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Medicare.gov - The Official U.S. Government Site for People with Medicare d   Screen Reader Version   |   Español   |     | Home   |  Glossary   |  Help   | Frequently Asked Questions   |  The Official U.S. Government Site for People with Medicare    Search Help   |   Site Map   |   Index   |   Site Tips   | Medicare Eligibility, Enrollment, and Premiums Nursing Homes Medicare Plan Choices Medicare Claims, Appeals Information, and Medicare Summary Notices Information to Help You Stay Healthy Frequently Asked Questions Have a question? Your answer could be here. Search Tools Medicare Personal Plan Finder Nursing Home Compare Prescription Drug Assistance Programs Dialysis Facility Compare Participating Physician Directory Supplier Directory Helpful Contacts Publications Your Medicare Coverage (coming soon) Local Medicare Events Medicare Health Plan Compare Medigap Compare News and Updates Frequently Asked Questions More News and Updates Search Tools Medicare Personal Plan Finder Helping you compare health plans in your area. Nursing Home Compare Compare nursing homes in your area. Prescription Drug Assistance Programs Programs that offer discounted or free medications. Dialysis Facility Compare Compare dialysis facilities in your area. Participating Physician Directory Locate Medicare participating physicians in your area. Supplier Directory Locate Medicare participating suppliers in your area. Helpful Contacts Find phone numbers and websites. Publications View, order, or download Medicare publications. Your Medicare Coverage (coming soon) Your health care coverage in the Original Medicare Plan. Local Medicare Events Includes events on Medicare related topics. Medicare Health Plan Compare Compare health plans in your area. Medigap Compare Locate supplemental insurance policies to cover expenses not paid by Medicare.   Home   |   Privacy Policy   |   Awards   |   Comments   |   Mailing List   |   Website Accessibility   | Centers for Medicare & Medicaid Services Department of Health and Human Services 76

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Medicare.gov - Paying for Nursing Home Care d   Screen Reader Version   |   Español   |     | Home   |  Glossary   |  Help   | Frequently Asked Questions   |  The Official U.S. Government Site for People with Medicare    Search Help   |   Site Map   |   Index   |   Site Tips   | Medicare Eligibility, Enrollment, and Premiums Nursing Homes Medicare Plan Choices Medicare Claims, Appeals Information, and Medicare Summary Notices Information to Help You Stay Healthy Frequently Asked Questions Have a question? Your answer could be here. Search Tools Medicare Personal Plan Finder Nursing Home Compare Prescription Drug Assistance Programs Dialysis Facility Compare Participating Physician Directory Supplier Directory Helpful Contacts Publications Your Medicare Coverage (coming soon) Local Medicare Events Medicare Health Plan Compare Medigap Compare Nursing Homes Paying for Care Medicare Under certain limited conditions, Medicare will pay some nursing home costs for Medicare beneficiaries who require skilled nursing or rehabilitation services. To be covered, you must receive the services from a Medicare certified skilled nursing home after a qualifying hospital stay. A qualifying hospital stay is the amount of time spent in a hospital just prior to entering a nursing home. This is at least three days. To learn more about Medicare payment for skilled nursing home costs, contact your Medicare Fiscal Intermediary or the State Health Insurance Assistance Program (SHIP) in your State. The phone number for the Medicare Fiscal Intermediary or SHIP office in your area can be found in the Helpful Contacts section of this website. Medicaid Medicaid is a State and Federal program that will pay most nursing home costs for people with limited income and assets. Eligibility varies by State. Check your State's requirements to learn if you are eligible. Medicaid will pay only for nursing home care provided in a facility certified by the government to provide service to Medicaid recipients. For more information about Medicaid payments, call the SHIP for your State or call your State's Medicaid office. The telephone number is in the blue pages of the phone book. Personal Resources About half of all nursing home residents pay nursing home costs out of their own savings. After these savings and other resources are spent, many people who stay in nursing homes for long periods eventually become eligible for Medicaid. Managed Care Plans A managed care plan will not help pay for care unless the nursing home has a contract with the plan. If the home is approved by your plan, learn if the plan also monitors the home for quality of nursing care. Medicare Suplemental Insurance This is private insurance. It's often called Medigap because it helps pay for gaps in Medicare coverage such as deductibles and co-insurances. Most Medigap plans will help pay for skilled nursing care, but only when that care is covered by Medicare. Some people use employer group health plans or long-term care insurance to help cover nursing home costs. Long-Term Care Insurance This is a private policy. The benefits and costs of these plans vary widely. For more information on these plans, contact the National Association of Insurance Commissioners (NAIC). It represents state health insurance regulators and has a free publication called "A Shopper's Guide to Long-Term Care Insurance." You also can get a copy of the Guide to Health Insurance for People with Medicare: by calling 1-800-MEDICARE. Counseling and Assistance SHIPs have counselors who might be able to answer your questions about how to pay for nursing home care, the coverage you may already have, or whether there are any government programs that will help with your expenses. Top of page Easy Print Overview Nursing Home Compare Checklist About Nursing Home Inspections Alternatives to Nursing Homes Paying for Care Resident Rights Nursing Home Awareness Campaigns Nursing Home Publications Nursing Home Related Sites   Home   |   Privacy Policy   |   Awards   |   Comments   |   Mailing List   |   Website Accessibility   | Centers for Medicare & Medicaid Services Department of Health and Human Services 145

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Centers for Medicare & Medicaid Services (Formerly HCFA)   Centers for Medicare & Medicaid Services       Medicare Medicaid SCHIP HIPAA Publications Local Information Stats & Data Research & Demos Laws & Regs Public Affairs About CMS Site Search The Centers for Medicare & Medicaid Services has a new website, cms.hhs.gov . Please visit cms.hhs.gov for the latest news and information. Over the next several months, we will completely migrate from the www.hcfa.gov website to the cms.hhs.gov website. Please see " About cms.hhs.gov " for further information. CMS provides health insurance for over 74 million Americans through Medicare, Medicaid and SCHIP. The majority of these individuals receive their benefits through the fee-for-service delivery system, however, an increasing number are choosing managed care plans. In addition to providing health insurance, CMS also performs a number of quality-focused activities, including regulation of laboratory testing (CLIA), development of coverage policies , and quality-of-care improvement. CMS maintains oversight of the survey and certification of nursing homes and continuing care providers (including home health agencies, intermediate care facilities for the mentally retarded, and hospitals), and makes available to beneficiaries, providers, researchers and State surveyors information about these activities and nursing home quality. To ensure public and expert involvement in running our programs, CMS maintains a number of chartered advisory committees . These committees, whose meetings are open to the public, are used to provide advice or make recommendations on a variety of issues relating to CMS's responsibilities and activities. DHHS/CMS Initiatives include: Beneficiary Notices Initiative Medicare Learning Network (MedLearn) The American Customer Satisfaction Index Home and Community Based Services: Americans with Disabilities Act / Olmstead New Freedom Initiative Real Choice for Systems Change Grants Systems Change Grants for Community Living Ticket to Work and Work Incentives Improvement Act of 1999 (TWWIIA) State Health Reform Maternal HIV Consumer Information Performance Measurement (APP) Health Insurance Portability and Accountability Act (HIPAA) , including the Administrative Simplification Act (AS) What's New Site Index Information for: Beneficiaries Plans and Providers Researchers States Students Learning Resources CMS Career Opportunities Events, Meetings, and Workgroups Program Integrity: Fraud and Abuse ; Medical Review ; Provider Enrollment ; and Medicare Integrity Program . Medicare.gov | Department of Health and Human Services | NMEP Privacy Policy | Feedback | Help | Website Accessibility Freedom of Information Act | Privacy Act

