This document provides an overview of long-term care, including what it is, the types of activities of daily living it covers, eligibility criteria, and different options for funding long-term care. It discusses that Medicare and Medicaid have limited coverage and outlines various private long-term care insurance policies features like daily benefits amounts, benefit periods, elimination periods, and riders. It also summarizes alternative strategies for funding long-term care such as life insurance policies, annuities, health savings accounts, and reverse mortgages.

1. Long-Term Care
Everything you need to know to make the
right decisions for your future

2. What is it?
 Typically provided for an
extended period of time
 Assistance with Activities
of Daily Living (ADL)
Long-term care can be broadly
defined as care provided for the
benefit of those who are unable
to care for themselves
Supervision due to a severe cognitive
impairment, such as Alzheimer's disease

3. Six Types of ADLs
• Bathing
• Dressing
• Eating
• Toileting
• Transferring
• Continence

4. …for long-term care?
• When/if you can no longer perform 2 of the 6
ADLs without substantial assistance
• When/if you need supervision due to severe
cognitive impairment (memory, orientation,
reasoning)
• Expected to last for 90 days
• Primary Care Physician

5. • Historically thought of as nursing home
coverage
• Most often in your own home (75% of
claims are for Home Health Care)
• Where you need it --
Most policies cover all
levels of care

6. You will probably live a long life.

7. You will probably live a long life.

8. More of a reality NOW than ever
Advancements in Medical
Technology, Treatment,
Medications

9. with living better
is not always synonymous

10. re
For Long-
Term Care

11. Out of love and necessity, families help.
BUT...
• Families are smaller, and are living farther
apart
• Work and other responsibilities put limits on
how much family is able to help
• Inadequate experience in providing care
• Physical and emotional demands
• Personal dignity

12. Medicare and Medicaid generally
Medicare
• Health insurance which
covers skilled, not
custodial care
• Limited coverage for
care at home (where
most coverage begins
and often continues)
• Less than 100 days in
total
Medicaid
• Designed for those in
financial need
• Level of need and care is
determined by state
• Medicaid is the largest
payer of LTC services
(50%)
limit your long-
term care
options.

13. Jeopardizes your goals and
may be costly.
Maine Asset Limits
Couple: $110,000
Single: $2,000
$70,000 per year for a
private room in a nursing
home
Expected to rise to
$190,000 per year by 2030
Spend down of assets in
order to qualify for a
government program
should you need additional
assistance

14. May prevent invasion of principal.
• Pays for covered skilled, custodial and community care
• Benefits are paid for covered care you receive
• Helps to protect your assets and financial strategies
• Transfers the risk -- pennies for dollars
Transfers some of the risks away from you, but
Long-term care insurance doesn't replace the
need for care -- it builds on it, allowing the
caregiver to take care of their loved one
better and longer.

15. MY OTHER
INSURANCE PLANS?
What
About

16. Designed to cover medical
expenses, not long term
care expenses.

17. Designed to primarily cover
skilled, not custodial care, and
only for a very limited time.

18. not cover
long-term
care expenses.
Designed to
Replace Income,

19. Basic Policy
Features & Riders

20. Benefit Amount
Benefit
Period
Benefits
of
Pool
Elimination
Period

21. Daily: $50 to $500
The amount of money you
(per day or per month) once you
determine you'll need
qualify for benefits.
Monthly: $1,500 to $15,000

22. Typically
2 to 10 years
OrLifetime
The period of time during
which benefits will be
paid.

23. • Example Calculation:
36 months x $6,000 permonth = $216,000 total pool of
benefits
• Example Calculation:
3 years x $200 per day x 365 days = $219,000 total pool
of benefits
Total amount of money available
for you to use once you are
eligible for a claim.
True 3 year plan vs.
Pool of benefits

24. • Period of time (waiting period) between the
benefits triggering event and the time
coverage starts.
• Represented in days; ranging from zero to one
year.
Calendar Day
vs.Service Day

25. Riders
• Shared Care
• Spouse Premium
Waiver
• Spouse Security
Benefit
• Return of Premium
• Non-Forfeiture
Payment
Options
• Inflation
protection
• Waiver of EP for
Home Health
Care
• Survivorship
• Restoration of
Benefits
Riders
Lifetime pay
Single pay
10-pay
20-pay
Pay to 65

26. Two ways to
design a plan
Short & Squat
Long
&
Lean
BenefitPeriod
Daily Benefit
Amount

27. Alternative
Strategies

28. ACCELERATED DEATH BENEFITS
• Feature or rider included with some
life insurance policies
• Life insurance death benefit paid in
advance (tax-free)
• Policyholder must have a life-
threatening diagnosis or be
terminally ill
• Generally, you must need long-term
care for an extended period of time,
be confined to a nursing home, and
need assistance with Activities of
Daily Living
SINGLE PREMIUM LIFE INSURANCE / LTCi POLICY
• Life insurance policies combined with
individual long-term care insurance
policies
• Purchased for sole purpose of long-
term care insurance, not for death
benefit
• Single premium (generally) of
$50,000 to $100,000
• Purchased with cash, CD's, money
market accounts or 1035 exchanges
from other life insurance policies
• Distributions from cash values inside
life insurance policy are used to fund
long-term care insurance policies

29. An annuity is a series of regular
payments over a specified and
defined period of time.
Immediate Deferred
Funds for annuity come from a single premium payment.
There are two types of annuities:

30. Immediate
Long Term Care
Annuity
• If you cannot qualify for LTC insurance, or if you are
already receiving care, you can still purchase an
annuity
• Available without regard to health
• Single premium payment made to insurance
company in exchange for specified monthly income
• Payout schedule varies based on amount of initial
premium, age, and gender

31. Deferred
Long Term Care
Annuity
• Long-term care annuity has two funds:
– One for long-term care expenses which can be accessed
immediately
– Separate cash fund can be used for anything, but is deferred
• Most people that cannot qualify for LTC insurance can
qualify
• If the long-term care fund is not used, it can be passed on
to your heirs

32. HEALTH SAVINGS
ACCOUNT
• Created by the Medicare Modernization Act (MMA)
• Offers tax-advantage alternative used to fund long-term care
insurance premiums and accumulate funds to pay for long-term
care expenses.
• Can be set up by an individual or employer
• Required to purchase a low-cost, high-deductible health insurance
plan
• Tax-free contributions can be made to HSA up to an annual limit.
Contributions made by an employer are excluded from employee's
taxable income. Funds are carried over every year and all gains are
tax-free

33. HOME EQUITY/
REVERSE
MORTGAGE

34. Home Equity
• When an individual needs long-term care they
usually have greatly reduced or paid off their
mortgages.
• Value of home has usually risen beyond original
purchase price.
• Home equity is the difference between appraised
value of home and what is owed.
• There are a number of options to tap into home
equity.

35. • You receive cash against the value of your
home without selling it
• Can receive lump-sum payment, monthly
payment, or a line of credit
Not taxable, and does not count toward income or affect
Social Security or Medicare benefits if payments received are
spent within the month they are received.

36. • You do not have to repay the loan until you
die, sell the home, or move out of the home.
• You are responsible for taxes, hazard
insurance, and home repairs.

37. Contact Blue Goose for more information.
855-353-7303
www.BlueGooseMaine.com
info@bluegoosemaine.com