Ohio Consumer Guide Series
Ohio Department of Insurance
1-800-686-1578
•
www.ohioinsurance.gov
Guide to Long-Term Care Insurance
This guide: • Explains how coverage works • Helps determine your personal risks • Includes premiums for sample policies • Lists company names and phone numbers
Ted Strickland Governor
December 2008
Mary Jo Hudson Director
Governor Ted Strickland Department of Insurance Director Mary Jo Hudson
The Ohio Department of Insurance has produced this consumer guide to help you learn more about long-term care insurance and the options available to you. Inside, you will find an overview of long-term care insurance as well as detailed information on types of policies, benefits and exclusions, tax issues and Ohio’s new Long-Term Care Insurance Partnership Program. Long-term care insurance is not for everyone. We encourage you to study your options thoroughly and consult with a trusted financial advisor or family member before you purchase a policy. If you have any questions after reading this guide, the Ohio Department of Insurance is ready to help. Please consult our representatives at the Department's Ohio Senior Health Insurance Information Program (OSHIIP). You can email us at oshiipmail@ins.state.oh.us or call 1-800-686-1578. Best wishes,
Ted Strickland Governor
Mary Jo Hudson Director, Ohio Department of Insurance
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Table of Contents
Page 2 .................... What is long-term care and who may need it? Page 3 .................... How much does long-term care cost and who pays? Page 4 .................... What’s new in long-term care? Page 4 .................... Where can I get help on long-term care issues? Page 5 .................... Do you need long-term care? Pages 6-7 ............... Self check of health and wealth Page 8 .................... How can I buy long-term care insurance? Page 9 .................... Buying is no easy decision Page 10 .................. Medicaid and long-term care Page 11 .................. Simplified view of Medicaid and long-term care Page 12 .................. Medicaid and estate recovery Page 13 .................. Ohio's Long-term Care Partnership Program Page 14 .................. Long-term care benefits: what's covered? Page 15 .................. What factors affect your premium? Page 16 .................. Protecting your benefits Page 17 .................. Bells and whistles: additional features Page 18 .................. Exclusions: what’s not covered? Page 19 .................. Benefit triggers: when benefits start Page 20 .................. Tax qualified policies Page 21 .................. Replacing an older long-term care policy Page 22 .................. Consumer protections Page 23 .................. Long-term care insurance shopping tips Page 24 .................. Self-assessment: a financial inventory Page 25 .................. Sample policy checklist Page 26 .................. Planning for long-term care costs: other options Page 27 .................. How to use the premium charts Pages 28-38 ........... Long-term care insurance premium charts Pages 39-40 ........... LTC insurance consumer complaints Pages 41-42 ........... Long-term care insurance shopping list Pages 43-44 ........... Long-term care definitions
Disclaimer notice: The information included in this publication is meant to serve as a guide and is not a substitute for legal or professional advice. Please be certain to check with a professional if you have questions. Published in December 2008. May change without notice.
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What is long-term care?
Examples of skilled care include physical therapy, caring for a wound or supervising the administration of intravenous medication.
Long-term care (LTC) is the help you may need if you are no longer able to care for yourself. You may need longterm care if you have a prolonged physical illness, a disability or a cognitive impairment such as Alzheimer’s disease.
Personal care helps you with the activities of daily living. These activities You may think long-term care is given include bathing, eating, dressing, only in nursing homes, but the term now toileting and transferring. Personal care applies to services that can be provided is less involved than skilled care and in a variety of settings. LTC services may may be given in a variety of settings. include help with activities of daily living, Sometimes personal care is called home health care, respite care, hospice custodial care. care, adult day care, nursing home care Who may need long-term care? and assisted living facility care. It is hard to know if and when you will LTC is different from traditional medical need long-term care, but some statistics care. Long-term care helps one live as may help. he or she is now and may not help to Life expectancy after age 65 has now improve or correct medical problems. increased to 17.9 years, up from 1940 The way long-term care services are when life expectancy after age 65 was provided is changing. Skilled care and only 13 extra years. The longer people personal care are the terms used most live, the greater the chances they will often to describe LTC and the type or need assistance due to chronic conditions. level of care you may need. Long-term care insurance policies specify "triggers" In Ohio in 2005, 5 percent of all people that must be present before benefits can age 65 and older resided in a nursing home. start (see page 19.) People usually need skilled care for serious medical conditions that require attention by medical personnel such as registered nurses or professional therapists. This care is usually needed 24 hours per day, a physician must order it and the care must follow a plan. Skilled care can be given in a nursing home but you may also receive it in other places. For example, you might get skilled care in your home with the help of visiting nurses or therapists. If you are now 65 years old, the chance of your entering a nursing home and staying for more than five years is four percent for men and 13 percent for women. Other factors may increase or decrease the chance that you might need long-term care. See pages 6-7.
Important note:
Neither Medicare nor traditional health insurance plans will cover most costs of long-term care.
How much does LTC cost and who pays?
The cost of long-term care
Cost depends on the level of care you need, where you receive it, and for how long.
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Who pays the bills for care?
• • • • You and your family Or Medicaid Or LTC insurance Or all of the above!
At home
Paying a professional for custodial care in your home could easily cost up to $50.00 per hour.