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What Consumers Need To Know About Private Long Term Care Insurance What Consumers Need To Know About Private Long Term Care Insurance Defining Long Term Care Long Term Care Is Offered In A Variety Of Settings Financial Issues And Long Term Care When To Buy Long Term Care Insurance What To Look For In A Policy Selecting A Good Company Finding A Policy Selecting A Policy How Much Insurance To Buy Services Covered By Long Term Care Insurance Services Not Covered By Long Term Care Insurance Other Available Options The Cost Of Long Term Care Insurance Comparison Of Total Premiums Paid By Issue Age Comparing Cost Of Policies Premium Increases Policy Cancellation Health Status Reviewing The Policy Complaints Switching Policies Conclusion Glossary Of Terms For More Information Long term care is a major concern of American families. Studies have shown that Americans rank long term care second, behind saving for retirement, when prioritizing financial needs. Unfortunately, many Americans do not want to think about needing long term care and, therefore, fail to plan for it. Others wrongly assume that Medicare or standard health insurance policies will cover the costs of long term care services. As a result of this failure to plan, tens of thousands of Americans are impoverished each year by the costs of long term care. The best time to plan for long term care is before it is needed. Start thinking about long term care when you plan for retirement. If you are already retired, it is not too late to begin planning for potential long term care needs. Private long term care insurance is an excellent way to finance long term care. This brochure will guide you through the important process of selecting the right long term care insurance policy. This booklet provides information on long term care services, what to look for in a long term care insurance policy, and a glossary of terms. Finding a good policy will take some effort, but the effort will be worthwhile. Here are some steps to take when considering the decision to purchase a long term care insurance policy: Talk to your financial planner or insurance agent about whether long term care insurance makes sense for you. Ask your financial advisor to recommend a company and a policy. Check with insurance rating services to make sure the insurance company you are considering is financially secure. Call your state insurance department and ask about the company and its record in your state. Make sure your insurance agent is licensed to sell long term care insurance in your state. Review all the details and options of the policy. Do not rely just on the marketing materials or outline of coverage. Make sure you understand all the provisions before you purchase any policy. Ask your insurance agent questions. Seek guidance from the state insurance commission office, the Area Agency on Aging, or local senior centers. Discuss policies with friends, family, and others whose opinions you respect. Take time when choosing a policy, and don't allow yourself to be pressured into making quick decisions. And remember: Never pay cash. The decision to purchase long term care insurance is not a simple one, but thorough investigation and thoughtful planning now can offer you and your family financial protection for the future, and, most importantly, peace of mind. Defining Long Term Care Long term care includes a range of nursing, social, and rehabilitative services for people who need ongoing assistance. Most people in long term care facilities are older, but many young people need long term care during an extended illness or after an accident. Assistance with routine personal needs such as bathing, dressing, eating, toileting, and taking medicine is the most common long term care service. Long term care facilities also provide skilled nursing and rehabilitative care, which is ordered by a physician and supervised by skilled medical personnel such as a nurse or licensed therapist. Long Term Care Is Offered In A Variety Of Settings Nursing facilities are the primary settings for people who require medical care daily or intermittently. You must have a physician specify needed services in a written treatment plan for admission to a nursing facility. Many nursing facility stays are short periods of recuperation from an acute medical episode such as a hip fracture or surgery. Assisted living facilities or residential care facilities provide general supervision, housekeeping services, medical monitoring, and planned social, recreational, and spiritual activities for people who are still independent and ambulatory. Assisted living facilities do not provide medical care. Facility care services include skilled nursing care, speech, physical, or occupational therapy, facility health aides, or help from facilitymakers. Sometimes, family members, or caregivers, provide most of the care with the help of facility aides and skilled professionals. Adult day care services are available in many communities, providing personal care, skilled care, and recreational services. Financial Issues And Long Term Care The cost of long term care varies by the level of care needed, the setting where the care is provided, and geographic location. Nursing facilities, assisted living facilities, and facility care services provide different levels of care to different resident populations; therefore, costs are not comparable. On average, round-the-clock long term care services in a nursing facility cost $40,000 per year, or $112 per day. Assisted living costs vary dramatically-anywhere from $900 to $3000 per month depending on room size, amenities provided, and services required. Facility care, if needed daily, also can be quite expensive. In 1996, an average facility care visit from a registered nurse (RN) cost $99. RN visits for facility care typically do not exceed 2-4 hours per day, so care is not round-the-clock. Eight hours of adult day care can cost an average of $45 per day. Nursing Facility Care: About one third of the costs of nursing facility care are paid directly by individuals and their families. Two government programs may pay for some of your care. Medicare, a health insurance program for people age 65 or older, only covers skilled facility care and up to 100 days of skilled care in a nursing facility if you are admitted after a three-day hospitalization (not required if you are an HMO member) and your physician prescribes skilled care in your treatment plan. Many people think that Medicare is the primary payor of nursing facility stays, but Medicare accounts for only 9 percent of nursing facility expenditures. Medicaid, a program for the poor, pays for approximately 52 percent of the nation's nursing facility care, but only for people who have spent almost all their assets and become impoverished. Due to lack of planning for long term care, Medicaid is the source of payment for nearly 70 percent of people in nursing facilities! Unless you have long term care insurance, qualify under limited conditions for Medicare coverage, or become poor, you will pay out of your savings for nursing facility services. Assisted Living: About 90 percent of the nation's assisted living services are paid for with private funds. The Supplemental Security Income, Older Americans Act, and Social Services Block Grant programs pay for some assisted living services, while about one-fifth of the states allow the federal Medicaid program to pay for some service components. Facility Care: Private funds pay for about 46 percent of facility care costs; Medicare covers 32 percent; Medicaid, 22 percent. Adult Day Care: There are some out-of-pocket expenses for adult day care; however, the majority of funding comes from public sources either the state exclusively, or, in some states, Medicare and Medicaid. Private donations from corporations and charitable groups such as the United Way also supplement the costs of adult day care. When To Buy Long Term Care Insurance Because long term care insurance premiums are based on age at the time of purchase, the younger you are when you purchase a policy, the less expensive the annual premium. These premiums for most policies stay level each year as you age. If you buy at age 55 a policy that cost $800 per year, you will continue to pay the same premium. However, if you wait until you are 65, the same policy will cost you $1,700 per year. What To Look For In A Policy The best policy for you depends on several factors, including your family arrangement, your financial situation, your preferences regarding long term care choices, and the level of risk you are willing to accept. There is no one best company or one best policy for everyone. You should select a policy that meets your needs. Before you buy a policy, make sure you know the product you are buying and from whom you are buying it. Be sure your agent is licensed to sell insurance in your state and has received specific training on long term care insurance. Consult friends, consumer guides, and information from your state's insurance counseling program or local agency on aging. Selecting A Good Company More than 115 companies now offer long term care insurance products, according to the Health Insurance Association of America . Contact your state insurance commissioner's office for a list of companies authorized to sell long term care insurance in your state. Investigate the financial health of any insurance company that you are considering. Look for ratings from insurance rating services, such as Moody's or A.M. Best. The insurance company should be rated in one of the top two categories by at least two services and have no low ratings. You can find these rating services in the reference section of your library, or you may call Moody's at 212-553-0300, or A.M. Best at 908-439-2200. Finding A Policy Long term care insurance is sold in the form of individual policies, individual policies through an organization, and group policies. An individual policy is sold directly to you, usually by insurance agents or financial planners. You have tremendous flexibility selecting the company, the policy, and the amount of coverage. Some individual policies are sold through groups, such as an association or organization. Although you do not have a choice of companies, you have the advantage that the organization selected a good company and policy to offer you. But you may have fewer choices in the amount of coverage and options in the policy. A group policy is usually offered through your employer, who contracts for the insurance plan. Group policies may cost less than comparable individual policies, but your choices are also limited. Selecting A Policy The most important factor in selecting a policy is the set of conditions required to qualify for coverage. Buying a policy that covers long term care services will not help if you do not qualify for benefits. Many policies require a policyholder to have an acute medical condition before he or she can qualify for benefits. The best policies are not contingent on an acute medical condition: They will pay for the long term care of a person with a physical or cognitive impairment. People who have a physical impairment need assistance with the activities of daily living (ADLs) feeding, dressing, transferring, bathing, taking medications, and toileting. Policies differ in the number of impairments a person must have before they qualify for benefits. Avoid policies that require physical impairment due to a