. If a 55 year old waited until they were 60 to insure they will end up spending a lot more for insurance over their lifetime.

The reason most people don’t buy long term care insurance is because they are not sure they will ever need it. But that is a question that will only be answered when they either die without needing long term care or when they need it. The fact that it cannot be answered in advance is why they should insure.

People also argue that if they have this insurance then die they would have wasted their money. True enough, but over half are going to need long term care before they die. That’s greater than 1 in 2. Are you willing to risk your families future on odds of 1 in 2?

Life insurance is a guaranteed payout because there is a 1 in 1 chance you’ll die at some point. What are you insuring now that you hope to collect on? Car crash, catastrophic health or home insurance, surely not life insurance! No one wants to collect on insurance. Your choice with long term care is pay now (insurance) or pay much more later (savings).

According to a 2008 Survey the average cost of nursing home care nationally is $75,000 a year. The cost of care is different in different regions. A nursing home private room in New York City averages $385 a day ($140,000+ per year).

Nursing home care is reserved for those who need medical attention yet most long term care is not medical care but custodial care, which is not covered by health insurance or Medicare.

When family and friends provide the care there is no bill presented for the care provided, but the toll to the family and friends can be very high.

When people no longer can stay in their homes or no longer want to but are not sick they have the option of moving into senior housing that provides assistance on demand.

Another option for custodial care is assisted living housing. Since this level of care is custodial and not considered medically necessary you pay out-of-pocket or with insurance.

Medicaid has always been for people who are at the low end of the economic scale based income and assets. The Medicaid system is somewhat complex and if someone has questions they should contact their local office.

Medicaid allows a person to keep up to $2,000 in cash assets, not counting a home, a car and some personal items. Even if they can qualify for long term care under Medicaid when they pass on, their estate is subject to recovery by the state. That means the house can be sold to reimburse the taxpayers for what Medicaid spent.

For example if the state Medicaid reimbursement rate is $150 a day and they spent 3 years on Medicaid their estate would have to reimburse the state $164,250.

Some people may look to legal ways to keep their assets and still qualify for Medicaid. That might work for some unless the government changes the rules again. It is a federal crime to try to defraud Medicaid. Even if you had a legal angle you would be on welfare and is that really how you want to live?

Everyone has different needs so each policy will be designed just for that person, there is no “one-size-fits-all” policy.

When designing a plan with you we would consider your family health history in addition to your health. You may have Alzheimer’s in your family and may need a lot of care, or maybe heart disease and need only short amount of care.

Then we consider how much it cost where you would receive care. Care will cost more in New York City than in Tucson.

Once we know your age, your cost of care and how much care you might need you can get a long term care insurance premium quote.

With Inflation Protection your benefit increases every year to keep up with inflation without a requirement of an increase in your premium. For example with a “5% compound benefit increase” your monthly amount will double every 14.5 years – a $5,000 a month benefit increases to $10,000 a month.

The older you are the more the premium will be but it will always be a lot cheaper than paying out of savings. You don’t save money by waiting to insure and it’s likely you may not qualify later in life.

Anyone who thinks long term care insurance is expensive hasn’t yet seen assets drained by long term care costs. With the average stay in a nursing home of 3 years and the average cost of nursing home care of $75,000 a year how long would it take to recover your insurance premiums.