Long term care coverage overview 4.6.12
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Long term care coverage overview 4.6.12

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Long-Term Care Protection is extended care when a person loses the ability to care for themselves due to a cognitive impairment (such as Alzheimer's disease or Parkinson's disease) an accident, ...

Long-Term Care Protection is extended care when a person loses the ability to care for themselves due to a cognitive impairment (such as Alzheimer's disease or Parkinson's disease) an accident, illness, or disabling condition and is in need of assistance with the basic “Activities of Daily Living” (“ADLs”).

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Long term care coverage overview 4.6.12 Long term care coverage overview 4.6.12 Presentation Transcript

  • www.ironcoveins.comLONG-TERM CARE COVERAGE OVERVIEWAPRIL 6th, 2012 Louis D’Agostino Senior Vice President Iron Cove Partners, LLC (516) 267-6179 Email: louisd@ironcoveins.com Twitter: @FINsure360
  • TABLE OF CONTENTS TOPIC PAGE # What is Long-Term Care? 3 What are ADL’s 4Why the Need for Long-Term Chronic Care 5Long-Term Care Isn’t Just For The Elderly 6 The Risk Of Needing LTC After 65 7 Where is Chronic Care Received? 8 Average LTC Costs in Long Island, NY 9Insurance Company Partners Writing LTC 10 Coverage Who Pays For LTC? 11 Glossary of LTC Terms 12-15 Our Team 16 Iron Cove Partners LLC, a WG Limited Company 2
  • WHAT IS LONG-TERM CARE?Long-Term Care Protection is extended care when a person loses the ability tocare for themselves due to a cognitive impairment (such as Alzheimers disease orParkinsons disease) an accident, illness, or disabling condition and is in need ofassistance with the basic “Activities of Daily Living” (“ADLs”).Long-term care services may include: •  Assistance with ADL’s; •  Home health-care; •  Respite-care; (short-term, temporary relief to those who are caring for family members who might otherwise require more permanent care) •  Hospice-care; •  Adult day-care; & •  Care in a nursing home or assisted living facility.Long-term care may also include care management services, which will evaluateyour needs and coordinate and monitor the delivery of long-term care services. Iron Cove Partners LLC, a WG Limited Company 3
  • WHAT ARE ADL’s?ACTIVITIES OF DAILY LIVING: Ø  Bathing; Ø  Continence (ability to retain a bodily discharge); Ø  Dressing; Ø  Eating; Ø  Toileting; & Ø  TransferringIf the policy you’re thinking of buying pays benefits when you cannot do certainADLs, be sure you understand what that means. Some policies spell out veryclearly what it means to be unable to feed or bathe oneself. Some policies say thatyou must have someone actually help you do the activities. That’s known ashands-on assistance. Specifying hands-on assistance will make it harder to qualifyfor benefits than if only stand-by assistance is required. The more clearly a policydescribes its requirements, the less confusion you or your family will have whenyou need to file a claim.(2011 NAIC LTC Buyers Guide) Iron Cove Partners LLC, a WG Limited Company 4
  •     WHY THE NEED FOR LONG TERM CHRONIC CARE?Ø  79 Million Baby Boomers (born 1946-1964) began turning 65 in 2011.Ø  Longer Life Expectancy – Medical TechnologyØ  Two-Thirds Women Work Outside the HomeØ  Adult Children Living in Different States     Iron Cove Partners LLC, a WG Limited Company 5
  • LONG-TERM CARE ISN’T JUST FOR THE ELDERLY40% of individuals who areneed of LTC Services arebetween the ages of 18-64 and3% are under the age of 18. Working Age 18-64 Age 65 & Older 40% 57% Under Age of 18 3% Iron Cove Partners LLC, a WG Limited Company 6
  • THE RISK OF NEEDING LTC AFTER 65 WOMEN MEN Major House Fire 2.6% Major House Fire 2.2% Severe Car Accident 18% Severe Accident 15.5% Chronic Care *ADL 72% Chronic Care *ADL 44%Or Cognitively Impaired Or Cognitively Impaired*Activity of Daily Living(Data 2002 Complied by Milliman) Iron Cove Partners LLC, a WG Limited Company 7
  • WHERE IS CHRONIC CARE RECEIVED?Ø  Home Health Care* Home CareØ  Adult Day Care 42% Assisted LivingØ  Assisted Living 27%Ø  Nursing Home Care Nursing Home 31% 80% of Long-Term Care is provided by friends and family in their home http://www.longtermcare.gov/LTC/main_site/understanding_Long_Term_Care/Services/Services.aspx Iron Cove Partners LLC, a WG Limited Company 8
  • AVERAGE LTC COSTS IN LONG ISLAND NY ANNUAL CARE COSTS IN 2011 ANNUAL COST MONTHLY PROJECTED PROJECTED MONTHLY COST IN IN 2011 COST IN 2011 COST IN 2036 2036HOME CARE Homemaker $50,336 $4,194 $170,456 $14,204 Services Home Health $50,336 $4,194 $170,456 $14,204 AideADULT DAY HEALTH CAREAdult Day Health $10,400 $866.66 $35,218 $2,934 CareASSISTED LIVING FACILTIY Private, One $52,020 $4,335 $176,158 $14,679 BedroomNURSING HOME Semi-Private $146,000 $12,166 $494,408 $41,200 Room Private Room $153,300 $12,775 $519,128 $43,260 Iron Cove Partners LLC, a WG Limited Company 9
  • INSURANCE COMPANY PARTNERS WRITING LTC COVERAGEIron Cove Partners LLC, a WG Limited Company 10
