Longterm care 27 February 2021 SHIBA mission statement

Long-term care 27 February 2021

SHIBA mission statement SHIBA provides free, unbiased information about health care coverage and access to help improve the lives of all Washington state residents. We cultivate community commitment through partnership, service, and volunteering. Long-term care 27 February 2021 2

What is SHIBA? Statewide Health Insurance Benefits Advisors • A free program of the Office of the Insurance Commissioner • We provide unbiased and confidential information about Medicare and other health insurance • We’re an educational service • We don’t sell anything! Long-term care 27 February 2021 3

Today’s overview • • • Long-term care overview Ways to pay for long-term care WA state Long-Term Care Partnership program Fraud protection Wrap up Long-term care 27 February 2021 4

Long-term care overview Long-term care 27 February 2021 5

Long-term care overview What does “long-term care” mean to you? Long-term care 27 February 2021 6

Why talk about long-term care (LTC)? • Many people live longer now than in the past. • More people will likely need long-term care help than in the past. • Long-term care is expensive! • The options for where people get long-term care have changed in the past 50 years • We want you to have the facts and make informed choices. Long-term care 27 February 2021 7

What do we mean when we talk about LTC? • Medical and non-medical support services needed by people with prolonged illness or disability • Often help people with cognitive impairment • Help people perform activities of daily living (ADLs) or independent activities of daily living (IDLs), or both. Long-term care 27 February 2021 8

Activities of Daily Living (ADL) Examples include: • • • Bathing Dressing Eating Using the toilet Transferring (getting out of bed) Continence (bladder/bowel control) Long-term care 27 February 2021 9

Independent Activities of Daily Living (IADL) Examples include: • Grocery shopping • Laundry • Preparing meals • Housework • Taking or managing medication • Transportation Long-term care 27 February 2021 10

Cognitive impairment Examples include: • • Alzheimer’s disease Dementia Mental illness Developmental disabilities Long-term care 27 February 2021 11

What types of care might LTC include? • Skilled or medical care: Medical or nursing care by a health professional • Personal/custodial care: Help with ADLs and IADLs • Supervisory care: Monitoring/supervision to prevent harm for people with cognitive impairment Long-term care 27 February 2021 12

Where does LTC occur? Informal settings: • • At home Care from family or friends Unpaid caregivers Often used when people don’t need skilled care Long-term care 27 February 2021 13

Where does LTC occur? Formal settings: • Licensed home care services – by professional staff • Community services – such as adult day care • Residential care – including nursing homes, assisted living facilities, group homes, etc. Long-term care 27 February 2021 14

Does private health insurance pay for LTC? • Usually not • Health insurance pays for care that cures, usually for acute (temporary) needs only • Most long-term care needs are chronic (long -term) • Most long-term care needs are for ADLs and IADLs – not medical care Long-term care 27 February 2021 15

Does Medicare pay for LTC? Not really, coverage is very limited Long-term care 27 February 2021 16

What LTC does Medicare pay for? Nursing home (skilled nursing facility) if: • Doctor says medically necessary (doctor certified) • Patient has already stayed three nights in hospital for same condition • Must be “INPATIENT” in the hospital – “Observation Stays” don’t count!! • Facility is Medicare-certified Long-term care 27 February 2021 17

What LTC does Medicare pay for? Home Health Care (skilled care in home) • This includes skilled nursing care, OT, PT or Speech Therapy services Can be covered if: • Doctor says patient needs skilled care on part -time basis (medically necessary) • Patient is homebound • Agency providing care is Medicare-certified Long-term care 27 February 2021 18

Medicare also pays for hospice care • End-of-life pain relief and symptom management • For terminally ill patients • Medicare Part A covers most of the costs of hospice care o Very little out-of-pocket costs Long-term care 27 February 2021 19

What Medicare does NOT pay for • 24 -hour care in home • Meals delivered to home • Homemaker services (shopping, cleaning, laundry) • Non-skilled personal care services for ADLs or IADLs (bathing, eating, dressing, supervisory care) Long-term care 27 February 2021 20

Ways to pay for long-term care Long-term care 27 February 2021 21

What are my options to pay for LTC? • Do nothing – if you choose not to plan for LTC • Rely on state or federal programs to take care of you & your estate • Make financial plans • Buy long-term care insurance You may use one or more of these options Long-term care 27 February 2021 22

Doing nothing may be an option for some • Prefer day-to-day living over long-term planning • Do not believe they will have a need for long-term care • Have reasons related to family, culture, or personal beliefs for not planning Long-term care 27 February 2021 23