In a nursing home
Medicare may pay for a short stay
It depends on the facility and its location, but a nursing home in Ohio can cost more than $200/day. That's $73,000 or more for a full year. Costs will probably keep going up. • Call a sampling of nursing homes in your area to get an idea of the local cost of care
You cannot depend on Medicare to pay your long-term care bills. Medicare pays about 10 percent of the nation’s total nursing home bills. • Medicare will fully cover a stay of 20 days... and Medicare pays that only when you need skilled nursing care after at least 3 days in a hospital (not counting the day of discharge) • After paying for the first 20 days, Medicare pays only a small part of the skilled nursing bill for another 80 days — after that, Medicare pays nothing • Medicare never pays for custodial or intermediate care, which is the level of care you will most likely need
Recent federal figures show...
• Medicaid pays about one-half of all nursing home costs • Patients pay out-of-pocket for about 40 percent • Medicare pays about 10 percent
LTC policies cover specific care
• LTC insurance pays someone to take care of you if you are not able • But you still need Medicare and/ or private health insurance... LTC insurance generally will not pay other medical or hospital bills
Medicare’s Hospice care
Medicare Hospice care provides services for patients with terminal illness. It covers counseling, pain relief, and symptom management, but will not pay for hospice room & board.
Buying LTC insurance through an employer or other group
Some organizations contract with insurance companies to offer LTC insurance to employees, members and other eligible people. For example, such coverage is available to state employees and teachers through the Public Employee and State Teacher Retirement Systems (PERS and STRS). Insurance companies negotiate premiums and coverage with each organization. Check with your employer or group.
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What's new in long-term care?
Ohio Department of Job & Family Services The Long-term Care Partnership Program lead agency, the Ohio Department of Job & Family Services administers Medicaid in Ohio and determines Medicaid eligibility for those who apply. Since Medicaid pays about half of all costs associated with longterm care, Job & Family Services may be a necessary resource for you. Job & Family Services has an office in every Ohio county. Look in your local phone book for contact information on your county Department of Job & Family Services. You can also visit www.jfs.ohio.gov or call 1-800-324-8680, the Ohio Medicaid hotline. Ohio Department of Insurance The Ohio Department of Insurance regulates insurance companies, agencies and agents licensed to do business in Ohio. Through its Ohio Senior Health Insurance Information Program (OSHIIP), the Ohio Department of Insurance assists consumers who have questions about long-term care insurance. OSHIIP offers unbiased information on which companies market LTC insurance in the state, how and where policies provide benefits, what policy terms mean, and more. Call OSHIIP at 1-800-686-1578. The Consumer Services Division at the Ohio Department of Insurance can help if you have an insurance complaint. Consumer Services investigates complaints and helps consumers resolve their insurance complaints. Call Consumer Services at 1-800-686-1526. Visit the Ohio Department of Insurance at www.ohioinsurance.gov.
Ohio's Long-term Care Partnership Program
Ohio's long-term care insurance companies can offer policies that allow you to keep more of your assets if you ever need to apply for Medicaid long-term care services. See page 13 for details.
Help with long-term care issues
Ohio government agencies may help answer your questions, provide information and — in certain situations — act as your advocate regarding LTC issues. Ohio Department of Aging The Office of the State Long-term Care Ombudsman is located at the Ohio Department of Aging. The Ombudsman advocates for the rights of people receiving long-term care in all settings, including the patient's own home, skilled nursing facilities and assisted living facilities. Through local Area Agency on Aging offices, the Department of Aging can also: • Help you identify the level of care needed • Help you identify appropriate long-term care facilities • Provide information regarding a facility's quality of care To contact the Ohio Department of Aging, visit www.goldenbuckeye.com or call the Office of the State Long-term Care Ombudsman at 1-800-282-1206.
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Do you need long-term care insurance?
Some people need long-term care (LTC) insurance, but it may not be a good buy for everyone! LTC policies pay for medical care given in a nursing home or your own home to treat chronic (ongoing) health problems. It’s very expensive to live for a year or more in a nursing home, but most people never face that situation. Long-term care insurance can also be expensive, particularly if you never have to use it. Should you buy LTC insurance? Only you can say. Your decision should depend on personal health and wealth matters. Start by asking yourself the questions below, then read the next two pages.
About your health
Are you a good candidate for a long stay in a nursing home during your lifetime?
• How healthy are you? • Do you have healthy habits? • What is your family’s health history?
About your wealth
What type of resources do you own? (Include income, savings, property and investments.)
• Can you afford the policy, now & later? • Can you afford extended nursing care? • Do you want to leave any resources for your family?
See pages 6-7 and complete the self-check of health and wealth.
As you read this guide
• Remember an important fact: even the best LTC insurance policy money can buy will not cover all your expenses! • Refer to pages 41-42 for common meanings of LTC words.
Military veterans:
The VA may pay all or part of your LTC costs. See page 14.
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Self-check of health & wealth
Will you need long-term care to protect your health?
You’d need a crystal ball to know for sure. Upon reaching age 65, about 33% of men and 52% of women will spend some time in a nursing home. But the typical stay for those who need to enter a nursing home might be shorter than you think (see the bottom of this page). While it's not guaranteed, if you answer YES to any of the statements below, your chances of needing long-term care may be higher than the average person’s.
Life expectancy
Your parents, grandparents, and other family members have generally lived into their 80s or older. There’s a good chance you’ll do the same. And the longer you live, the more likely it is you’ll need long-term care.
YES
NO
Sex
You are female. One fact of American life is that women live longer than men. As a result, women have a greater chance of being alone and needing long-term care.
