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Published byKenneth McKenzie Modified over 8 years ago
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PRICING MODELS AND OPTIONS Continuing Care at Home: Finding Success in a Brave New World SUSAN HAWKINS Executive Director, Cadbury Consulting
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CONTRACT DESIGN Continuing Care at Home programs offer contracts similar to CCRC Type A and Type B Lifecare contracts Plan options evolved as we better understood our consumers Pricing based on: Period of service coverage Services included and costs (in today’s dollars) Defined cap (daily and lifetime) Elimination period Inflation coverage Underwriting Consulting
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FEE STRUCTURE Consulting One time membership fee based on age and plan option Monthly fee based on plan option Discount for couples Tax deductible as a medical expense Monthly fees have annual increases
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PLAN OPTIONS Consulting All Inclusive Plans – Traditional Lifecare Lifetime coverage All services included No co-pays 2% declining refund Member fees range $46,337 - $86,433 Monthly fees range $366 - $566
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PLAN OPTIONS Consulting Co-Pay Plans Lifetime coverage All Services included 2% Declining Refund Co-pay when services are needed - 15% for home care services - 30% for community based services Member Fees range - $36,078 -$69,436 Monthly Fees range - $345 - $545 Other co-pay amount plans
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PLAN OPTIONS Consulting Home Care Plans Lifetime coverage Only home care services included 2% declining refund Assisted living or nursing care available fee-for-service Member fees range $16,487 - $38,554 Monthly fees range $269 - $468 Additional options for community-based care
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PLAN OPTIONS Consulting Refundable Options Same lifetime benefits as All Inclusive 90% Refundable Member Fees range $99,199 - $262,341 Monthly Fees $466 Blending with Long-Term Care Insurance Evaluate individual policy benefits Credit insurance benefit toward program costs Program costs will vary depending on policy benefits
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PLAN OPTIONS Consulting Type B Options Small membership fees included in monthly fees Defined limits and coverage options similar to long-term care insurance, e.g. waiting period; daily benefit limit; lifetime benefit limit; etc. Prices are lower because benefit is limited Daily benefit $75 - $250 Elimination period 0-365 days Appeals to a younger member Provides less up front cash to cash flow new program
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PLAN VARIATIONS Consulting Co-pay options of 15%, 20%, 25%, 30% and 50%. Facility only plans Refundable options of 25% and 50% (this adds life insurance to the long-term care insurance) Elimination periods of 0, 30, 60 and 90 days Varying daily and lifetime caps
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PLAN VARIATIONS Consulting Flexible payments – higher member/lower monthly, lower member/higher monthly Membership fee paid over a number of years Consultative Care on a fee-for-service basis or a package of care coordination and services Care coordination navigation Wait List options Referral and concierge programs Additional community programs and activities
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