What to think about if you do nothing It may increase the chance you won’t have control over health or financial decisions made on your behalf later in life. Long-term care 27 February 2021 24

Rely on federal programs Department of Veterans Affairs (VA) may be an option for people who: • Are a U. S. military veteran • Are or were married to a U. S. military veteran Long-term care 27 February 2021 25

Points to think about with the VA • Some veterans and spouses may qualify for both federal and state programs • These programs may work together to help pay for long-term care • Not all veterans or spouses qualify – check with the VA to make sure Long-term care 27 February 2021 26

Rely on state programs Medicaid/State Dept. of Social & Health Services (DSHS) may be an option for people who: • Meet income and asset limits • Meet a DSHS category (such as aged, blind, or have a disability Long-term care 27 February 2021 27

Points to think about with Medicaid/DSHS • It may cover Medicare’s gaps. • It may require you to spend down assets impoverish yourself to qualify. • If you transfer assets to others to qualify, it may require you to meet legal time limits. • It may affect your choice of providers and locations of care. • The state may try to recover funds from your estate after your death (estate recovery). • I’ll talk about the Long-Term Care Partnership Program in a minute. Long-term care 27 February 2021 28

Making financial plans as an option You: • Are unlikely to qualify for Medicaid • Are not interested in or qualified for long -term care insurance • Are willing and able to do some financial planning with appropriate professionals • Own (or are close to owning) your home outright Long-term care 27 February 2021 29

Points to think about for making financial plans • May or may not keep pace with long-term care cost inflation. • May or may not be protected if you have financial emergencies. • Using home equity (for example, in a reverse mortgage) may affect inheritance available for heirs. Long-term care 27 February 2021 30

Buying LTC insurance may be an option • Can afford the premium • Are healthy enough to qualify • Won’t qualify for Medicaid • Or can buy a Long-Term Care Partnership program plan • Want to ensure control over assets Long-term care 27 February 2021 31

Points to think about with buying LTC insurance • The Office of the Insurance Commissioner (OIC) requires insurers to provide certain consumer protections. • Insurers can raise premium rates on classes of policy holders. • Insurance may cover only some needs. • Plan coverage may/may not keep pace with inflation and changes in the medical and longterm care field. • Plan premiums may/may not be affordable. Long-term care 27 February 2021 32

Points to think about with ALL options • Some facilities may have waiting lists. Have a back-up plan. • Changing life events may affect your plans. • Think about discussing your planning with others, such as family members and friends. • Check into local resources: o Your county’s Senior Information & Assistance Program o Local senior resource guide for your county Long-term care 27 February 2021 33

WA state Long-Term Care Partnership program Long-term care 27 February 2021 34

WA state Long-Term Care Partnership program • Offers you Medicaid asset protection on a dollar-for-dollar basis o Protects most assets – up to the amount of benefits paid under the policy • Can protect you against inflation, depending upon your age when you buy the policy o Best protection if you buy it before age 61 • Can protect your assets in different states o National reciprocity agreement Long-term care 27 February 2021 35

WA state Long-Term Care Partnership program More information and list of companies that sell these plans at: www. insurance. wa. gov Type “Long Term Care Partnership” into the search box. Long-term care 27 February 2021 36

What’s your plan for long-term care? Here are some examples: • Susan exercises, eats right, and stays healthy. • Donald bought long-term care insurance. • Bill moved into an apartment attached to his daughter’s garage. • Mary set aside enough money for three years in a nursing home. • Jack lives one day at a time and enjoys the moment. Long-term care 27 February 2021 37

Fraud protection Long-term care 27 February 2021 38

Protect yourself from fraud • Review your insurer's explanation of benefits statement. • Only give your insurance/Medicare identification information to those who provide you with medical services. • If you suspect fraud, call the Insurance Consumer Hotline at 1 -800 -562 -6900. Long-term care 27 February 2021 39

Wrap up Long-term care 27 February 2021 40

How to contact us Insurance Consumer Hotline 1 -800 -562 -6900 TDD: 360 -586 -0241 TDD Relay: 1 -800 -833 -6384 Long-term care 27 February 2021 41

Need help with other insurance questions? The Office of the Insurance Commissioner can also help you with questions, information and complaints about all types of insurance, such as: • Homeowner • Annuities • Auto • Health • Life • And more! Call our Insurance Consumer Hotline: 1 -800 -562 -6900 On the web at: www. insurance. wa. gov Long-term care 27 February 2021 42

More questions? • Please complete and return evaluation form • Let us know if you want us to contact you to: • Discuss your personal situation • Learn more about becoming a volunteer THANK YOU!!! Long-term care 27 February 2021 43