Health & habits
You’ve been a heavy smoker, have high blood pressure or diabetes, or other health habits or conditions that could result in more serious problems in the future. Anyone can have a disabling accident, develop Alzheimer’s, or have a stroke. The chances are greater if you’ve had a history of health problems.
Family history
Your parents, grandparents, or other relatives have suffered from senility or Alzheimer’s in their old age. There’s no guarantee the same thing will happen to you, but your chances may be greater.
How long is long-term?
• Two of every three people entering a nursing home stay 3 months or less • Only 7% of all nursing home patients stay a full year • About 10% stay in a nursing home as long as 3 years
Should you buy long-term care insurance to protect your wealth?
Many people who need long-term care may not need long-term care insurance. This page should help you decide where you fit financially.
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Medicaid
Do you now receive Medicaid or Supplemental Security Income (SSI)? If YES, you do not need LTC insurance. See pages 10-12 for more about Medicaid. If you were eligible for Medicaid, would you be willing to have Medicaid pay your long-term care bills? If NO, you will need a supportive family or a good insurance policy.
YES
NO
Family support
Would relatives or friends be willing and able to take care of you if you needed continual help with such things as eating, dressing, bathing, etc.? If NO, you might have to pay someone to help you.
Income
Can you depend on having a monthly income of at least $4,500 at the same time your health requires long-term care? If YES, you might not need LTC insurance. You would be able to pay the average cost of care out of your own pocket... at today’s prices.
Income / savings
Can you afford to pay $100-200 (and more, the older you are) from your income or savings every month for insurance premiums? If NO, you might not be able to afford LTC insurance. Today’s premiums will probably be even higher in the future.
It’s a matter of opinion — so get one
Financial experts have different ideas about who should and who should not buy long-term care insurance. Deciding which group you're in is not an exact science. To have a better idea, hire a financial advisor you trust to analyze your specific situation.
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How can I buy LTC insurance?
Depending on your situation, you may have many options to buy a long-term care policy.
Federal government:
Federal and U.S. Postal Service employees and annuitants, members and retired members of the uniformed services, as well as qualified relatives, are eligible to apply for long-term care insurance coverage under the Federal Long Term Care Insurance Program. Private companies underwrite the insurance and you pay the premiums. Be sure to compare the group plans to individual plans.
Individual policies
Today, most LTC plans are sold as individual policies. Policies may vary from one company to the next. Each company may also offer policies with different benefit combinations. Take your time and study various policies and companies to get the coverage that best fits your needs. You may want to seek a financial advisor to assist with your decision.
Through a private employer
Your employer may offer a group plan or offer individual plans at a group discount. As an active employee, you may not have to submit to medical underwriting to qualify for an employer group policy. Employers may also allow retirees, spouses and parents to apply, although medical screening may be required for relatives. Generally, insurance companies must let you keep your coverage after your employment ends or your employer cancels the group plan. In most cases, you will be able to continue your coverage or convert it to another long-term care insurance policy. However, your premiums and benefits may change.
Through association membership
These policies are like other types of longterm care insurance and typically require medical underwriting. Association policies usually give members a choice of benefit options. In most cases, policies sold through associations must allow members to keep or convert their coverage after leaving the association.
Through a continuing care retirement community
Continuing Care Retirement Communities (CCRCs) are retirement complexes that offer a broad range of services and levels of care. Many CCRCs offer or require you to buy long-term care insurance. You must be a resident or on the CCRC's waiting list and meet the insurance company’s medical requirements to buy its long-term care insurance policy.
Through a public employer
State government:
If you or a member of your family is employed by the State of Ohio, you may be eligible to buy long-term care insurance under a state government program. Information is available in the State of Ohio Employee Benefits Handbook.
Buying is no easy decision
The sales pitch can be emotional
The prospect of spending your last years in a nursing home can be very scary in itself. Even scarier is how to pay for it. You can work and save all your life, only to see your retirement nest egg wiped out and your home sold to pay the high cost of a couple of years in a nursing home. So, you must be extra careful not to let your emotions run away with your checkbook. • You should not make a purchase based only on a 2-hour sales pitch or reading the company’s sales brochure. • Take time to consider all of your options. If you consider buying, make sure you need and can afford a long-term care policy. • If you decide to buy, use this guide to help you identify the coverage you want and the company you want to buy it from.
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High incidence of lapse
Over time, people who buy LTC insurance often decide they can no longer afford it. Up to 25 percent of LTC policy buyers give up their policies within the first two years. In such cases, the premiums are wasted unless the insured filed claims. Remember: you buy LTC insurance for the future. Make sure you can afford the premiums today and tomorrow.
Policies are expensive
Long-term care insurance could be one of the most expensive policies you will ever buy. • If you're age 65 or older, expect your premium to be more than $1,000 per year. It will probably increase in the future. • If you’re blessed with good health as you grow older, you might never have to use the policy. • Look at the sample premiums on pages 28-38 for an idea of policy costs from Ohio companies. Remember, rates will most likely increase in the future.
Every policy is different
Long-term care insurance is a relatively new product. Companies are still experimenting, looking for the best way to design and market these plans. That makes it impossible to give you a set of hard and fast shopping rules. And that’s why this guide is full of words like some, most, could and might.
Medicaid safety net
Medicaid is a state program that pays longterm care costs for people with low incomes and resources. One reason people buy longterm care insurance is to avoid depending on Medicaid. See pages 10-12 for a better understanding of how Medicaid works.
Unpredictable...
