New York State Partnership for Long-Term Care

Transcription

1 New York State Partnership for Long-Term Care Program Guide PRT-364-NY (2013)

2 Understanding Your Long Term Care Needs While planning for future long term care needs can be difficult and overwhelming, it is also necessary. In many cases, long term care insurance (LTCi) can be an effective part of that plan. What Makes Partnership LTCi Policies Unique? Partnership LTCi policies are unique because in addition to the protection the policy benefits provide, they also offer policyholders who exhaust their benefits with the opportunity to qualify for Medicaid Extended Coverage while keeping many or all of their assets. Non-Partnership policies do not provide this additional protection, so once benefits are exhausted, you may be required to spend down most of your resources before qualifying for the state Medicaid program. The asset protection feature of Partnership plans extends to Medicaid recovery actions. Keep in mind that while these plans protect your assets, your income would still be subject to Medicaid rules and would be used for care once your policy is exhausted. New York State Offers Two Types of Partnership Policies: With Total Asset Protection policies, there is no limit to the assets you may keep and still qualify for Medicaid Extended Coverage once your policy benefits are exhausted. With a Dollar for Dollar policy, your assets are protected in an amount equal to the benefits you received from your insurance policy.

3 Choosing a Program The decision as to which program best fits your needs can easily be broken down into a series of smaller choices: A. Do you wish to protect 100% of your assets? B. Do you wish to protect a specific amount of your assets? A Total Asset Plan May Be Your Best Choice If: You are in the process of continuing to accumulate assets and it is therefore difficult to determine a specific amount to protect; The assets you are planning on protecting exceed the benefits available under a Dollar for Dollar plan; You are planning on passing along a significant amount of your wealth to heirs; or You are financially conservative and have little risk tolerance. A Dollar for Dollar Plan May Be Your Best Choice If: You have a limited amount of assets that will remain steady or decrease over time and whose value can be covered by the underlying insurance program. You plan on getting care outside of the State of New York. Many states offer reciprocity, which means that if you exhaust your Partnership policy benefits and need to utilize Medicaid while residing outside of New York, that state may honor the asset protection feature of your policy, but only on a dollar for dollar basis. Your advisor can provide you with a full explanation on this topic. Considerations For Both: Your ability to afford one plan over another may have a significant impact on your choice. While price is important, we recommend you consider both affordability and value. Be sure the plan you choose reflects both the price point you are comfortable with and the value you are seeking in an insurance program. Your trusted insurance advisor is well-equipped to guide you through the decision making process and help you find a solution that best suits your needs. While the state of New York mandates specific benefit minimums, all five of the MedAmerica Partnership policies are designed to provide a wide array of affordable benefits. Decision Guide: To help you determine which Partnership plan is right for you, MedAmerica offers this helpful two-question decision guide: Question 1 How much asset protection do I desire? Partial or full? Full Question 2 Do I want equal benefit amounts for nursing home and home care? Yes 4/4/100 Total Asset Plan Partial Question 2 Do I want equal benefit amounts for nursing home and home care? No Yes No 2/2/100 Dollar for Dollar Plan 3/6/50 or 2/4/50 Total Asset Plan 1.5/3/50 Dollar for Dollar Plan

4 Benefits & Features All Partnership Plans Include the Following: Nursing Home Care A state or federally licensed, accredited or certified nursing home, hospital-based long term care unit, Alzheimer s or Hospice facility. Home Care & Community Care Home care, community-based care, assisted living facility, and adult day care. Alternate Care Qualified long term care services provided in a hospital setting while awaiting access to a nursing facility or home care services. Respite Care 14 nursing home equivalent days per year. Hospice Care Nursing Home Care Bed Reservation Reserves your bed should you leave the facility temporarily for up to 20 days per calendar year. Consultation Care Management Services Pays for up to two days of the nursing home daily benefit amount toward the consultation services of a licensed health care practitioner of your choice, in addition to the optional benefit planning services provided by our personal care advisors.

