Long Term Care Insurance
The California legislature requires the Insurance Commissioner to annually prepare a Consumer Rate Guide for long-term care insurance. This website consists of an overview of long-term care insurance, the types of benefits and policies you can buy, both as an individual and as a member of a group, information on what to consider before purchasing a policy and the premium rate history of each company that sells long-term care insurance in California.
This website will help answer some of your questions about long-term care insurance. It explains why people may need long-term care and how this type of insurance can help cover the cost for care. Long-Term Care policies most often pay for benefits on a reimbursement basis which means that the payment will be made to you after you have received the covered care and/or incurred the costs and submitted a claim. However, there are some policies that will pay a cash benefit. It is important to understand the coverage provided and how benefits will be paid/reimbursed before you purchase a long-term care insurance policy. When you receive your policy, be sure to read it and ask questions if there is anything in the policy that you don’t understand. The Rate Guide explains how long-term care insurance is structured and what benefits you can buy. A qualified long-term care insurance agent or the Health Insurance Counseling and Advocacy Program can help you with these questions and many others.
Sample Federal Long Term Care Insurance Comparisons
Comparing private “market” insurance plans vs the Federal Long Term Care Insurance plan, here are some actual examples. The individual plans listed were from Genworth , MassMutual , and Mutual of Omaha versus actual quotes from the Federal plan on an annualized basis.
* Note: Savings are annual. Over the course of the policy, this could lead to tens of thousands of dollars for these real-world clients we analyzed.
Can I Afford Long
Remember that after retirement, income often does not keep pace with inflation. As you age you may have unexpected medical expenses such as prescription drugs or other medical costs that may not be covered by your medical insurance. The loss of a spouse can also result in reduced income. Select a premium you can comfortably afford. Take into consideration that your premium may increase during the years you own the policy. When talking to a long term care insurance agent about long-term care insurance, it is important for you and your agent to understand your financial circumstances so that he or she can tailor a plan best suited to your needs.
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What Is Inflation Protection
Inflation Protection is intended to help maintain the value of the benefits you purchase today so they will keep up with future increases in the cost of care. In the past, long-term care costs in California have increased at an annual rate of more than 5%.
Protecting against the rising cost of care is one of the most important choices you will make. Inflation protection increases the Daily Maximum, the Maximum Lifetime Benefit and other benefit amounts. If you purchase individual long-term care insurance, your insurer must offer you at the time you purchase the policy the option to purchase an inflation protection feature. Your insurer must offer inflation protection which is no less favorable than the following options: Increases benefit levels annually so that the increases are compounded annually at least 5% or a Benefit Increase Option.
Should I Replace My Existing Policy With A Newer One
The advantage of replacing an older policy is that newer policies may offer more desirable benefits and features and fewer restrictions. Assisted living in an RCF/RCFE, home care benefits, inflation protection and no requirement for a prior hospital stay are some of the benefits and features being offered in current long-term care products. However, just because a policy is newer does not necessarily mean it is better than the one you have. In some instances, your insurer may be required to offer you its newer policy but you may have to undergo new underwriting to obtain the new coverage.
One disadvantage to replacement is that the insurance company will charge higher premiums because you are older than you were when you bought your original policy. In addition, if you have any preexisting conditions or you are 80 years old or older, companies may refuse to issue new coverage. If you are still insurable, you might consider adding new coverage to the benefits you already have or buying an additional policy to supplement your existing benefits.
Before you add benefits to an existing older policy you should check with your long term care insurance agent, company or tax advisor to see if you will lose the grandfathered tax status granted policies purchased prior to January 1, 1997. Whenever you are considering replacing a policy, consulting a HICAP counselor is recommended.
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Do Your Homework And Be A Smart Shopper
Be sure to read the Bureau’s Consumer Guide to Long-Term Care Insurance and Maine’s Long-Term Care Partnership Program , which includes sample plans and rates, and review the other resources listed below. When shopping for a policy:
- Work with a reputable agent who is knowledgeable about long-term care insurance.
- Check with multiple companies to get personalized rate quotes.
- Ask the company for an Outline of Coverage before you buy.
- Make sure that you understand the benefits and the limitations of the policy.
- Ask the company about its history of rate increases.
Longevity In The Long
Long-term care insurance is a relatively new product. While a handful of companies have been offering long-term care insurance for a decade or more, there are many companies that have recently entered the marketplace. Some companies have long experience with this type of insurance while others have less. Experience is just one more element to evaluate when purchasing this type of insurance.
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Plan And Benefit Options
In October 2019, the Office of Personnel and Management rolled out the programs latest plan FLTCIP 3.0. This version of FLTCIP places an emphasis on home and community care services and includes a premium stabilization feature which is intended to reduce the variability in premiums .