A lot of things could change between now and when you actually need long-term care. • The government could change the way Medicaid works • Health care reform could put more controls on the cost of care • Insurance companies could change the structure of their policies
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Medicaid and long-term care
Medicaid rules apply if:
• You are over age 65, or • You are blind, or • You have a disability.
Medicaid eligibility
Medicaid will pay for long-term care when you no longer have the resources to pay your own bills. Medicaid pays about one-half of America’s bills for long-term care. Many people “spend down” to Medicaid eligibility. That means they pay their own bills until they run out of money. Then Medicaid begins paying their bills. At some point in their stay, almost two-thirds of Ohio’s nursing home patients are covered by Medicaid. Medicaid pays your LTC bills if you: • Didn’t have much money starting out, or • Entered a nursing home with some savings that are wiped out by the high bills.
Medicaid and your house
Spouse in a nursing home Even if Medicaid pays your spouse’s bills for years, you don’t have to sell the house as long as you live in it. If the spouse in the nursing home dies, the house may be yours to keep or sell, depending on how you own it. Read about “estate recovery” on page 12. Single homeowner in a nursing home If you enter a nursing home and leave no spouse or dependent living in your home, your home will be “safe” for at least six months. After you’ve been in the nursing home for that six-month period, you may have to sell the house and use the proceeds to pay your bills until you are poor enough to qualify again.
Medicaid & assets
• Medicaid looks at your assets — from money in the bank to your car and house. • Some assets (such as your wedding ring, household goods and one car) aren’t counted. Your house isn’t counted as long as you, a spouse or dependent live in it. • You are eligible when your “countable” assets fall below $1,500 and your monthly income is less than your nursing home bill. • Medicaid pays the difference between your income and the actual bill.
Where will Medicaid cover care?
• In any Medicaid-approved nursing home that provides the level of care you need. • Under some circumstances, Medicaid will pay for home health care. Call your local Area Agency on Aging for information on Ohio’s PASSPORT program.
Medicaid is complicated!
In fact, it is impossible to fully explain Medicaid here. To find out if you qualify, apply at your county Department of Job & Family Services (DJFS). Or call your county DJFS for a copy of the free publication Medicaid Questions & Answers for specific eligibility information.
Can I qualify for Medicaid if I give all my assets to my children?
Assets must be transferred at least 60 months before you apply for Medicaid. It’s tricky, and there are a lot of exceptions. Be sure to see a trusted attorney or financial advisor before making such arrangements.
Medicaid & long-term care: a simplified view
Married couple Single person
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Spouse at home keeps
House Furnishings One car Half of joint assets (up to $104,400) • Up to $2,610 in monthly income • • • •
Spouse in nursing home
Uses remaining available assets and income to pay long-term care bills
Runs out of money
Medicaid starts paying LTC expenses
Questions?
Call your county Department of Job & Family Services for details about your specific situation. Based on Ohio regulations for Medicaid as of September 2008.
“Protected” assets
House (for 6 months) One car Personal belongings $1500 cash value in life insurance • Burial plot • A few others • • • •
Uses savings, investments, insurance & income to pay own LTC bills
Runs out of money
Medicaid starts paying LTC expenses
After being in nursing home for 6 months, person sells protected assets: • House and car
Pays LTC bills with cash from sale of assets
Runs out of money
Medicaid starts paying LTC expenses
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Medicaid and estate recovery
What is an estate?
It’s the property (your land, jewelry, clothes, furniture, etc.) available to your family or heirs when you die. Medicaid’s claim on payments made toward Medicare coverage
Although assets such as your car and home can be protected from Medicaid while you are alive, the state may file a claim against your estate after you die. Ohio’s Estate Recovery program requires the Ohio Attorney General’s Office and the Ohio Department of Job & Family Services (the agency that administers Medicaid) to recover payments from the estate of anyone who was 55 or older when receiving Medicaid.
Medicaid will have a claim against your estate when:
• You and your spouse have both died and you have no dependent children, and • All taxes, funeral expenses, and other administrative expenses have been paid, unless • Your heirs can persuade probate court that Medicaid recovery would create an “undue hardship” on them.
o
Medicaid has a legal claim against your estate for the total amount of payments made on your behalf for all long-term care and medical expenses under the Medicare program.
Joint survivor exception... check your deed!
Example: your estate is a family business or family farm and Medicaid recovery would put the survivors out of work.
Most married couples share home ownership with a deed that describes them as “joint tenants with right of survivorship.” Other kinds of property (including bank accounts) can also be owned in “joint tenancy.” With a deed like this, your house would not become part of your estate when you die. Instead, full ownership passes to your spouse.
“Understanding Estate Recovery”
You can get more information in a free brochure called Understanding Estate Recovery. Call the Ohio Department of Aging at 1-800-282-1206 or (614) 466-3253 to request a copy. You may also be able to get a copy of the brochure from your local Area Agency on Aging.
Be very careful!
The rules change often, so transferring your resources can be risky! It’s a good idea to get advice from a trusted attorney or financial advisor before you make any arrangements.
Ohio's LTC Partnership Program
What is Ohio’s Long-term Care Partnership Program?
The program is a way for people to buy LTC insurance, receive policy benefits and protect a matching amount of assets if they need to apply for Medicaid. Ohio encourages those at risk who can afford long-term care insurance to buy a policy. Shoppers can choose a policy under the state’s Long-term Care Partnership Program.
