Medicare and Long-Term Care What Advisors Need to Know. Marlene Lund, CLTC, CSA Lund Insurance Agency, Inc. Speaking of Aging, Inc.
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1 Medicare and Long-Term Care What Advisors Need to Know Marlene Lund, CLTC, CSA Lund Insurance Agency, Inc. Speaking of Aging, Inc.
2 Consumer Concern and Confusion 61% of high net worth Americans who are close to retirement are terrified of what health care costs may do to their retirement plans.¹ 64% of these individuals have not discussed retirement health care costs with a financial advisor because they are unsure as to whether their advisor is knowledgeable about the issue.¹ 4/5 baby boomers cite uncovered health expenses and the risk of becoming ill as their top financial concerns in retirement.² 1. Harris Interactive, Putnum Investments Lifetime Income Score Research 2012
3 When you enroll in Medicare, what percentage of your annual health care costs do you expect Medicare will cover? - Female: 45% - Male: 37% How did you arrive at this percentage? - Guessed: - Female: 85% - Male: 70% Source: Harris Interactive, 2012
4 Healthcare Coverage in Retirement Type of Care Covered By Monthly Premiums Notes Hospital Care Medicare Part A $0 Can buy Medicare Supplement to cover Deductibles and Coinsurance Costs Doctor Care Medicare Part B $ and up depending on income Can buy Medicare Supplement Plans to cover deductibles, coinsurance and excess charges Prescriptions Medicare Part D Varies Shop for drug plans Managed Health Care Medicare Part C (MA) Varies Med Supp plans not available for these plans Long term care Medicare Part A and/or Part B Included Medicare varies coverage at home and facilities can cover remaining costs through Medicare Supplement plans and LTC Insurance
5 The biggest confusion Does Medicare cover long-term care?
6 Medicare and Long-Term Care Medicare does cover: Care in a long-term care hospital (LTCH) - LTCH s specialize in treating patients who may have more than one serious condition, but who may improve with time and care, and return home. Skilled nursing care in a skilled nursing facility. You pay: Days 1-20: $0 for each benefit period, Days : $157 coinsurance per day of each benefit period Days 101 and beyond: all costs
7 LTC Insurance = Medicare supplement? You can t market LTC insurance as Medicare Supplement but maybe you should! THIS POLICY IS NOT A MEDICARE SUPPLEMENT POLICY.
8 Key facts about Medicare and Home Health Care Intermittent skilled care nursing care Physical therapy, speech language pathology, occupational therapy Must be Medicare approved home health care provider and under doctor care Must be homebound Doesn t cover 24 hour a day care average claim 6 hours per WEEK Homemaker services Personal Care Dental, Hearing Aids, Normal Eye Maintenance Source: Medicare.gov
9 Medicare and chronic care = careful! Court Case: Jimmo vs. Sebelius January 24 th 2013 CMS issued revisions to benefit policy manual to cover chronic conditions such as Parkinson's, Multiple Sclerosis, or Alzheimer's Advisors can no longer say Medicare only pays for improving conditions. Still a lot of confusion about this ruling and its implications. Source: Advisory.com
10 Long-term care elimination periods The vast majority of LTC policies include 90 day elimination periods. Do LTC costs covered by Medicare or Medicare Supplement plans count towards the elimination periods?
11 TransAmerica: We will give you credit toward the Elimination Period for days of Long Term Care Facility confinement covered under this policy, even though they are paid or payable by Medicare Mutual of Omaha: Any days for which Medicare pays benefits for qualified long-term care services can be used to satisfy the elimination period Genworth: Any days for which Medicare pays benefits for qualified long-term care services can be used to satisfy the elimination period
12 Medicare Certified Home Health Care Agency Check your policies some LTC contracts or riders require that the home health care agency be Medicare certified
13 The future of Medicare and LTC Will there be a Medicare Part E covering long-term care? Voluntary or mandatory? Will there be Medicare-Supplement LTC policies? Funding for Medicare in the future What Medicare giveth, it can taketh away. On the other hand, the LTCi contract between the insurer and policyholder is written down.
14 Marlene Lund, CLTC, CSA Long-Term Care Specialist Speaking of Aging, Inc. Lund Insurance Agency, Inc South 172 nd Street Omaha NE
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