Long-term care June 11, 2016

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. June 11, 2016Long-term care2

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! June 11, 2016Long-term care3

Long-term care overview June 11, 2016Long-term care4

Long-term care overview June 11, 2016 Long-term care5 What does “long-term care” mean to you?

Why talk about long-term care (LTC)? June 11, 2016 Long-term care6 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.

What do we mean when we talk about LTC? June 11, 2016 Long-term care7 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.

Activities of Daily Living (ADL) June 11, 2016 Long-term care8 Examples include: Bathing Dressing Eating Using the toilet Transferring (getting out of bed) Continence (bladder/bowel control)

Independent Activities of Daily Living (IADL) June 11, 2016 Long-term care9 Examples include: Grocery shopping Laundry Preparing meals Housework Taking or managing medication Transportation

Cognitive impairment June 11, 2016 Long-term care10 Examples include: Alzheimer’s disease Dementia Mental illness Developmental disabilities

What types of care might LTC include? June 11, 2016 Long-term care11 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

Where does LTC occur? June 11, 2016 Long-term care12 Informal settings: At home Care from family or friends Unpaid caregivers Often used when people don’t need skilled care

Where does LTC occur? June 11, 2016 Long-term care13 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.

Does private health insurance pay for LTC? June 11, 2016 Long-term care14 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

Does Medicare pay for LTC? June 11, 2016 Long-term care15 Not really, coverage is very limited

What LTC does Medicare pay for? June 11, 2016 Long-term care16 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 Nursing home (skilled nursing facility) if:

What LTC does Medicare pay for? June 11, 2016 Long-term care17 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

Medicare also pays for hospice care June 11, 2016 Long-term care18 End-of-life pain relief and symptom management For terminally ill patients Medicare Part A covers most of the costs of hospice care Very little out-of-pocket costs

What Medicare does NOT pay for June 11, 2016 Long-term care19 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)

Ways to pay for long-term care June 11, 2016Long-term care20

What are my options to pay for LTC? June 11, 2016 Long-term care21 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

Doing nothing may be an option for some June 11, 2016 Long-term care22 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

What to think about if you do nothing June 11, 2016 Long-term care23 It may increase the chance you won ’ t have control over health or financial decisions made on your behalf later in life.

Rely on federal programs June 11, 2016 Long-term care24 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

Points to think about with the VA June 11, 2016 Long-term care25 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

Rely on state programs June 11, 2016 Long-term care26 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

Points to think about with Medicaid/DSHS June 11, 2016 Long-term care27 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.

Making financial plans as an option June 11, 2016 Long-term care28 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

Points to think about for making financial plans June 11, 2016 Long-term care29 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.

Buying LTC insurance may be an option June 11, 2016 Long-term care30 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

Points to think about with buying LTC insurance June 11, 2016 Long-term care31 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 long- term care field. Plan premiums may/may not be affordable.

Points to think about with ALL options June 11, 2016 Long-term care32 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: Your county’s Senior Information & Assistance Program Local senior resource guide for your county

WA state Long-Term Care Partnership program June 11, 2016Long-term care33

WA state Long-Term Care Partnership program June 11, 2016 Long-term care34 Offers you Medicaid asset protection on a dollar-for-dollar basis 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 Best protection if you buy it before age 61 Can protect your assets in different states National reciprocity agreement

WA state Long-Term Care Partnership program June 11, 2016 Long-term care35 More information and list of companies that sell these plans at: Type “Long Term Care Partnership” into the search box.

What’s your plan for long-term care? June 11, 2016 Long-term care36 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.

Fraud protection June 11, 2016Long-term care37

Protect yourself from fraud June 11, 2016 Long-term care38 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

Wrap up June 11, 2016Long-term care39

How to contact us June 11, 2016 Long-term care40 Insurance Consumer Hotline TDD: TDD Relay:

Need help with other insurance questions? June 11, 2016 Long-term care41 The Office of the Insurance Commissioner can also help you with questions, information and complaints about all types of insurance, such as: Homeowner Auto Life Annuities Health And more! Call our Insurance Consumer Hotline: On the web at:

More questions? June 11, 2016 Long-term care42 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!!!