5 Other Features, Options & Riders Inflation Protection Options Some level of inflation protection is required for applicants ages 18 to 79. You may choose one of the following: 5% Compound Coverage increases annually by 5% of your prior year s benefits. 3.5% Compound Coverage increases annually by 3.5% of your prior year s benefits. Elimination Period 30, 60 or Service Days The elimination period ends after you have received services for the number of days chosen. Benefits are not payable during the elimination period. Days used to satisfy your once-in-a-lifetime elimination period do not need to be consecutive. Independent Provider Option Pays for home care received by an officially trained or certified home health care provider, or licensed health care practitioner who is not affiliated with a licensed or certified entity such as a home health agency. Waiver of Premium Option Premium payments are waived on a monthly basis starting on the first day of policy-paid benefits. This waiver ends on the date you are no longer benefit eligible. Premium Payment Options Lifetime Premiums are payable as long as your policy is in force. 10 Year Paid in Full Payment terms allow for a paid-in-full benefit in 10 years. With this option, your policy cannot lapse after you satisfy the payment term. Exclusions & Limitations Expenses for the following are not covered: Treatment for illness or medical condition arising out of war or any act of war, declared or undeclared. Services for intentionally self-inflicted injury. Services provided by a member of your immediate family. Services for which no charge is normally made in the absence of insurance. 1 Not available with 1.5/3/50 and 2/2/100 plans.

6 Total Asset Protection Plans All three Total Asset protection plans will protect 100% of your assets from Medicaid spend down requirements and allow you to access Medicaid Extended Coverage once all policy benefits have been paid in accordance with policy provisions. 2/4/50 Plan Duration Two years in a nursing home, or four years in a home or community setting, or a combination of both where two days of home or community care equal one day of nursing home credit. Home & Community Care Coverage Paid at 50% of the nursing home benefit Residential Care Facility Examples include an assisted living facility or adult care facility that provides room and board; 24-hour coverage for services such as, but not limited to, nursing care, maintenance or personal care, and therapy services. Residential Care Facility Bed Reservation Pays the fee charged to reserve your bed should you leave the facility temporarily for up to 20 days per calendar year. 3/6/50 Plan Duration Three years in a nursing home, or six years in a home or community setting, or a combination of both where two days of home or community care equal one day of nursing home credit. Home & Community Care Coverage Paid at 50% of the nursing home benefit. Survivor Benefit Rider If a Care Partner dies after your policies are in force for 10 years and remain in force at time of death, the surviving Care Partner pays no further premiums. 4/4/100 Plan Duration Four years in any eligible setting. Home & Community Care Coverage Paid at 100% of the nursing home benefit. Residential Care Facility Examples include an assisted living facility or adult care facility that provides room and board; 24-hour coverage for services such as, but not limited to, nursing care, maintenance or personal care, and therapy services. Survivor Benefit Rider If a Care Partner dies after your policies are in force for 10 years and remain in force at time of death, the surviving Care Partner pays no further premiums. Non-Licensed/Non-Certified Caregiver When you have a Plan of Care developed by a Licensed Health Care Practitioner, you may arrange to have home care benefits, including homemaker services, given by a non-licensed/non-certified provider or caregiver as paid covered services. This does not include family members. Residential Care Facility Bed Reservation Pays the fee charged to reserve your bed should you leave the facility temporarily for up to 20 days per calendar year. Permissible Alternative Benefits Additional respite benefit, home modification, informal caregiver training benefit, emergency response system benefit, therapeutic device benefit, supportive/durable medical equipment benefit, specialized transportation benefit such as transportation to and from adult day care.

7 Other Features & Optional Benefits for All Total Asset Plans Elimination Period Option to select 100 service days Shortened Benefit Period Rider Adds a benefit to your policy that may provide coverage, subject to a reduced lifetime benefit amount, if your policy has been in force for three or more years and your coverage lapses due to cancellation or non-payment of premium. Inflation Options All three Total Asset plans provide a choice of either 5% compound or 3.5% compound inflation. Inflation protection is mandatory for applicants aged Inflation is not required for applicants aged 80 and older. Premium Worksheet Plan Choice r 2/4/50 r 3/6/50 r 4/4/100 Inflation Choice r 3.5% Compound r 5% Compound r No Inflation (Issue Ages Only) Daily Benefit Amount Elimination Period Proposed Premium* * Eligibility and final premium can only be determined by MedAmerica after completion of the underwriting process.

8 Dollar for Dollar Plans Both Dollar for Dollar plans protect your assets in an amount equal to the benefits you received from your insurance policy. The remainder of your unprotected assets and income would then be subject to Medicaid rules and would be used for care once your policy is exhausted. 1.5/3/50 Plan Duration One and a half years in a nursing home, or three years in a home or community setting, or a combination of both where two days of home or community care equal one day of nursing home credit. Home & Community Care Coverage Paid at 50% of the nursing home benefit. Inflation Options Both Dollar for Dollar plans provide a choice of either 5% compound or 3.5% compound inflation. Inflation protection is mandatory for applicants aged Inflation is not required for applicants aged 80 and older.

