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Florida Long Term Care Health Insurance

People are living longer today. However, as we get older, our quality of life is usually not the same. We often need more assistance with daily activities, like bathing and getting dressed, especially after suffering a major illness like a stroke or heart attack. Take a look at the following statistics:

• More than 40% of people who reach age 65 will need some form of long-term care;
• the average annual cost of a nursing home in 2006 was over $74,000;
• the average stay in a nursing home is 2 ½ years

The cost of long-term care in Florida can be extremely high, so we need to find a way to finance it. Long-term care insurance is an effective option.

Owning long-term care insurance can help defray the cost of long-term nursing or home health care. Without insurance, you must either pay expenses out-of-pocket or rely on other sources such as family members, Medicare, or Medicaid.

Common Myths about Medicare

A common myth is that Medicare will pay for all of their long-term care costs. However, this is not the case.

Nationally, Medicare covers less than 11 percent of all nursing home costs. Many people don’t understand the parameters set up by Medicare that are necessary to qualify for long-term care. To qualify for long-term skilled nursing home care payments by Medicare, you must:

• require daily skilled nursing care, can only be provided in a facility thatb provides skilled nursing care on an inpatient basis;
• You must be confined as an in-patient for at minimum of three consecutive days (not including the day of discharge) before entering a skilled nursing facility that is certified by Medicare;
• be admitted to the skilled nursing facility for the same condition for which you were treated in the hospital;
• In general you must be admitted to the facility within 30 days of your discharge from the hospital; and
• A doctor must certify that skilled nursing or skilled rehabilitation services are needed on a daily basis.

If you do qualify for Medicare payments in a nursing home, the benefits will be paid as follows:

• all approved charges for the first 20 days are fully paid by Medicare;
• after the 20th day, the patient is responsible for a daily co-insurance amount (in 2008 it is $128.00);
• if a patient requires more than a 100 day stay, he or she will be responsible for the entire amount, beginning on the 101st day.

Thus, even a Medicare-qualified 100-day stay in a nursing home can cost the patient $10,240 (80 days at $128 per day).

How Much Does It Cost

There are many factors that affect the annual premiums of long-term care insurance. The primary factors which should all be considered when deciding on a policy are:

• Your Age. This is, in many cases, the age of the applicant on the day they sign the application.
• Nursing home only, or nursing home and home care coverage. Applicants are given the choice of applying for facility only coverage, or coverage in a facility as well as coverage in their homes.
• Simple, compound, or no inflation protection. Simple, or equal, inflation protection will increase the policyholder’s daily dollar amount of coverage by 5 percent of the original amount each year; the compound option will increase the daily dollar amount of protection by a compounded 5 percent each year;
• Benefit duration. Applicants are given the choice of signing up for a policy that will cover them for a certain number of years, or for life;
• Elimination Period (deductible). The elimination period is the period of time (normally expressed in days) that a policyholder must pay for care out of pocket before the insurance coverage begins; and
• Daily dollar amount of coverage. Since most nursing homes and home care providers charge by the day, applicants can apply for coverage based on a daily dollar amount.

Before Choosing a Plan

Before you choose a long-term care insurance plan, you should have a good idea of your income, savings, expenses and spending preferences. By combining these factors with your age and current health, you should be able to determine which policy is most suitable.

Are You a Qualified Buyer?

Companies selling long-term care insurance look at your health and health history before they issue a policy. On the application for coverage, they will ask you to answer a few questions about your health. For example, they may want to know if you have been hospitalized in the last 12 months. Some companies may examine your current medical records and ask for a statement about your health from your doctor. Having certain conditions that are likely to require a nursing home stay in the near future (Parkinson’s disease, for example) will probably disqualify you for coverage. In any case, you must answer certain questions that the company uses to determine if it is going to issue the coverage.

Age

Many individual long-term care insurance policies are offered to people between the ages of 18 and 84. And like many other types of insurance, the longer you wait to purchase, the more the premium increases. In addition, by purchasing a policy sooner, you may be more likely to meet the acceptable underwriting criteria. Plus, most long-term care insurance policies are guaranteed renewable, meaning that the policy cannot be canceled unless you stop paying premiums. By purchasing early, it may be possible for you to maintain a lower rate throughout the life of the policy.

When Should You Buy?

The purpose of owning a long-term care insurance policy is to give you protection against the high cost of care. A good time to consider the purchase of long-term care insurance is between the ages of 55 and 75. Because the premiums increase with age, the sooner a policy is purchased, the lower the annual premium will be, and the more likely it is you will maintain a lower premium. The same policy purchased at age 55 could cost two and a half to three times more if the purchase is delayed until age 75, all health considerations being equal. In addition, as people age, medical problems could develop. By purchasing long-term care insurance at an age when you are relatively healthy, you may also reduce the risk that you will not qualify for medical reasons.

What Should You Buy?

Long-term care insurance policies offer a wide variety of coverage. Your decision on purchasing a certain policy should not be based on price alone. Because many long-term care insurance policies are somewhat similar, the most important part of your decision is buying the right policy from the right company. The companies you consider should have top ratings from at least three of the major credit-rating agencies, which include A.M. Best, Standard & Poor’s, Moody’s, and Duff & Phelps. You will also want to find out how much experience the company has with long-term care insurance, it’s claims paying history and whether its premiums have been stable.

Benefit Options

You may also want to choose a company that offers a wide variety of benefit options. For example, make sure the company offers inflation protection. In addition, a long benefit duration option, like a lifetime/unlimited option, may be desired. Also, a variety of options with regard to elimination periods are preferable. That way you may choose whether you would like benefits to begin sooner or after a longer period of time.

Affordability

You will also want to make sure the policy is affordable for you. For some, a long-term care policy is an affordable and attractive form of insurance. For others, the cost is too great, or the benefits they can afford are insufficient. You should not buy a long-term care policy if it will cause a financial hardship and make you forgo other more pressuring financial needs. Each person should carefully examine his or her needs and resources to decide whether long-term care insurance is appropriate. It is also a good idea to discuss such a purchase with your family.

Some people with significant assets may not wish to buy a long-term care policy because they have the financial wherewithal to pay their own costs. On the other hand, people may buy a long-term care insurance policy because they do not want to pay for their own care nor burden their children with nursing home bills. It may be more desirable to transfer the cost to the insurance company.

Underwriting

During the underwriting process, one of the following procedures may be necessary:

• if you are under the age of 60, but have not seen a doctor in two years, you may need a medical interview;
• if you are over 60, but have not seen a doctor in one year, you will have a medical interview; and
• if you’re in your mid-70’s or over, you may have a personal interview to determined cognitive abilities.

If you’re found to be uninsurable, you will receive a refund of your initial submitted premium from the insurance company.

For More Information

Please contact NISONA today at 888-564-7662 to obtain more information from one of our dedicated and experienced agents. Always delivering the best in customer service and satisfaction, we look forward to helping you determine if a Florida Long Term Care Insurance policy is right for you.