  • WHO PAYS FOR LONG-TERM CARE?Neither  private health insurance  (including HMOs, PPOs, Medicare supplements,Medicare Advantage or retiree health plans) nor Medicare pays for long-term care. Remember, long-term care is primarily custodial care (which is help with ADLs,cognitive impairment) not medical care. If anything, private health insurance andMedicare only pay for short-term care. Iron Cove Partners LLC, a WG Limited Company 11
  • GLOSSARY OF LTC TERMSCompound Inflation Protection- An option offered on some long-term care policies to increase themaximum daily and lifetime benefits each year by a pre-set percentage on a compound basis. It isavailable at an additional premium. Elimination Period- A type of deductible; the length of time the individual must pay for covered servicesbefore the insurance company will begin making payments. The longer the elimination period in a policy,the lower the premium. The elimination period may also be called the waiting period. Home Health Care- Services for occupational, physical, respiratory, speech therapy, or nursing care. Alsoincluded are medical, social worker, home health aide, and homemaker services. Home and Community-Based Health Care- Includes nursing and related personal care provided topatients at home by a home health agency. Policies covering home and community-based care shoulddescribe the types of care and the types of agencies that are covered and should specify when and wherethis type of care can be provided. Home and Community-Based Health Care usually includes homehealth care, adult day care, and homemaker services.    Iron Cove Partners LLC, a WG Limited Company 12
  • GLOSSARY OF LTC TERMS (CONT’D)Hospice Facility- A facility that provides care for individuals with terminal illnesses. While individualsreceive care, they are typically not receiving the type of care that will bring about recovery or can beexpected to improve their medical condition. Hospice care is intended to provide comfort for the terminalpatient and support for their families. Informal Care- Care that is received at home, or at a relatives home, by family or friends. A carecoordinator or medical professional may supervise the care. Lifetime Maximum Benefit- The lifetime maximum benefit is the maximum amount that a long-termcare insurance company will pay for all covered expenses throughout the life of a policy. The lifetimemaximum benefit is often described as a pool of money that an insured can draw against. When thelifetime maximum benefit is exhausted, the pool is dry and the policy will not pay any more benefits. Lifetime Home and Community-Based Care Maximum- The maximum amount that an insurancecompany will pay for covered expenses for home health care, adult day care and homemaker services.  Maximum Daily Benefit (MDB)- The pre-set amount that a long-term care insurance policy will pay upto for each day during a claim period. The maximum daily benefit is specified in the original long-termcare insurance policy, but may increase on an annual basis if the policyholder also purchased a benefitincrease rider.  Iron Cove Partners LLC, a WG Limited Company 13
  • GLOSSARY OF LTC TERMS (CONT’D)Benefit Period- The amount of time that a long-term care insurance policyholder will be able to collectbenefits for a qualified long-term care event. The time period is usually specified as a minimum # of yearsor until the pool of money has been exhausted. Non-Forfeiture Benefit- A policy feature that provides either reduced paid-up insurance, extended termor a shortened benefit period upon lapse of the policy due to non-payment of all or part of the premiumafter the policy has been in force for a specified period of time. Nursing Care Facility- A facility providing skilled, intermediate or custodial nursing care which must bestate- licensed. Rate Class- A group of insureds with similar long-term care insurability levels. Extremely healthy peoplewho are less likely to need long-term care are usually placed in healthy classes and receive a preferredrating (lower rates). For example, the price of a long-term care insurance policy typically increases as anindividuals rate class decreases. Restoration of Benefits- Occurs when an insurance provider adds benefit dollars back into apolicyholders lifetime maximum benefit after recovery from a long-term care need for which benefitswere paid.  Iron Cove Partners LLC, a WG Limited Company 14
  • GLOSSARY OF LTC TERMS (CONT’D)Simple Inflation Protection- This benefit provides for an insureds long-term care maximum dailybenefits and lifetime maximum benefits to increase each year by a set amount. Increases are always basedon the initial benefit. Rider is available at an additional premium. Spouse Shared Care Benefit- Provides the insured with the ability to utilize his/her spouse’s or partner’sbenefits when their own policy benefits have been exhausted. Therapeutic Devices- Devices such as grab bars & ramps, which help an individual perform the basicactivities of daily living without another persons assistance.     Iron Cove Partners LLC, a WG Limited Company 15
  • OUR LTC TEAM Louis D’Agostino Gregory C. Sibilio, Esq. Senior Vice President Vice PresidentE: louisd@ironcoveins.com E: gregs@ironcoveins.com T: (516) 267-6179 T: (516) 267-6177 Bob Quinlan Director E: bquinlan@whitmoregroup.com T: (516) 267-6131 Patricia Alaimo Director of LTC Sales Highland Capital Brokerage Iron Cove Partners LLC, a WG Limited Company 16