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totalling $50,000. Medicaid will let you keep $50,000 of your assets should you require further care and apply for Medicaid. By purchasing the partnership policy, you take personal responsibility for paying for your care, while protecting a portion of your assets in the event you get coverage from Medicaid. Please note: buying and using a partnership policy does not guarantee you will be otherwise eligible for Medicaid.
How do these policies work?
You pay premiums just as you would with any insurance contract. If needed, you use policy benefits to pay for covered care. You receive benefits as long as you need care and have not exhausted the coverage your premiums bought. If you use the coverage (that is, receive benefits from the policy) a partnership policy will let you protect some of your assets should you apply for Medicaid. To qualify, companies’ policies must meet several requirements, including: • The policy must have been issued after Sept. 10, 2007; • The insured must be a resident of Ohio when coverage first becomes effective; • The policy must be a federally taxqualified plan based on the Internal Revenue Service Code (see page 20); • The policy must meet strict consumer protection standards; and • The policy must include certain protection against inflation.
Will the policy protect me better than standard LTC insurance?
With any insurance policy, it is important to choose the type of coverage that fits your needs. Properly purchased, LTC insurance will pay most of the costs associated with skilled nursing care.
If you exhaust the benefits of a standard policy and still need care, you would become eligible for Medicaid only after “spending down” your assets to Medicaid levels. Your bills for care would then be paid by Medicaid. A partnership policy protects your assets from Medicaid spend-down. You keep assets that match the amount of coverage you received. You may need to spend assets which are over and above the protected amount before Medicaid starts its coverage.
Who benefits?
Everyone benefits from these new plans. • You benefit by protecting assets. • Medicaid benefits because, by taking responsibility for paying for your own care, you delay applying for Medicaid. • Ohio citizens benefit because Medicaid is a public program funded by taxes. Medicaid resources will be better used for those who truly need the financial assistance.
How much can I protect?
You can protect assets up to the amount of the coverage you buy. For every dollar you use in benefits, you can protect a dollar of your assets if you later apply for Medicaid. Here’s an example. You buy an Ohio LTC Partnership policy and receive benefits
Get more information at www.LTC4me.ohio.gov
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LTC benefits: what's covered?
Most long-term care insurance policies usually do not pay benefits for: • A mental or nervous disorder or disease, other than Alzheimer’s disease or other dementia • Alcohol or drug addiction • Illness or injury caused by an act of war • Attempted suicide or intentionally selfinflicted injuries In Ohio, insurance companies must pay for covered services for Alzheimer’s disease that may develop after a policy is issued. Nearly all policies say they will cover Alzheimer’s disease. See page 18 for more about common exclusions in long-term care policies.
Coverage can vary significantly
What services are not covered Long-term care policies are not standardized exclusions and limitations
like Medicare supplement insurance. Companies sell policies that combine benefits and coverage in different ways.
Understand the benefits your policy provides. Policies may cover some or all of these services: • Nursing home care • Home health care • Respite care • Hospice care • Personal care in your home • Services in assisted living facilities • Services in adult day care centers • Services in other community facilities
Where services are covered
Make sure you know what types of facilities your long-term care insurance policy covers. If you choose a type of facility not included in the coverage, the insurance company will not pay for eligible services.
Are you a military veteran?
Veterans can receive various levels of nursing home benefits, depending on the nature of the disability or illness. • Those with service-connected disabilities or illnesses get first priority and the care is free. Care can be received in a Veterans Affairs (VA) facility or a private nursing home at VA expense. • Veterans with disabilities or illnesses which are not connected to armed service can receive care in a VA facility if space and resources permit. Those with a specific income level must pay a deductible and a copayment. Veterans’ health benefits are subject to change. For more information, contact your local VA office or medical center by calling 1-800-827-1000.
What factors affect your premium?
Age & premiums
Age is an important factor in long-term care insurance premiums. The older you are when you buy the policy, the higher your premiums will be. • Once you buy the policy, the premiums on most policies do not automatically increase because you get older • But it’s likely the company will raise the rates for all customers as costs increase
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Elimination (deductible) period: how long before the policy pays?
Policies call it either the “elimination” period or the “deductible” period. You’ll have certain options as to its length. • This period is the number of days you must pay your own nursing home or home care bills before insurance payments start • A 100-day elimination or deductible period means you will pay for the first 100 days out of your own pocket • Companies in the premium charts (pages 28-38) are arranged by the length of the elimination period for the policies shown
Daily benefit: how much will the policy pay?
Most policies define benefits in terms of the maximum daily benefit and offer numerous choices (e.g. $50, $90, or $120 per day). • You’ll pay a higher rate for higher benefits • A policy that pays $90 per day could pay the actual bill (up to the $90 limit), or pay a flat per diem of $90 — read the policy to know exactly how the daily benefit is paid • Sample premiums on pages 28-37 use a daily benefit of $100; page 38 uses $50
Elimination period & premiums
The premium for a company’s policy with a 100-day elimination period is more affordable than the same policy with a shorter period. Of course, that 100-day elimination period means you’ll be paying for the first 100 days of care yourself. At today’s LTC prices, that could cost you more than $15,000. And if you leave the nursing home within 100 days, such a policy pays nothing!
Inflation protection & nonforfeiture of benefits
Benefit period: how long will the policy pay?
• The benefit period can be as short as one year or as long as “lifetime” (unlimited)
These two features can make a big difference in LTC insurance premiums. See the next page for more information on these features.
The “benefit period” tells you how long the policy will pay daily benefits.