medical condition, or that require assistance with ADLs to be medically necessary. People who are cognitively impaired have Alzheimer's disease or other forms of dementia. A policy's definition of cognitive impairment should never refer to the activities of daily living. People with dementia usually can perform ADLs if prompted, but often exhibit inappropriate or bizarre behavior. Another important factor is which entity or gatekeeper decides whether or not you qualify for benefits. Most policies require your physician to certify the reasons you need long term care services. Some policies require your physician to write a treatment plan. Some insurance companies offer a care (or case) manager to determine if you qualify or continue to qualify for benefits. Some care managers also help you find and monitor long term care services available in your community. How Much Insurance To Buy Most long term care insurance policies pay a maximum fixed dollar amount for each day you receive covered services. When you buy a policy, you decide the value of the fixed dollar amount and the length of time your benefits will run. For example, if you buy a policy that pays $100 per day for three years, the policyvalue is $109,500 a figure that is computed by multiplying 365 days times 3 years for the maximum number of days multiplied by $100, the amount the policy will pay per day. Remember that no policy guarantees to cover all costs of long term care without a limit. Because most retirement income is fixed and may not keep pace with inflation, your ability to afford premiums may diminish. Buying too much insurance may mean that you cannot afford to pay the premium later. The four components used to determine how much insurance to buy are: Benefit Amount Inflation Adjustment Benefit Period Deductible Period Benefit Amount is the maximum fixed dollar amount that a policy will pay each day. A potential purchaser of long term care insurance usually has the option to choose a daily benefit amount ranging from $40 per day to $200 per day for nursing facility coverage. Most policies offer a daily benefit for facility care that is equal to half of the nursing facility daily benefit, while some allow you to select the benefit amount you want for facility care. To determine the benefit amount best for you, find out today's cost of a nursing facility of your choice, then decide how much from your income you could afford to spend per day. Couples, likely to need the entire income for the other spouse, should figure that no income will go to cover long term care costs. The difference between the cost of a good nursing facility and the amount from your income is the benefit amount you should buy. Generally, this is 80 percent to 100 percent of today's long term care cost. Inflation Adjustment is the increase of the benefit amount to cover the effect of inflation. The cost of long term care services increases every year due to inflation. A policy paying $100 per day will cover most of the cost of a nursing facility today. However, this same policy probably will cover only a fraction of the cost in future years unless you buy inflation protection. There are several optional policy features. The best, and most expensive, is an inflation adjustment that increases the benefit amount by a certain percentage (usually 5 percent) compounded for the life of the policyholder including while you are receiving benefits. In other words, the benefit amount increases 5 percent annually over what the policy would pay the previous year. Instead of a compounded rate, you can buy a simple rate inflation adjustment, which increases the benefit amount by 5 percent of the original benefit, instead of the previous year's benefit amount. The difference is small in a short period of time, but quite substantial over a long period of time. Policies may limit the length of time the inflation adjustment will increase the benefit amount. Some policies limit the increase of the benefit amount to a specific number of years generally about 20 or until the policy doubles, which is about 16 years for a compounded rate of inflation, and 20 years for a simple rate. Some policies will increase the benefit amount until the policyholder reaches a specific age. Any limit on the benefit amount increase will reduce the cost of the inflation adjustment option. You may want to consider an inflation adjustment restriction, if the option would not leave you without inflation protection. If you are 60 years old and expect to live into your nineties, a policy that stopped increasing the benefit amount after 20 years would leave you with 10 or more years without any inflation adjustment to your benefit amount. Meanwhile, the cost of long term care has continued to increase. It is worth it to pay a little extra to ensure that you are protected. However, if you are 70 and believe you will need long term care by the time you are 80, you could save some money by buying a policy that has a simple rate inflation adjustment for 20 years. A few policies allow you to purchase additional benefit amounts in future years. However, you will buy these additional amounts at the higher premium based on age. You may want to consider this option if you are under age 50. However, for older ages, this option is substantially more expensive than the automatic annual inflation adjustment option. Ask your financial advisor to compare various inflation options and the resulting premiums. You should select the inflation option that is best for your situation. Benefit Period is the length of time the policy will pay for covered services. Policies offer benefit periods ranging from two years to an unlimited benefit period. You should first determine the benefit amount before you consider the benefit period. Many people worry about the potential of a very long stay in a nursing facility. However, there is a very small probability (less than 8 percent) that you will stay more than five years in a nursing facility. The primary consideration is how much you can afford in premiums. The average length of stay in a nursing facility is two-and-a-half years. If all you can afford is two years of coverage, it probably will be adequate. If you can afford a longer benefit period, you should buy it. Deductible Period , also called the elimination period, is the number of days that you pay for covered services before the policy pays. Consumer advisors recommend a deductible period between 20 days and 100 days. Policies with longer deductible periods have lower premiums, but you will have to pay for needed services until you meet the deductible. The length of the deductible period you should buy depends on the assets you have available to pay for services during the deductible period and how much you can afford in premiums. Services Covered By Long Term Care Insurance The most important service a policy should cover is custodial or personal care. A good long term care insurance policy will cover all levels of care, especially personal care, and all settings, including facility care, community adult day care, assisted living facilities, and nursing facilities. Policies usually differentiate between nursing facility care and facility care. Under facility care, most policies include the community services of adult day care and respite care (temporary overnight care to relieve family caregivers). Most policies pay a different benefit amount for facility care, usually amounting to half the nursing facility daily benefit. However, many are now offering equal benefit amounts or the option to choose a benefit amount. Assisted living facility services are usually covered under facility care. If a policy requires you to purchase facility care services from a facility health agency, it may not cover assisted living facility care because the facility provides the service, not a facility health agency. Some policies cover assisted living facilities under nursing facility benefits. If you are interested in assisted living facilities, make sure you know how the policy handles the service. Services Not Covered By Long Term Care Insurance Like all insurance policies, long term care insurance contains limitations and exclusions. Without limitations and exclusions, premiums would be unaffordable. In general, the following conditions are NOT covered: Health problems you had before you purchased the policy (some insurance companies exclude coverage for pre-existing conditions for six months); Mental and nervous disorders or diseases, other than Alzheimer's disease and related dementia; Alcohol and drug addiction; Illnesses caused by an act of war; Illnesses resulting from intentionally self-inflicted injury; Attempted suicide; and Treatment already paid for by the government. Other Available Options Some policies offer a nonforfeiture benefit, which provides a return of some premiums paid or a reduced benefit if the policyholder stops paying the premium after some period of time. You should consider the likelihood of not being able to pay your premium if the premium increases or your income decreases. Because this benefit significantly increases the cost of the premium, carefully review the available nonforfeiture benefit options. For policies that offer a reduced benefit for the premiums paid, it is usually preferable to have a policy that will pay the full benefit amount for a shorter benefit period. On the other hand, if your financial situation is secure, and you foresee no risk of losing your coverage because you cannot pay the premium, you might choose a lower premium with no nonforfeiture benefit. It is helpful to keep in mind the comparison between investment and insurance. If you are considering long term care insurance as an investment, paying a higher premium now and having some protection against lapsing in the future makes sense. The other option for those seeking an investment, rather than pure insurance, is to purchase a life insurance policy with a long term care rider or accelerated death benefits, or to invest the additional premium amount in a high-return investment. The Cost Of Long Term Care Insurance The cost of a long term care insurance policy primarily depends on your age. The older you are when you purchase a policy, the higher your premium. The annual premium for a low-option policy for a person at age 50 is about $400. This same policy for a 65-year-old person is about $1,100 per year; for a person age 79, the policy would cost more than $4,300. Of course, the younger person pays the premium for a longer period of time. However, if long term care is needed at age 85 in each of these cases, the 50-year-old person would have paid a total of $14,175 for long term care insurance, compared to the 79-year-old person paying $26,232. In addition, the 50-year-old will receive a higher benefit amount from the inflation adjustment. Simply, the earlier you buy the policy, the less expensive it will be in the long run. Comparison Of Total Premiums Paid By Issue Age Issue Age Annual Premium No. of Years Paying Premium Total Premiums Paid At Age 85 50 $405 35 $14,175 65 $1,086 20 $20,000 79 $4,372 6 $26,232 Of course, there is nothing you can do about your age. But you can control the premium by controlling the amount and options you purchase in a policy. Higher daily benefits and special features, such as inflation protection and nonforfeiture benefits, increase your premium. Studies of the cost of long term care insurance show a three-fold difference from a low-option policy to