Some of the key benefits and features of FLTCIP 3.0 include:
- Choice of Care Location: Care can be provided at home, an assisted living facility, adult day care, hospice facility, or nursing home.
- International Benefits: Care received outside of the United States is covered up to 100% of a beneficiarys daily benefit amount.
- Friends and Family Member Caregivers: Excluding spouses or domestic partners, other family members can serve as informal caregivers for a 500-day period and up to 100% of a beneficiarys daily benefit amount can be applied.
- Built-in Flexibility: An alternate plan of care may incorporate customized benefits that are not already included in FLTCIP 3.0, allowing some flexibility to meet specific needs.
- Stay-at-Home Benefit: Certain costs that make care at home more feasible and comfortable are covered up to 30 times the daily benefit amount.
- Guaranteed Renewable: Coverage cannot be canceled due to age or a change in health.
- Break for Caregivers: Benefits are paid to provide your primary caregivers with temporary relief from caregiving responsibilities.
How Much Does Long
The cost of care in the future will be much higher than it is today. California nursing home rates increased at an average rate of over 5% per year during the past twenty years and are likely in the future to continue to increase by at least 5% per year. A 5% annual increase means a year of care that costs $50,000 today will cost twice that amount in 14 years, or $100,000 a year.
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What Types Of Long
There are a variety of long-term care services in the Commonwealth that are regulated or monitored by a state agency. Listed below are brief descriptions of each of the services and what organizations to contact for more information. It is important to remember that each service has different financial, medical and functional eligibility requirements.
Services in the Home
- Non-medical services provided in an individuals home to help continue independent living, including: vacuuming, washing floors and walls, defrosting freezers, cleaning ovens, cleaning attics and basements to remove fire and health hazards, changing storm windows, performing heavy yard work, shoveling snow and making minor home repairs.
- Contact your local Aging Services Access Points through the Executive Office of Elder Affairs.
- Non-medical services designed to maintain an individuals ability to live independently including shopping, planning menus, preparing meals, home delivered meals, laundry, and light house cleaning and maintenance, including vacuuming, dusting, dry mopping, dishwashing, cleaning the kitchen/bathroom and changing beds.
- Contact your local ASAP through the Executive Office of Elder Affairs.
Home Health Care
Services in a Community Setting
Social Day Care
Adult Foster Care
Adult Day Health
Dementia Day Care
Services in a Facility Assisted Living
Continuing Care Retirement Communities
Individual Vs Group Insurance
An individual long-term care insurance policy is a contract between you and the insurer. These policies must be approved by the California Department of Insurance and have all of the consumer protections required under California law. Individual policies are “guaranteed renewable” and cannot be canceled by the insurance company unless the premium is not paid on time. However, every company has the right to increase the premiums it charges with proper notification and approval from the Department of Insurance.
Group long-term care insurance is a contract between an insurer and a group such as an employer on behalf of its employees or a trade or professional association on behalf of its members. If you are covered under a group plan, you receive a “certificate” rather than a “policy” of insurance. Also, many of the policy terms have already been negotiated by the group, and the group has the option to terminate the policy at any time. Often, but not always, group insurance is less expensive than individual insurance. If group coverage is terminated, you have the right to continue the coverage or buy a conversion policy depending on the provisions of the policy and other factors. If you purchase group coverage, ask about what options will be available to you if the group cancels the policy or if you lose your membership or eligibility.
Be sure to ask if the premiums will change and ask how you will be notified.
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Choosing A Health Insurance Plan
Reading the fine print is important when choosing health care plans. These questions may help:
- Can I go to any doctor, hospital, clinic, or pharmacy I choose?
- Are specialists, such as eye doctors and dentists covered?
- Does the plan cover special conditions or treatments such as pregnancy, psychiatric care, and physical therapy?
- Does the plan cover home care or nursing home care?
- Will the plan cover all medications my physician may prescribe?
- What are the deductibles? This is the amount you must pay each year before your insurance company will begin paying claims.
- Are there any co-payments? This is the amount of money you pay each time you receive medical services or a prescription.
- If there is a dispute about a bill or service, how is it handled?
Eligibility And Premium Stabilization
For those who are eligible for FLTCIP, it is worth a look if youre considering an LTC policy. Not just federal employees and annuitants are eligible, either. Spouses, domestic partners, parents , and adult children of federal employees and annuitants are all eligible to apply for FLTCIP if the associated Fed is eligible as well. Armed service members can also apply for FLTCIP.
In 2019, FLTCIP added a premium stabilization feature to all new policies. Essentially, if the policyholder dies before age 85 and the insurance was never needed, 35% of premiums paid will be reimbursed to a chosen beneficiary as a death benefit. If the individual covered by FLCTIP lives to 85, they can start using 50% of their premiums paid to pay for their future premiums due. These options are better than the older policies without this feature, where the LTC insurance was use-it-or-lose-it with no way of recovering any amount of the premiums paid.