9 2/2/100 Plan Duration Two years in any eligible setting at home, in the community, or in a nursing home. Home & Community Care Coverage Paid at 100% of the nursing home benefit. Residential Care Facility Examples include an assisted living facility or adult care facility that provides room and board; 24-hour coverage for services such as, but not limited to, nursing care, maintenance or personal care, and therapy services. Residential Care Facility Bed Reservation Pays the fee charged to reserve your bed should you leave the facility temporarily for up to 20 days per calendar year. Non-Licensed/Non-Certified Caregiver When you have a plan of care developed by a Licensed Health Care Practitioner, you may arrange to have home care benefits, including homemaker services, given by a non-licensed/non-certified provider or caregiver as paid covered services. This does not include family members. Permissible Alternative Benefits Additional respite benefit, home modification, informal caregiver training benefit, emergency response system benefit, therapeutic device benefit, supportive/durable medical equipment benefit, specialized transportation benefit such as transportation to and from adult day care. Premium Worksheet Plan Choice r 1.5/3/50 r 2/2/100 Inflation Choice r 3.5% Compound r 5% Compound r No Inflation (Issue Ages Only) Daily Benefit Amount Elimination Period Proposed Premium* * Eligibility and final premium can only be determined by MedAmerica after completion of the underwriting process.

10 MedAmerica Insurance Company of New York Since its inception more than 25 years ago, MedAmerica Insurance Company of New York has been driven by a singular mission: To provide affordable and innovative long term care financing solutions to residents of New York State. With a large New York State health insurer as our parent company, MedAmerica has a keen insight into health care delivery and a singular focus on long term care that provides us with unmatched expertise in the industry. As a founding member of the New York State Partnership for Long Term Care, MedAmerica was one of the first carriers to offer Partnership policies. Today, we remain active in the New York State Partnership, serving on the Partnership board and continuing to offer quality, competitively-priced Partnership policies. Headquartered in New York State, MedAmerica has a vested interest in providing long term care financing solutions to our fellow residents. Our dedication to the communities we serve is evident in our ongoing effort to help assure better quality of life for our nation s aging population by supporting the New York State Coalition on Elder Abuse, Family Service of Rochester, the Greater Rochester Area Partnership for the Elderly, and Lifespan. MedAmerica is New York State s insurer of choice for the New York State Public Employee and Retiree Long Term Care Insurance Plan (NYPERL), which is available to nearly 500,000 eligibles. Recognized for our quality products, excellent service, and strong financial position, MedAmerica is above all totally committed to being there when our policyholders need long term care services. MedAmerica Insurance Company of New York is the long term care subsidiary of Lifetime Healthcare, Inc., a $6 billion not-for-profit health insurer that finances and delivers health care to approximately 2 million people.

11 Great Reasons to Choose MedAmerica 1. Longevity MedAmerica was a founding member of the New York State Partnership for Long-Term Care. As one of the first companies to offer Partnership policies, we are committed to meeting the needs of the citizens of New York. 2. Insurer of Choice MedAmerica is the insurer of choice for the New York State Department of Civil Service. The New York State Public Employee and Retiree Long Term Care Insurance Plan (NYPERL) has been providing long term care protection since A Local Company Headquartered in Rochester, New York, MedAmerica is uniquely positioned to understand the needs of New Yorkers. You can support the local economy by choosing an insurer located right in your home state. 4. Price Our Partnership policies offer great value at a competitive price. 5. Service It is our promise and our privilege to help our claimants receive the long term care services and support they need. Whether it s answering questions about policy benefits or finding a provider for a specific need, MedAmerica s team of Personal Care Advisors are committed to our policyholders care. 6. Singular Focus Long term care insurance is our only business, and with this singular focus, we are able to devote all of our expertise and energy to serving our policyholders needs in a specialized way. 7. Vision with Passion We approach our business with heart, soul and passion, aiming to promote value and accessibility of long term care insurance through innovation.

12 165 Court Street Rochester, New York The New York State Partnership for Long-Term Care Program (NYSPLTC) symbol indicates the coverage advertised complies with New York State (NYS) requirements for participation in the NYSPLTC. However, NYS and the NYSPLTC do not take part in specific insurer marketing plans, and do not endorse specific insurers or their policies/certificates.