a high-option policy in every age category. The following chart will help you compare the premiums of different insurance policies. Indicate the amount of insurance and the option you select for each policy. Comparing Cost Of Policies   Policy A Policy B Policy C Annual Premiums ________ ________ ________ Benefit Amount       Nursing facility ________ ________ ________ Facility Care ________ ________ ________ Inflation Adjustment       Annual Percent ________ ________ ________ Simple/ Compounded ________ ________ ________ Time Period ________ ________ ________ Benefit Period       Nursing Facility ________ ________ ________ Facility Care ________ ________ ________ Deductible Period ________ ________ ________ Special Features       _________________ ________ ________ ________ _________________ ________ ________ ________ _________________ ________ ________ ________ Premium Increases Most premiums for long term care are level. After you have purchased a policy, the premiums do not automatically increase as you get older. However, level premiums do not mean that the premium will never increase. It means that the company cannot raise the premiums due to increased age or the health of an individual policyholder. The insurance company may raise premium rates for an entire class of people in the state, with permission from the state insurance commission. Policy Cancellation The best policy to buy is guaranteed renewable, meaning that the insurance company cannot cancel the policy for any reason, except if you do not pay the premium. Most companies selling individual policies clearly state that the policy is guaranteed renewable. Some policies provide lapse protection for individuals who develop dementia. Thus, if a person who has regularly paid premiums for years develops Alzheimer's disease or some other condition affecting mental health, and forgets to pay the premium, coverage will not be canceled. Some companies offer to notify a third party if a premium is not paid on time. Health Status All insurance companies ask questions regarding your current health status. The better companies will medically underwrite the policy by asking you to complete a medical history form and supply the name of your physician. The insurance company may contact you or your physician to verify your answers or clarify your medical conditions. If you have medical conditions in your history or have current medical programs, the company may refuse to insure you. Medical underwriting is not an exact science. Therefore, if you are denied a policy, appeal the decision. Ask the company why it refused to insure you. At the time you submit a claim, a few companies will claim that you failed to disclose your entire medical history when purchasing a policy, and state they would not have sold that policy to you if they had known your full medical history. This procedure, known as post claims underwriting, is illegal in many states. Be sure to purchase a policy from a company that asks the detailed medical questions up front. A good company will sell a long term care insurance policy only to people who are reasonably healthy and at relatively low risk of needing long term care in the near future. Some companies will not sell to a person over age 85, or will sell only a lower benefit policy to people between 80 and 85 years of age. Some companies require a waiting period for any pre-existing conditions. Regardless of these consequences, you should fully disclose your medical conditions. Reviewing The Policy You should review the actual policy before buying. If your agent will not leave a sample policy for you to review at your leisure, then find a new agent. After you buy, you have a right to review the policy for 30 days with the option to cancel for a full refund. Complaints If you have any complaints regarding the agent or the company that sold you long term care insurance, write to the consumer affairs or insurance department in your state. Your complaint will trigger an investigation, which could help you, as well as other consumers. The policy should explain how to file a complaint, where to get information from your insurance company, and how to appeal a claim denial. Switching Policies There might be situations in which canceling an existing policy and buying a new one makes sense. You should carefully compare the increased premiums to the added benefits of the new policy. Remember that your premium is based on your age at the time you initially purchase a policy. Insurance companies introduce new products about every two or three years. Ask your agent about the company's record regarding policy upgrades. Many companies automatically notify existing policyholders and offer the new policy at a higher premium. Some companies automatically upgrade existing policies to new policies. However, some companies do not always notify policyholders of newer, better products, and require you to buy the improved policy as though you were a new buyer. Conclusion Long term care insurance can protect your assets and provide you with peace of mind. You and your financial advisor should discuss whether long term care insurance is right for you. If long term care insurance fits your needs, purchase from a reputable company a policy that offers benefits that cover physical or cognitive impairment. Carefully consider how much insurance and the options you need. There is no one best policy. However, with a little research, you will find a policy that fits your needs at a premium you can afford. Glossary of Terms Accelerated Death Benefits - Some life insurance companies offer life insurance policies with a special feature that allows payment of the death benefit when the insured person is still alive. Such payment usually is limited to situations in which the individual is terminally ill. The benefits are available to cover the costs of long term care services. Activities Of Daily Living (ADLs) - The physical functions necessary for independent living. These usually include bathing, dressing, using the toilet, eating, and moving about (transferring). Some long term care policies pay benefits based on an individualÕs need for assistance to perform several ADLs. Cognitive Impairment - A diminished mental capacity, such as difficulty with short-term memory. Case Management - A system in which one individual helps the insured person and his/her family determine necessary services, and the best setting for those services. Custodial Care - Board, room, and other personal assistance services (including assistance with ADLs, taking medicine, and other similar personal needs), that do not include a health care component and may be provided by people without medical skills or training. Deductible or Elimination Period - These terms refer to the waiting period, the initial number of days before the benefits are paid by the insurance company. Most policies offer a choice of waiting periods, ranging from 0 to 365 days, during which policyholders pay for needed services out of their own pockets. Dementia - Progressive mental disorder that affects memory, judgment, and cognitive powers. One type of dementia is Alzheimer's disease. Exclusion - Any condition or expense for which a policy will not pay. Free-Look Period - After purchasing a policy, you usually have 30 days to review it. You may cancel the policy for a full refund during this time. Guaranteed Renewable - With this policy provision, an insurance company cannot cancel a policy unless you fail to pay premiums when due. Premiums cannot be raised unless there is a rate increase for all policyholders in a particular group. Facility Care - Health services rendered to an individual in his or her facility. Facility care includes a wide range of services, such as part-time skilled nursing care, speech therapy, physical or occupational therapy, facility health aides, or facilitymakers. Indemnity Benefit - A flat payment made directly to the policyholder, rather than to the nursing facility or facility care agency for services rendered. Inflation Protection - One of several mechanisms that can be built into insurance policies to provide for some increase over time of the daily benefit to account for inflation. Addition of this feature to a policy can be important depending on your situation, but it also raises the price of the policy. Lapse - To allow insurance coverage to expire by not paying premiums. Level Premiums - The company cannot raise the premiums due to age or medical condition. The company may raise the premium rates for an entire class of people with permission from the state insurance commission. Medicaid - The federally supported, state operated and administered public assistance program that pays for health care services to low-income people, including elderly or disabled persons. Medicaid pays for long term nursing facility care and some limited facility health services. Medicare - The federal program providing hospital and medical insurance for people aged 65 and older, some disabled persons, and those with end-stage renal disease. Medicare provides only very limited benefits for skilled care, and under specific conditions, for nursing facility and facility health care. Medigap - Private insurance that supplements Medicare. While Medigap policies typically cover Medicare's deductibles and coinsurance amounts, they do not provide benefits for long term care. Like Medicare, Medigap policies primarily cover hospital and doctor bills. Nonforfeiture Benefit - A policy feature that provides for some return on premiums paid or reduced benefits, even if the policyholder quits paying the premium after a minimum period of time. This feature makes the insurance purchase more of an investment than true insurance, and raises the basic policy price. Outline Of Coverage - A description of policy benefits, exclusions, and provisions that makes it easier to understand a particular policy and compare it with others. Out-Of-Pocket Payments or Costs - Costs borne without benefit of insurance, or payment required under insurance cost-sharing provisions. Period Of Confinement - The time during which you receive care for a covered illness. The period ends when you have been discharged from care for a specified period of time, usually six months. Preexisting Conditions - Medical conditions that existed, were diagnosed, or were under treatment before you took out a policy. Long term care insurance policies may limit the benefits payable for such conditions. Post Claims Underwriting - A practice whereby a claim is denied on the basis of the individual's health status at the time the policy was purchased. Most reputable companies do medical underwriting at the time a policy is sold, rather than at the time a claim is submitted. Skilled Nursing Care - Nursing and rehabilitative care that can be performed only by, or under the supervision of, skilled medical personnel. Skilled Nursing Facility - Under Medicare, an institution (or a distinct part of an institution) that provides daily skilled nursing care and related services for patients who require medical, nursing, or rehabilitative services. For More Information Your state Insurance Commissioner's office Your local Area Agency on Aging American Association of Retired Persons (or your local AARP chapter) 601 E St., NW Washington, DC 20049 (202) 434-2277 Health Insurance Association of America 555 13th St. NW Washington, DC 20004 (202) 824-1600 National Association for Home Care 519 C St., NE Washington, DC 20002 (202) 547-7424

