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S HIBA HelpLine Statewide Health Insurance Benefits Advisors Long-Term Care Overview. Sponsored by the:. SHIBA HelpLine mission:.
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SHIBAHelpLine Statewide Health Insurance Benefits AdvisorsLong-Term Care Overview Sponsored by the: June 2010
SHIBA HelpLine mission: SHIBA HelpLine 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. June 2010
Long-term care overview • What does “long-term care” mean to you? June 2010
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. June 2010
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. June 2010
Activities of Daily Living (ADL) Examples • Bathing • Dressing • Eating • Using the toilet • Transferring (getting out of bed) • Continence (bladder/bowel control) June 2010
Independent Activities of Daily Living (IADL)Examples • Grocery shopping • Laundry • Preparing meals • Housework • Taking or managing medication • Transportation June 2010
Cognitive impairmentExamples • Alzheimer’s Disease • Dementia • Mental illness • Developmental disabilities June 2010
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 June 2010
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 June 2010
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. June 2010
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 June 2010
Does Medicare pay for long-term care? • Not really, coverage is very limited June 2010
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 • Facility is Medicare-certified • Patient is improving June 2010
What long-term care does Medicare pay for? • Home Health Care (skilled care in home) if: • Doctor says patient needs skilled care on part-time basis (medically necessary) • Patient is homebound • Agency providing care is Medicare-certified June 2010
Medicare also pays for hospice care • End-of-life pain relief and symptom management • For terminally ill patients June 2010
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) June 2010
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 June 2010
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 June 2010
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. June 2010
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 June 2010
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 June 2010
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 June 2010
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. and • 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. • DSHS offers multiple programs to help people. • The state may try to recover funds from your estate after your death (estate recovery). June 2010
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 June 2010
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. June 2010
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 • Want to ensure control over assets June 2010
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. • Insurers may go out of business. • 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. • Some LTC policies may have tax implications. June 2010
Points to think about with ALL options • Some facilities may have waiting lists. In case this happens, you may want to have a back-up plan. • Changing life events may affect your plans. • You may wish to discuss your planning with others, such as family members and friends. • Check into local resources • Washington Information Network 2-1-1 • Local senior resource guide for your county June 2010
Affordable Care Act to offer a new long-term care option New Community Living Assistance Services and Supports (CLASS) Act Takes effect Jan. 1, 2011, but enrollment may not start until 2013 Voluntary LTC insurance program Working people may buy LTC coverage through employer Feds still working out the details June 2010
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. June 2010
Want more information on your long-term care options? • Fill out the Long-Term Care Options Workbook • Make an appointment with a SHIBA HelpLine counselor: • Call the Hotline at 1-800-562-6900 • Call the local office at ____________ • Go online at www.insurance.wa.gov June 2010
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. June 2010
SHIBA HelpLine volunteer opportunities You might be interested in becoming a volunteer if you: • Love to learn and help people • Like problem solving • Don’t mind paper work or computer work • Are organized • Can attend regular training • Speak English and another language June 2010
Want more LTC information? • For options, ask for a SHIBA HelpLine volunteer. • For state laws and complaints against insurance companies, ask for a compliance analyst. 1-800-562-6900 TDD: 1-360-586-0241 www.insurance.wa.gov June 2010
Contact information To contact SHIBA via U.S mail: SHIBA HelpLine WA State Office of the Insurance Commissioner PO Box 40256 Olympia WA 98504-0256 June 2010
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 June 2010 The Office of the Insurance Commissioner can also help you with all types of insurance, such as:
