Long-Term Care Insurance from Sedona Benefits

Long-term care is the type of care needed to help you perform daily activities if you had an ongoing illness or disability. This includes the kind of care needed if you had a severe cognitive problem like Alzheimer’s disease or if you need assistance with one or more of the six Activities of Daily Living (ADLs). This type of care is not received in hospitals, nor is it meant to cure you. It is chronic care that you may need for the rest of your life. You may be able to receive this care in your own home, at a nursing home, or other long term care facility.

ADL’s are basic activities and functions performed on a daily basis that are usually done without assistance. The six ADLs are:

  • Eating
  • Dressing
  • Bathing
  • Toileting
  • Transferring
  • Continence

Long Term Care (or LTC) refers to a wide variety of medical care, personal assistance, and social support that may be needed later in life. Long Term Care can also be received for shorter periods of time during an extended recovery period following an illness or accident.

Long Term Care is most often associated with the words "Nursing Home", however, that is not always true. There are several different options for care, such as: Home Health Care, Adult Day Services, Assisted Living Facilities and Nursing Facilities. Basically, long-term care provides care for a person when they cannot care for themselves - either for a brief period of time or indefinitely.

Did you know?

  • Long-term care services are expensive? The cost of one year in a nursing home can exceed $70,000 (and that's just room and board. It doesn't include the cost of drugs, incidental supplies, etc.). The cost of home care for only three 8-hour shifts per week can easily exceed $20,000 a year. Both of these costs can be significantly higher in high-cost areas. And that's before inflation! Paying for long term care can easily exhaust your savings. Buying long term care insurance can protect your savings.
  • Long-term care is not just for senior citizens? Over 40% of people who are receiving long-term care are under age 65. They may need continuing care due to a serious accident, a stroke, a brain tumor, multiple sclerosis, Parkinson's disease, etc. You can't always prevent your need for long-term care, but you can protect your assets, preserve your choice of care, and reduce the burden on your family by buying long term care insurance.
  • Your health plan probably doesn't cover long-term care services? Take a look at your health plan brochure. Chances are there are specific exclusions for nursing home care and extended or chronic care provided in the home. If you're like most people, the lack of coverage will surprise you.
  • Most long-term care is not skilled care? Only 18% of long term care is nursing home care. Most long-term care is home care, home health care, adult day care, assisted living facility care, etc.

Long Term Care Insurance is private insurance specifically designed to cover some or all of your long-term care costs. LTC insurance policies cover skilled, intermediate, and custodial care whether the care is provided in the home, an adult day care center, assisted living facility, or if necessary, a nursing home.

A new LTC product is now available called a hybrid policy that provides up to $1,000 per month in cash for out-of-pocket expenses. A 30% discount is common when two spouses are both insured.

There is a federal law, the Health Insurance Portability and Accountability Act (HIPAA), which gives some federal income tax advantages to people buying policies called Tax-Qualified (or simply Qualified) Long Term Care Policies.

Will Medicare cover long-term care?

In most cases it will not. Medicare is a Federal health insurance program for people who are age 65 or older, some people with disabilities under age 65, and people with End-Stage Renal Disease or people with Lou Gehrig’s disease. Medicare will cover the first 100 days of care in a nursing home if: 1) you are receiving skilled care, and 2) you have a qualifying hospital stay of at least 3 days and enter the nursing home within 30 days of that hospital discharge. There are also some deductibles and co-pays. Medicare also covers limited home visits for skilled care.

What is Medicaid, and won’t Medicaid cover long-term care?

Medicare is a state-based program supplemented by Federal funds that acts as a safety net to provide health services to the poor and impoverished. Medicaid covers long term care services and might cover you if you meet your state’s poverty criteria and receive care that meets your state’s guidelines. Usually this means expending all but $2,000 of your assets and savings (except for your house and maybe your car). It also means receiving care from a limited number of state approved caregivers, which are mostly institutions like nursing homes, that are willing to accept Medicaid’s payments.