Results from search: http://www.seniorcarehelp.com/

Nursing Home Report Cards Now Online from SeniorCare Resources! Nursing Home Reporter to   Ask Jennifer   Specific Questions - click here for Long Term Care Insurance - click here for Terminated Facilities - click here Affiliate Program - click here Researchers - click here click here for What We Do what we can do for you Begin Now click here to get started Return Here returning subscribers Get Help FAQs,support, contact us Home Care Home Health Care Reporter   Nursing Home Inspection Results - Made Easy ! Every year, every nursing home in America goes through mandatory health and safety inspections . The results are kept in a huge, cryptic, coded database by the Health Care Financing Administration. SeniorCare Resources brings these inspection results to you here in our on-line database. It contains the results of the 4 most recent annual inspections of the 17,367 nursing homes in the United States. THIS IS A TWO-STEP PROCESS! Browse Snapshots of as many nursing homes as you choose. SeniorCare Resources' Nursing Home Reporter will serve you up a quick "Snapshot" on each selected home. The Snapshot gives you the basics of ownership, violations, facilities, staffing, etc. Order Comprehensive Surveys on as many nursing homes as you choose. A Comprehensive Survey of any nursing home includes detailed reports on the following: click here for full table of contents......or click below for examples Residents' Conditions : From radiation to restraints, Staffing: From social workers to kitchen workers. Facilities: From dialysis to pharmacy. Health Violations from poor nutrition to drug errors. Safety Violations: From doorstops to fire drills. Repeat Offenses: What problems recur year after year. Health History: How things are resolved year after year. Safety History: Do the facilities pass muster. Bed Distribution: Shows what is available. Ownership: Nonprofit, chain, church, state, etc. Inspection Details: Complaints, red flags, special attention. And much much more ... ADVISORY: We strongly recommend that you DO NOT use "Snapshots" by themselves to select a nursing home. They include only 30 out of about a thousand database fields and WILL NOT provide adequate information to judge a nursing facility. WE INVITE YOU to use the Snapshots to narrow your search. Once you have identified those facilities which merit further consideration, then order our COMPREHENSIVE SURVEY REPORTS , which detail all 1000 database fields in an easy to use, easy to understand format. Rely on SeniorCare Resources so you can make an INFORMED decision. How It Works First, subscribe to the on-line SeniorCare Resources Nursing Home Reporter. For $9.95, you can subscribe for 24 hours $9.95 One Day subscribe for a day For $14.95, you can subscribe for an entire week $14.95 One Week subscribe for a week For $24.95, you can subscribe for 1 month $24.95 One Month subscribe for a month During your subscription you can: Identify all nursing homes in any state, and generate Snapshots on as many as you wish. Identify all the nursing homes within an acceptable driving radius from a zip code you choose, whether they are within that state, or in adjacent states Find a specific nursing home. Browse Snapshots on as many nursing homes as you wish. Order Comprehensive Surveys for $19.95 each. Once you have identified those nursing homes which really interest you, order a Comprehensive Survey on each. There are twelve different kinds of detailed reports included in every Comprehensive Survey, and a single nursing home may generate sixty to a hundred pages of data. Your Surveys will be generated instantly and stored in your own secure directory here at SeniorCareHelp.com. You may print them, bookmark them, download them, or periodically consult them for as long as your subscription lasts. Now you can order your Comprehensive Surveys printed and bound and sent out to you for only $29.95! All Surveys will be sent Priority Mail within 1 business day after receipt of your order. To Begin Click Here Now click here to start right now Sources Sources of data. Resources Other resources which you may find helpful. The Database More details about this database are available here Long Term Care Insurance Plan ahead for your own future. It's time to find out what Long Term Care Insurance can do for you now. Ask Jennifer AskJennifer Jennifer Helfrich-Will, a credentialled Nursing Home Administrator, has generously offered to answer your questions with practical advice. Good Health and Long Life to You and Yours Feedback let us know what you think Affiliate Program become an affiliate Researchers health or legal researchers © SeniorCare Resources, Inc., 2000 www.seniorcarehelp.com 1112 First State Blvd., Wilmington, DE 19804 (302) 998-6099

Results from search: http://members.tripod.com/~volfangary/Medicare.html

NURSING HOME INFORMATION SITE: Medicare Summary   Unbiased Ratings & Evaluations of Nursing Homes, Assisted Living Centers, and Home Health Agencies MEDICARE INFORMATION More and more Americans are living longer and the need to understand the benefits of Medicare is increasing. Back To NURSING HOME INFORMATION Home Page If in the future, you find you or a loved one are in need of skilled services, you may wish to make the Medicare program an important part of your insurance coverage. Since Medicare is a complicated program governed by numerous rules and regulations, many of which change from time to time, I will try to explain some of the more frequent misunderstood aspects of the program, as well as the benefits of Medicare. I want to help you take the guess work out of Medicare. What is Medicare? For anyone 65 or older; people of any age with permanent kidney failure; or those receiving Social Security disability benefits, Medicare is a federal insurance program providing two types of coverage: Hospital Insurance - Part A helps pay for inpatient hospital care, inpatient care in a skilled nursing facility, and certain home health care services. Medical Insurance - Part B helps pay for your doctor's services and other medical services and supplies not covered by Medicare hospital insurance - Part A. Medicare Benefits Can Help You to Live and Recover at a Skilled Facility if. You have been a hospital patient for 3 consecutive days, not counting the day of discharge. You are admitted to the skilled nursing facility within 30 days of your hospital discharge. The services you require are related to the condition for which you were treated in the hospital. You require skilled nursing services or rehabilitation services on a daily basis. These services, as a practical matter, can only be provided on an inpatient basis. Your doctor orders and certifies at time of admission that you need skilled care services on a daily basis, and again, certifies your need 14 days after admission and every 30 days thereafter. A Utilization Review Committee of professionals regularly reviews and approves your continued need for skilled care services. Your stay in the skilled nursing facility is 100 days or less. You May Receive Help From Medicare on all These Services: a semi-private room all meals, including special diets nursing care rehabilitative therapies drugs prescribed by a physician medical supplies use of appliances and equipment What Kinds of Illnesses or Disabilities Does Medicare Ordinarily Cover in a Skilled Care Facility? Many different illnesses or disabilities can be covered by Medicare hospital insurance - Part A. Your eligibility for coverage depends on your need for skilled care services on a daily basis. A skilled care service is defined as a service that is provided on a daily basis directly by or requiring the supervision of a licensed nurse or registered therapist. The following services are considered the most common skilled care services: decubitus care; Levine tube; intravenous therapy; sterile dressings; tracheostomy care (if surgery is recent); daily multiple injections; physical, speech and occupational therapy which must be required on a daily basis. The facility's staff should be glad to assist you in determining whether an illness or disability qualifies for Medicare coverage. How Many Days of Service Will Medicare Hospital Insurance - Part A , Help Pay For When I am in a Skilled Nursing Facility? Medicare hospital Insurance - Part A helps pay for up to 100 days in a participating skilled nursing facility in each benefit period. The 100 days of coverage are not automatic since continued eligibility for coverage remains in effect only as long as the preceding conditions are met and skilled care services are required on a daily basis. The foregoing information explains the maximum coverage under Medicare hospital insurance - Part A. However, actual experience shows that patients receive an average of about 24 days of covered care. Medicare Summary as of January 1, 2002 HOSPITAL INSURANCE - PART A Service: Skilled Nursing Facilities Certified By Medicare (Inpatient) First 20 Days: You Pay Nothing, Medicare Pays 100% Next 80 Days: You Pay $101.50 a day, Medicare Pays balance of covered charges Requirements: Admission to a skilled nursing facility must occur within 30 days of a hospital confinement of 3 or more days; must be an extension of the hospital treatment; and must be for daily skilled nursing and/or therapy services which as a practical matter can only be provided on an inpatient basis. Not Covered: Private duty nurses, first three pints of blood, personal convenience items such as barber, beautician, personal laundry, private telephone and television. MEDICAL INSURANCE - PART B Service: Skilled Nursing Facilities, Certified By Medicare (Outpatient) Doctor's visits; physical, occupational, and speech therapy; lab and X-ray services; prosthetic devices and some supplies and equipment. Unlimited Time Limit: You Pay one annual deductible of $100 plus 20% of the balance of reasonable charges, Medicare Pays balance of reasonable charges. *Beneficiaries of Medicare Insurance - Part B must satisfy only one $100 deductible. All products or services covered by Part B count toward that deductible. Requirements: Not eligible for Medicare Part A (Hospital Insurance) benefits. Not Covered: Most central supplies, pharmacy, personal items, and room and board. **If you want more detailed information about your Medicare benefits, please contact the administrator of your nearest nursing home facility. **This information pertains only to the fee-for-service (traditional) Medicare program. The above information does not apply to the additional Medicare options that are now available, such as Medicare HMO programs and Medicare replacement policies. The creator of this web page has taken all due diligence in insuring the accuracy of all information provided. In order to protect myself, I must include the following disclaimer: The creator of this web page makes no implied or expressed warranties about the reliability of this page or the information it contains and is not responsible for any damages caused by its use. Please Support My Advertisers! Every Click Helps!   Unbiased Ratings & Evaluations of Nursing Homes, Assisted Living Centers, and Home Health Agencies GUEST BOOK - Please Sign! Visits To This Web Page .Thanks For Happening By................ Check Out The NURSING HOME INFORMATION Home Page! Copyright © 1996 - 2002 The Nursing Home Information Site All rights reserved. COPYRIGHT © and DISCLAIMER! Back To NURSING HOME INFORMATION Home Page

Results from search: http://www.ltcipros.com/

Welcome to LTCi Pros - nursing home insurance, LTC insurance, long term care quotes, long term care insurance, insurance quote and insurance are our expertise. Home Who are LTCi Pros? Buyers Checklist FAQ Testmonials Partners Newsletter Application Procedures Contact LTCi Pros Request for Quote Senior Sites       At LTCi Pros, our expertise is in nursing home insurance and long term care insurance. We will be happy to provide you with a long term care quote for your insurance needs. This insurance quote will be specifically designed based on the information you submit to us. We hope that you will browse through our site and find some answers to your questions. Let LTCi Pros assist you in making your Long Term Care plans. Click here for DISCLAIMER LTCi Pros 7522 Campbell Road Suite 113, PMB 201 Dallas, TX 75248 972-317-1608 Fax 972-317-3607 1-888-281-0779 E-mail: info@ltcipros.com LTCi Pros 19226 N. 88th Avenue Peoria, AZ 85382-8542 888-806-4825 623-566-6197 Fax 623-566-3171 E-mail info@LTCiPros.com Copyright 1999, 2000, 2001 LTCi Pros Site development by Apex Webs

Results from search: http://www.bliss-resources.com/homeowners_insurance_quotes.htm

Free & Instant Home Insurance Quotes      Homeowners Insurance Quotes      Comparing home insurance quotes has never been so quick and easy. By using the below companies (Nationwide Insurance & Net Quote) you can now compare thousands of different home insurance quotes for free in a instant! Once you complete a secure quick online application  your home insurance information and requirements will be submitted securely to thousands of auto insurance companies across the U.S. instantly! Net Quote and Nationwide then automatically gather the best insurance quotes and e-mail the insurance quotes to you or display the quotes in your browser. To receive your free auto insurance quotes simply click on the desired banner in the right column. Auto Insurance Quotes  . Health Insurance Quotes . Life Insurance Quote   Bliss Resources Consumer Shopping &  News Credit Card Deals . Secured Credit Cards . Visa Credit Cards . Unsecured Credit Cards . Student Credit Cards . U.K. Credit Cards . Free Credit Reports . Debt Reduction . Capital One Insurance . Auto Insurance Quotes . Health Insurance Quotes . Home Insurance Quotes . Life Insurance Quote Online Loans . Auto Loans . Home Loans . Personal Loans . Payday Loans Money Transfers Telecommunications . Calling Cards . Long Distance Services . Add URL Insurance Sites . Auto Insurance quotes . Life Insurance Quote . Health Insurance Quotes . Car Insurance Quotes . Home Insurance Quotes . Disability Insurance . Health Insurance . Renters Insurance . Medical insurance . Home Insurance . Life Insurance    . Long Term Care   . Auto Insurance quotes     Net Quotes Home Insurance   Since 1989, Net Quotes free service has been working closely with Brokers, Captive Agents, and Direct Writers to help identify those consumers they can offer the best rates. Net Quote matches you to companies with the best rates based on your home insurance needs.  Receive homeowners insurance quotes only from the most competitive companies. You can expect to receive between 3 to 6 home owners insurance quotes, usually within 3 hours. The selected home insurance companies process your request and either FAX, Phone, or Email your quote Nationwide Homeowners Insurance Quotes Nationwide Insurance provides a FREE consumer referral service. Nationwide Insurance  has been helping people find the most competitive insurance rates available Since 1993.   Complete one quick easy online quote form and your information will go through a network of thousands of participating homeowners insurance agents and companies across the United States. Nationwide Insurance instantly matches your profile to the best five homeowners insurance companies for you. Receive most of your quotes within minutes!  