The BIG question:
Can you afford to pay the policy premiums every year?
• Increasing a policy’s benefit period will also increase its price • Sample LTC premiums on pages 28-32 have a benefit period of two years • LTC policy premiums on pages 33-37 have a benefit period of four years • The home health care policies priced on page 38 have a benefit period of one year
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Protecting your benefits
Nonforfeiture: what if you stop paying premiums?
Long-term care insurance is term insurance. That means you have the protection only as long as you continue paying the premiums. It is not an investment or savings account of any kind no matter how many years you have had the policy or how much you have paid into it. The coverage disappears when your payments stop. But you can keep some benefits if you bought a policy rider called “nonforfeiture.” If you stop paying premiums for any reason, nonforfeiture may help you still get some benefits. Your new level of benefits will be equal to the premiums you paid. • Since August 12, 2002, policies sold in Ohio must offer a nonforfeiture option, and, if the offer is declined, a notice explaining your right to “contingent benefit upon lapse” (see page 22) Note: a common feature in many long-term care policies is “waiver of premium” which allows you to stop paying premiums once you start using the policy.
Inflation protection: will the policy you buy today be enough to cover the cost of care 10 years from now?
The average cost for one day in an Ohio nursing home is $160! But you buy LTC insurance for the future, not the present. And long-term care costs could be a lot higher in the future.
That’s why Ohio law requires companies to offer you “inflation protection.” • The most common inflation protection automatically increases benefits each year by 5% (compounded interest) • Many companies build the cost of inflation protection into your policy premium so your payments are the same every year • Inflation protection could increase your premium by as much as 100% • Many company premiums on pages 28-38 give two rates: one with inflation protection, and another without it
Guaranteed purchase option
A few policies offer a “guaranteed purchase option” (GPO). Instead of adding benefits automatically, your benefits increase at specific intervals (e.g., every 5 years).
Accidental lapse protection
Protection by rider
Ohio law requires companies to include protection against the possibility that your deteriorating mental condition will result in missed payments and a cancelled policy. Third party notice: You can designate in advance another person (e.g., a relative) to receive a copy of all cancellation notices. Reinstatement: If the policy is cancelled for late payment, you can reinstate within five (5) months... if your doctor certifies that you had a mental disability.
To keep prices low, the company’s basic policy may not include inflation protection. You pay more for the extra protection. But consider this: to beat inflation, you’ll pay either a higher premium today, or higher LTC costs in the future for benefits your policy doesn’t cover.
Bells and whistles: additional features
Death or “survivor” benefit
Some LTC policies double as life insurance. If you die, the company may pay your beneficiary part or all of the premiums you paid, minus any benefits the company has paid.
17
The variety can be confusing!
In addition to promising to pay your nursing care bills, companies offer various features to make their policies more attractive than the competition.
Hospice care
Each company has its own labels and Hospice care is continuous care for the definitions. Read the policy carefully to terminally ill. It may be provided in a be sure of what you’re buying. hospice facility or by professionals in your home. Remember: most hospice services are covered by Medicare, but it does not pay Prescription drugs Some policies will pay part or all of your hospice room & board charges. drug expenses while you’re in a nursing Restoration of benefits home. Some policies let you restore benefits you Respite care used. Example: Respite care gives an in-home caregiver • Your 2-year policy is “used up” after it a short break. It pays for a temporary has paid your nursing home bills for two substitute (a health care professional) for years your spouse or others who regularly take • You go home and resume paying care of you at home. premiums Medical equipment • After 6 months out of the nursing home, The policy may pay for equipment that your benefits are “restored” and the relieves your need for physical assistance. policy is now good for another 2 years Some policies require that this would help • But note: although it’s possible, you’re you remain at home. not likely to be checking in and out of a nursing home very often
Ambulance
Alternative care
Some policies pay a limited amount to cover an ambulance ride to or from a nursing home or hospital.
If your health qualifies you for nursing home care, the policy may agree to pay for care somewhere else as well.
Bed reservation
Discounts
If you have to leave the nursing home and go to a hospital, you can make sure you have a nursing home bed if you return within a short period (e.g., 10 days).
• You may get a discount if you and your spouse both buy — of course, you’ll still pay more to insure two people than one • Nonsmokers will generally pay less for any kind of health insurance
Your life insurance policy could help with your medical bills
An Accelerated Death Benefit may be part of a life insurance policy. It generally lets you use part of your death benefit before you die to pay personal health care bills. But beware: by using it, you reduce the death benefit amount paid to your family.
18
Exclusions: what’s not covered?
Every insurance policy has a long list of things it doesn’t cover. Check any policy you consider for exclusions. Here are some to look for in an LTC policy.
Pre-existing conditions
Health problems that were diagnosed or treated within six months before you bought the policy may not be covered if you need care beginning in the first six months after you buy the policy. • If a pre-existing condition causes a nursing home stay within the first six months, the policy may pay nothing • Some policies will cover any pre-existing condition that you disclosed on your application... but chances are your application won’t be approved if you have a serious health problem
Prior stay conditions
Many older policies did not pay benefits unless you spent at least three days in the hospital first. • Nursing home: policies sold today cannot have a prior stay restriction for nursing home care • Home health: some policies might require a prior stay in a hospital or nursing home before paying for home health care or adult day care
o
Note: a prior stay exclusion reduces your chances of actually collecting for home health care or adult day care
Caregivers (family members)
Mental diseases or disorders
Some LTC insurance policies will pay to train a family member to take care of you.