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Some VA lenders are tailored for borrowers with weaker credit, while others offer a larger variety of VA loan types. The best way to determine if you are eligible is to start by connecting with a lender. Lenders can pull your Certificate of Eligibility in minutes to see if you meet the basic service requirements and have VA loan entitlement. Additionally, a lender can review your financial information to determine if you meet credit and income guidelines.
Health Coverage For People With Disabilities
If you have a disability, you have three options for health coverage through the government.
Medicaid provides free or low-cost medical benefits to people with disabilities. Learn about eligibility and how to apply.
Medicare provides medical health insurance to people under 65 with certain disabilities and any age with end-stage renal disease . Learn about eligibility, how to apply and coverage.
Affordable Care Act Marketplace offers options to people who have a disability, dont qualify for disability benefits, and need health coverage. Learn about the .
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Federal Retirees Vision For Older Adult Care
One of Federal Retirees key advocacy priorities is the implementation of a national seniors strategy. In its vision for a national seniors strategy, Federal Retirees advocates for quality and equitable health-care services for all older Canadians, and for policy, programs and services that allow older adults to age with dignity, in the place of their choosing.
Achieving this vision requires a national pivot from delivering care in institutional settings, like hospitals and long-term care, to providing these services in homes and communities. It will require resource and system shifts to move us toward an expansion of home and community care services, which are less costly, allow Canadians to remain in their homes and communities for as long as possible and generally lead to better health outcomes and quality of life. To ensure quality and equitable care for all older Canadians, national standards for both long-term care and home and community care must be implemented.
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Premium Discounts And Other Premium
Companies may offer discounts if both spouses or domestic partners purchase long-term care insurance and may provide discounts for those who do not use tobacco products and are healthy. The definition of spouse in California includes domestic partners in accordance with insurance code section 381.5. Companies may provide that the policy of the surviving spouse is “paid-up” when the first spouse dies – no further premium payments are required. The policy may also have a “Waiver of Premium” option that relieves the insured of paying the premiums while receiving benefits. Policies may offer rate guarantees for certain time periods for an additional premium. A qualified long term care insurance agent can assist you in reviewing the options available.
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Fltcip Eligibility And Enrollment
As specified in the law, individuals eligible to apply for this insurance coverage are:
- Federal employees and members of the uniformed services. This includes employees of the U.S. Postal Service and Tennessee Valley Authority, but does not include employees of the District of Columbia government. For federal and postal employees, in general if you are in a position eligible for FEHB coverage, you are eligible for this program . The exception is that temporary employees and employees working on seasonal or intermittent schedules are not eligible even if they are eligible for health insurance.
- Federal annuitants, surviving spouses of deceased federal or postal employees or annuitants who are receiving a federal survivor annuity, those separated and who will be eligible for a deferred annuity, individuals receiving compensation from the Department of Labor who are separated from the federal service, members or former members of the uniformed services entitled to retired or retainer pay, and retired military reservists at the time they qualify for an annuity or those separated and not yet drawing an annuity .
- Current spouses of employees or annuitants.
- Adult children of living employees, annuitants, and of surviving spouses receiving an annuity.
- Parents, parents-in-law, and stepparents of living employees and their spouses .
The program does not conduct regular open seasons.
Will You Need Long
It is impossible to predict your individual chances of needing long-term care. For some, the need may follow a major illness, while for others the need may evolve more gradually. Some may require many years of long-term care, while others might need services for only a matter of months.
The following chart outlines the probability of an individual being admitted to a nursing home at age 65.
Please note that these figures do not include people who require home or community-based long-term care services. There are a large number of different services that are available to you in your home which can allow you to age in place and never have to move into a nursing home. The above statistics also do not reflect the fact that as lifestyle and medical advancements allow people to live longer, more people will need long-term care. Therefore, your actual probability of needing at least some type of long-term care during your life is probably higher than these numbers suggest.
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Transforming Older Adult Care
Transforming older adult care requires a different approach, with an emphasis on providing care at home and in the community so that Canadians can age in place. It also involves implementing national standards for long-term care, home care and other older adult care, to ensure a baseline level of quality care for older Canadians, regardless of where they live.
Governments and likely the federal government will need to enact laws that support this new direction. The Canada Health Act, which outlines Canadas health-care framework, establishes criteria, conditions and funding related to insured health services. However, it focuses on hospitals and physicians, the services most Canadians needed when the legislation was drafted. Canadas aging population means the needs of Canadians have changed, and our health-care framework must keep pace.