Results from search: http://free-online-long-term-care-insurance-quotes.com/

Free Long Term Care (LTC) / Nursing Home Insurance Quotes FREE Online Long Term Care Insurance Quotes Get FREE online long term care insurance quotes for affordable long term care (LTC) and nursing home insurance plans from top rated LTC insurance companies; compare and SAVE $$$! We also provide an introduction to long term care insurance , the latest long term care insurance news , a long term care insurance glossary , a long term care insurance word search puzzle , and long term care insurance links . Long Term Care Insurance Quotes Instant quotes, for affordable long term care (LTC) and nursing home insurance plans, from top rated LTC insurance companies. Find an affordable long term care insurance plan that suits your personal and financial circumstances! Long Term Care Insurance Basics Brief introduction to long term care insurance. Long Term Care Insurance News Latest news and events regarding long term care insurance. Long Term Care Insurance Glossary Key terms and expressions related to LTC insurance. Long Term Care Insurance Word Search Puzzle Game that challenges you to find the hidden LTC insurance terms. Long Term Care Insurance Links Other sites where you can find more information about long term care insurance. Home - Quotes - Basics - News - Glossary - Links - About Us / Privacy This page is part of a directory providing information on Auto Insurance , Burial Insurance , Business / Liability Insurance , Credit Cards , Credit Repair , Credit Reports , Dental Insurance , Disability Insurance , Discount Hotels / Hotel Reservations , Health Insurance , Homeowners Insurance , Motorcycle Insurance , Long Term Care Insurance , Discount Magazine Subscriptions , Pet Insurance , Renters Insurance , Survivorship Life Insurance , Term Life Insurance , Travel Insurance , Universal Life Insurance , Variable Life Insurance , and Whole Life Insurance . Click on a link, fill out a brief application, and get your free quotes! Last modified: November 16, 2001