Other insurance
LTC policies will not pay any expenses that are covered by other insurance policies, Medicare, or other government programs.
Ohio law requires all policies to pay for care due to Alzheimer’s or senility, but policies do not have to pay for care resulting from other kinds of mental or nervous disorders, such as insanity or nervous breakdown.
Alcoholism or drug addiction
Claim problems?
The health insurance experts of Consumer Services at the Ohio Department of Insurance can help settle disputes about your policy.
Policies won’t pay if your condition was caused by either alcoholism or addiction to drugs. They may pay if the condition is the result of medications prescribed by your doctor.
Attempted suicide or self-inflicted injuries
Visit www.ohioinsurance.gov or call 1-800-686-1526.
Most policies that provide health insurance coverage won’t pay claims when it’s clear that you were hurt by your own hand.
Illness caused by an act of war
The majority of insurance policies rule out paying claims for problems that result due to “acts of war.”
Benefit triggers: when benefits start
Physical impairment Cognitive (mental) impairment
19
Each policy has its own “triggers” for determining when your physical or mental condition has reached a point that you are entitled to benefits from the policy. The examples on this page use language from a national model for a nonqualified plan. See page 20 for benefit triggers for federal tax-qualified plans. Definitions in specific policies may be different. Below are examples of custodial care, and common reasons for entering a nursing home. If you cannot perform a certain number (usually three) of the activities of daily living — known as ADLs — without the “hands-on” assistance of another person, you qualify for custodial care. ADLs are described below:
Bathing ........... Wash yourself either by sponge bath, or in the tub or shower; get in or out of the shower. Dressing ......... Put on and take off all items of clothing and any necessary braces, fasteners or artificial limbs. Toileting.......... Get to and from, on and off the toilet; perform associated personal hygiene. Continence ..... Maintain bowel and bladder control or perform personal hygiene associated with a catheter or colostomy bag. Transferring ... Move in and out of a chair, bed, or wheelchair. Eating.............. Feed yourself by getting food into your body from a plate, cup, or table, or by using feeding tubes or intravenous tubes.
• You have been diagnosed as having a condition such as Alzheimer’s Disease or senile dementia (senility), and • The deterioration or loss of your cognitive (mental) ability requires “verbal cueing” by another person to protect yourself and others, and • Your condition has been verified by tests that are approved by the insurance company to reliably measure your impairment in the following areas:
o o
Your memory, or Your orientation as to person (such as who you are), place (where you are), and time (day, date, year), or Your deductive or abstract reasoning
o
Compare
Benefit triggers in tax-qualified policies are more strict than those described here. See the next page for details.
Custodial care must be included
Ohio-approved policies sold since 1993 must cover at least two levels of care, including custodial care.
Example of an ADL impairment You have rheumatoid arthritis and need help to get in or out of the tub or shower, and you can’t hold your soap or washcloth. Please note: Medical experts agree that bathing is the activity most likely to give physically impaired people trouble.
20
Tax-qualified policies
Tax treatment examples
If you own a qualified LTC insurance policy: • Your age limits the amount of expenses you may deduct (see chart, this page). • You can deduct insurance premiums as medical expenses only if you qualify for medical deductions and you itemize your deductions. • You can deduct costs not covered by your insurance if you qualify for medical deductions and you itemize your deductions. • Insurance benefits you receive are not treated as income, up to an annual limit. • Employer-paid premiums are not treated as income, but employers can deduct premiums as a business expense. • Only the buyer can claim special tax treatment when the insured and the buyer are not the same person.
Starting benefits is more difficult
LTC policies provide benefits based on “benefit triggers” — levels of physical and mental health conditions defined in the policy. Review page 19 for details. Qualified plans can lower your federal taxes, but they have benefit triggers that are less flexible than those required by nonqualified plans.
Comparing benefit triggers
• Physical health benefit triggers use the basic tasks of self-care known as “activities of daily living” or ADLs.
o
Nonqualified policies start benefits if your doctor certifies you are unable to perform a certain number of ADLs (usually 3 out of 6) without help, at any time. Tax-qualified plans start benefits only if the doctor certifies you cannot perform at least 2 ADLs out of 5 or 6, without help for at least 90 days. Nonqualified plans start benefits when your doctor certifies that cognitive impairment requires a level of care that is “necessary and appropriate.” Tax-qualified plans start benefits when the doctor certifies that you need “substantial supervision” as protection for your health and safety due to cognitive impairment.
o
Saving taxes vs. getting benefits
• Mental health benefit triggers
o
As you decide between policy types, figure out how much you would actually save in taxes with a qualified plan. The dollar amounts shown below apply to tax year 2007. These amounts may change annually.
o
Age
Limit on deduction
40 or younger .............. $ 290 41-50 ........................... $ 550 51-60 ........................... $ 1,110 61-70 ........................... $ 2,950 71 or older ................... $ 3,680
Note: only 29% of taxpayers
actually itemize deductions. Unreimbursed medical expenses must exceed 7.5% of your adjusted gross income before you are eligible to deduct them.
Replacing an older LTC policy
Shop before you replace
If you’ve owned a long-term care policy for several years, you may have good reasons to consider shopping for a new model. Below are some things that could have changed since you bought that older policy. • Many policies sold today include such benefits as home health care and adult day care, which may not be in your older policy. • If your current policy has no inflation protection, the benefit level may have fallen behind increased health care costs. • Older policies included some limitations that now have been outlawed. For example, many older policies would not pay for long-term care unless you spent at least three days in a hospital before going into a nursing home, but that’s not allowed in policies sold today.