Results from search: http://www.ianr.unl.edu/pubs/homemgt/g1013.htm

Nursing Home Insurance Insights; G91-1013-A G91-1013-A (Replaces HEG88-229) Nursing Home Insurance Insights Kathy Prochaska Cue * , Extension Family Economics and Management Specialist Definitions of nursing home care and alternatives for covering nursing home costs are covered in this guide. Previous Category | Catalog | Order Info Definitions of Nursing Home Care Alternatives for Covering Nursing Home Costs Medicare Coverage Before Buying a Nursing Home Policy Read the Policy Need Help? Filing Claims Resources Used Nursing Home Insurance Worksheet Nursing home costs now average $22,000 or more annually nationwide. A recent Massachusetts research study found that almost half of the single 75-year-olds interviewed would be poor within three months after entering a nursing home. Almost three-quarters would have nothing left within a year. While 90 percent of adults 65 and older never go to a nursing home, one in 10 do. Of those who enter a nursing home, half get well and return home from a skilled or intermediate care facility. The other half go from skilled or intermediate care into a long-term care facility, and very seldom go home. The odds of entering a nursing home increase dramatically for people 80 and older. One-quarter of those 85 and older go into long-term nursing home care and never return home. Many people erroneously believe long-term nursing home care is covered by Medicare, or by a Medicare supplement insurance policy. Usually this is not the case. Medicare and Medigap policies restrict coverage to skilled nursing care in a Medicare-certified facility. Medicare's rules about skilled care state that the services of a doctor or registered nurse must be required daily. Needing help with dressing, eating, going to the bathroom or taking medication does not qualify a person for Medicare funds. Few people require the type of skilled care covered by Medicare for long. The average stay in a Medicare-approved facility is 10-18 days. Definitions of Nursing Home Care There are three levels of nursing home care. They are: Skilled Care: The everyday meaning of skilled care generally is more liberal than Medicare's definition. Most insurance policies require a stay of at least three days in a hospital not more than 14 to 30 days before the patient is admitted to a nursing home by a physician. Skilled care means nursing care performed under the orders of a doctor, supervised by a licensed registered nurse, and carried out by licensed registered or practical nurses available around the clock. Skilled care includes one or more professional nursing procedures performed for the patient's benefit on a daily basis. It might include such things as changing IVs, or physical, occupational or speech therapy. The care is expected to result in some significant improvement in the medical condition of the patient that will aid the patient in convalescing from a sickness or injury. Intermediate Care is nursing care that must be performed under the orders of a doctor and under the supervision of a licensed registered or practical nurse. Intermediate care provides the patient, on a periodic basis, with one or more procedures which cannot be done without professional skill or training. Examples include giving injections or changing bandages. A person is seldom in skilled and/or intermediate care for longer than six months. The patient usually returns home or enters custodial care within 120 to 180 days of skilled or intermediate care. Custodial Care is primarily for meeting personal needs, and could be provided by persons who do not have professional skills or training. Assistance with eating, bathing, dressing, walking, getting in and out of bed, and taking medication which could be self-administered is considered custodial, and does not require trained medical personnel. Medicare does not pay for custodial care. Alternatives for Covering Hurting Home Costs "Going bare" -- Buying no insurance and hoping to stay healthy. As already mentioned, 90 percent of those 65 and older never go to a nursing home. The odds of going to a home increase drastically for people 80 and older, and most long-term nursing home insurance is not sold to people that age. For those who take the risk of going bare and do end up going to a nursing home, the costs can be devastating in a very short time. Buying insurance for skilled and/or intermediate level care. This is insurance for short-term care. It covers only medical convalescence as a result of early release from the hospital. With this, there is no coverage for custodial care. Patients who lose the bet that custodial care will not be needed end up paying for custodial care out-of-pocket or going on Medicaid to pay for it. Buying insurance for skilled/intermediate/custodial level care. This is short- and long-term insurance. People must have the financial means to pay for it, and even with it may pay $10-$20 per day for custodial care. People with a private insurance contract are independent of government agencies. Governmental benefits and eligibility requirements change unexpectedly, and people who have been counting on them may find themselves stranded when it is too late. This insurance protects the spouse of a nursing home patient by preserving joint assets that otherwise would be exhausted to pay for the nursing home bills. Great financial distress results for the impoverished spouse. Having Medicaid only. This is a government program to pay for the health care of people who have no assets. It is the largest payment source for nursing home care. People who "go bare" and do not beat the odds must impoverish themselves by using up almost all of their assets before Medicaid begins to pay nursing home bills. Also, as with other government programs, there is no guarantee that the benefits and requirements of Medicaid will not change in the future. Finding alternatives to nursing home confinement. Nursing home care may not be needed if the person can take advantage of either of the following: --home health care through Medicare or a commercial agency. --family support and help. Dying before nursing home is required. Unpleasant as it is to think about, this possibility must be considered as an option. Death definitely precludes any necessity for further insurance. Medicare Coverage Nursing home care is the weakest coverage in the Medicare system, presumably because the cost of long-term care is very high....$80-$100 per day. It is, however, less expensive than the $500 per day for hospital acute care. It already has been noted that Medicare does not pay for custodial care at all, and that the conditions for paying skilled care are extremely restrictive. The nursing home care must be similar to intensive care in a hospital before Medicare will pay. Moreover, the care must be obtained in a Medicare-approved skilled nursing facility. Even when such a facility participates in Medicare, not all its beds may be participating. Patients must be in a participating bed before Medicare will pay the bill. Here are three common examples of Medicare not paying for nursing home care: The patient enters a skilled nursing facility but requires less than Medicares definition of skilled care. This is the case with most Medicare applications. Patient must pay private rates. The patient qualifies for Medicare skilled care but the nursing home does not participate in Medicare. Patient must pay private rates. The patient enters a Medicare skilled nursing facility, qualifies for Medicare level of skilled care, but there is no Medicare bed available. Patient must pay private rates. Before Buying a Nursing Home Policy Shopping around for the best policy is especially Important when looking for nursing home insurance. The coverage is relatively new, and insurance companies still are trying to figure out the right premiums to charge for benefits offered. Benefits and costs vary widely between companies. Some questions to ask before buying a nursing home policy include: What levels of nursing care are covered by the nursing home policy? Skilled and intermediate care are needed for reasonable protection. Custodial care is optional if it is affordable. How long will the nursing home policy pay for a stay in a facility offering skilled/intermediate care? The policy should provide at least six months to one year of coverage. How much per day will the policy pay for skilled and intermediate care? Some will pay the same amount for both. Others pay less for intermediate care. It is recommended that the policy include at least $40-$50 daily for both skilled and intermediate care. Even with this amount, some people covered with nursing home policies still will have to pay an additional $300-$600 per month. When do benefits begin? Most policies begin to pay on the first or the 21st day the patient is in the nursing home following hospitalization of at least three days. A few policies start paying on the 101st day. The earlier benefits begin, the more expensive the policy is. Consumers should weigh the price of the first day protection against the savings in premiums paid for a policy starting on the 21st day. The first 20 days in skilled care could cost $1,000 or more. Starting on the 101st day is too late. Patients often are discharged from skilled or intermediate care by the 101st day and never would receive any benefit from the policy. Consumers must decide how much they can afford out-of-pocket, and then must buy nursing home coverage accordingly. What exclusions or limitations are in the policy? If a patient has been treated for a medical condition by a physician prior to buying a nursing home policy, a claim for that medical condition (called a pre-existing condition) might not be covered until the policy has been in force for one month to two years, depending on the policy. How long must a patient stay in a hospital in order to be covered by the policy? Most policies require a three-day stay, but a few have no requirement. With the new limits on what Medicare will pay hospitals for inpatient care, normal time in the hospital has been cut drastically. Patients might not be in the hospital for three full days and would, therefore, not qualify for Medicare or private nursing home insurance coverage. Policies requiring more than a three-day hospital stay should be avoided. What does the nursing home policy cost? Annual premiums for long-term care insurance vary enormously -- from under $100 to as high as $2,500. Age, health and policy benefits determine the price. In general, the younger you are when you buy a policy, the lower your premium will be. The price of such a policy generally increases every five years, at ages 70, 75, 80, etc. Most companies will not sell policies to those over the age of 79. Can the consumer afford a nursing home policy? Only the consumer can decide what coverage is needed. More and more nursing home policies will pay custodial care, but coverage is expensive and generally will pay only up to one or two years in custodial care. Custodial care cannot be bought separately from skilled/intermediate care in a nursing home policy. Remember, about 80-90 percent of the senior population never go to a nursing home, and only about five percent ever reach the point of needing custodial care. Does the policy cover organically based mental conditions, such as Alzheimer's disease? Many policies do not cover this, although a few do. It is worth keeping in mind that very few nursing homes will accept Alzheimer's patients even if they have insurance to pay for it. Read the Policy It is important to carefully read the policy. Be aware of the type of home and level of care necessary to qualify for benefits. If you have difficulty reading a policy, contact your nearest Area Agency on Aging office or a family member. An attorney or nursing home administrator also may be a source of help. Need Help? If you have a problem with an insurance company or agent, contact: Nebraska Department of Insurance Claims and Inquiries Division Box 94699 Lincoln, NE 68509-4699 Telephone:(402) 471-2201 Filing Claims When considering a claim, insurance companies may obtain copies of the nurses' notes from the nursing home. If daily nursing notes, showing receipt of skilled care, are not kept by the nursing home, the patient may be receiving intermediate or custodial care in the opinion of the insurance company. The company also may review the nursing home notes to determine if the patient is well enough to leave the home for short periods of time (a family outing, for example). Generally the companies feel that if patients are well enough to leave the home, they are not ill enough to be in need of skilled care. Companies then may say patients are receiving intermediate or custodial care, and benefits may be reduced or denied. If a policy pays benefits for intermediate or custodial care, its benefits usually are payable provided the patient was in need of and received skilled care previously. When filing a nursing home claim with an insurance company, be sure to complete the proper claim form and attach a copy of the nursing home bill. In order to avoid delays in claim payments, it might be helpful to include a copy of the nurses' notes from the nursing home. Keep a copy of the claim and the original nursing home bill for your own records. Resources Used Abbott, Susan D. "Health Care and Finances: A Guide for Adult Children and Their Parents," American Council of Life Insurance/Health Insurance Association of America, 1987. Horton, Sally. "What You Should Know About Nursing Home Insurance," Cooperative Extension Service, Washington State University, 1987. "Who Can Afford A Nursing Home?" Consumer Reports, May 1988, pp. 300-309. Liewer, Paul, and Chet McPherson. "Check List When Selecting Nursing Home Coverage," Lincoln Information Service for the Elderly, Lancaster County, 1987. Nursing Home Insurance Worksheet Policy 1 Policy 2 Policy 3 Company Is the company licensed in Nebraska? Rating by Best Insurance Guide (see local library) Agent/Agency Knowledge about this type of insurance Service available Benefits Daily benefit limit for skilled care Maximum number of days for skilled care payments What do local nursing homes charge per month for skilled care? Daily benefit limit for intermediate care Maximum number of days for intermediate care payments What do local nursing homes charge per month for intermediate care? Daily benefit limit for custodial care Maximum number of days for custodial care payments What do local nursing homes charge per month for custodial care? Qualifications Wait before benefits begin (number of days) Days of prior hospitalization required before eligible for nursing home benefits Minimum number of days of skilled or intermediate care required before eligible for custodial care benefits Waiting period for pre-existing medical conditions Coverage provided for organically based mental conditions such as senility, dementia, Alzheimer's (yes/no) Home Benefits Daily benefit limit for home health care Maximum number of days of home health care covered What do home health care agencies in your area charge per month for unskilled care? Skilled care? Days of prior hospitalization or nursing home confinement required before eligible for home care benefits Limited on types of care covered by home care benefit? Waiver of premium if in a nursing home (number of days must be confined before premium is paid, length of time premium will be paid) Other Restrictions Must care be delivered in a certain type of facility? (Skilled, intermediate, custodial) Any lifetime maximums for benefits? Is policy guaranteed renewable? Under what conditions may policy be canceled? Will benefits be paid for confinements in facilities away from your area of residence? Outside the U.S.? Does policy allow premium payment 30-31 days after the due date without cancellation? Under what conditions can policy premiums be changed? Policy Costs for First Year Annual premium Policy fee Membership or other fee Total Cost First Year: * Much of this material was written by Sally Horton, Washington State University. File G1013 under: HOME MANAGEMENT B-3i, Insurance Issued July 1988; 10,000, printed. Electronic version issued May 1996 pubs@unl.edu Issued in furtherance of Cooperative Extension work, Acts of May 8 and June 30, 1914, in cooperation with the U.S. Department of Agriculture. Kenneth R. Bolen, Director of Cooperative Extension, University of Nebraska, Institute of Agriculture and Natural Resources. University of Nebraska Cooperative Extension educational programs abide with the non-discrimination policies of the University of Nebraska-Lincoln and the United States Department of Agriculture.

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