21
No new pre-ex period
If you complete a 6-month waiting period for pre-existing conditions and move directly from one LTC policy to another, you will not have a new waiting period!
Will you be able to switch? If you are no longer in good health, there
may be no point in shopping for a new policy. It’s likely you won’t be able to find a company willing to sell you a new long-term care policy. Since most companies charge premiums based on your age when you buy, you may also discover that you have passed the age when you can afford to switch!
The replacement form helps protect you
Use a checklist
If you buy a policy to replace your existing long-term care insurance, the sales agent must complete a replacement form that explains the risks of changing policies.
To see how your policy stacks up against “modern” policy standards, check it carefully for the following items.
A “good” policy should
• Provide equal coverage for skilled, intermediate, and custodial care • Include some form of inflation protection • Include any of the “modern” features that you feel you need — home health care, adult day care, respite care, etc.
Attn: Compulsive replacers!
Some unscrupulous insurance agents would love to sell you a new policy every year. Why? The first year of the policy often pays the highest commissions! So, if you’re satisfied with the policy you have, it’s a good idea to keep it.
A “good” policy should NOT
• Require prior hospitalization before paying for nursing home care • Exclude care for Alzheimer’s, Parkinson’s, or similar nervous disorders
22
Consumer protections
To tell or not to tell is your decision. Telling the company about money matters may be uncomfortable, but the worksheet's purpose is to help protect you from buying insurance you don’t need, can’t afford or both. After reviewing your application: • The company will sell you the policy if it appears to fit your financial situation, or • If it appears the insurance does not fit with your finances, or you have chosen not to provide financial information, your application may be delayed or denied Disclosure: "Things you should know before you buy long-term care insurance" is a State of Ohio form. The company must give you a copy when you consider buying. Nonforfeiture option: This optional coverage may increase your premium; it must be offered. The option allows you to collect partial benefits if you stop paying premiums for any reason. It adjusts benefit limits based on the total premium amount you actually paid. Contingent benefit upon lapse: If you do not buy nonforfeiture, a provision state law calls “contingent benefit upon lapse” can still protect you from large premium increases. If the increases exceed a certain percentage of the original premium, the company must: • Either reduce benefits to keep your premium the same or convert your policy to “paid-up” status (the policy would pay benefits up to the amount you paid in premiums — the “paid-up” option is automatic if you don't choose). The company must give you advance written notice of this provision, along with a standard schedule of percentage increase limits based on your age at purchase. If premiums increase more than the schedule allows, your policy can be adjusted as described above.
Ohio law requires LTC insurance companies to provide information to help you protect yourself. The company must give you all the information described below.
A Shopper’s Guide to Long-Term Care Insurance: Written by the National Association of Insurance Commissioners (NAIC), this booklet has a lot of good information about long-term care insurance. An outline of coverage: A summary of the policy that explains what the policy will do, and what it will not do. Notice of your 30 day free-look period: Even if you sign a contract and write a check, once you receive the policy you have 30 days to look it over and, if you change your mind, get a full refund. Company history of rate increases: When you apply or enroll, the company must disclose its past premium increases and: • Show rate hikes for the policy you are considering, and for similar plans • Show these increases for policies sold in Ohio and in other states • Show the increases for the last 10 years • Explain your options if the premium goes up
o Note:
If you buy, the company must give you 45 days notice of any future rate increases.
Suitability standards: State law requires a standard form to be part of your application. The Personal Worksheet can help determine your ability to pay premiums and your reasons for buying. • What is the Personal Worksheet? When you apply for insurance, the agent must fill out the parts of the worksheet that describe the policy. You will be asked to complete the sections about your finances.
LTC insurance shopping tips
Always do these things
• Tell the whole truth: if your answers are wrong or incomplete, the company might sell you a policy but refuse to pay claims • Do your homework: get a realistic idea of what you need and how much you can afford to pay • Make sure you can pay the premiums and still have enough money for basic needs such as housing, food, medicines, etc. • Ask a trusted friend to join you when an agent visits your home • Shop around — LTC policies can have big differences in price and benefits • Read the outline of coverage very carefully and ask for a specimen policy • Ask questions about everything you don’t understand • Ask your lawyer, a friend, or a relative to review the policy to see what you may have missed • Use your free-look option (see page 22) • Call OSHIIP for information or individual counseling: 1-800-686-1578
23
Questions to ask the agent
• What type of insurance is it, and what coverage does it provide? Is the policy considered a long-term-care, nursing home only or home health care only policy? • What types of facilities or providers are eligible to provide the care covered by the policy? Are these facilities and providers available in my community? • How long will the benefits last? • Does the policy have elimination periods before benefits begin? How long are they? • What happens if you don’t pay your premium? • What is the cost of nonforfeiture benefits? Inflation protection? Waiver of premium? • What conditions are not covered by the policy? • What number of ADLs (activities of daily living) must be deficient? • Is the policy considered a “tax-qualified” policy? • Whom do you contact if you have questions about coverage or if you need help filing a claim?
Never do these things!
• Don’t buy on the first sales visit • Don’t sign a blank application • Don’t pay in cash • Don’t write checks payable to an agent — always make them payable to the insurance company • Don’t buy until you are sure you understand exactly what you are getting • Don’t buy unless you are sure you can afford to make the payments every year
24
Self-assessment: a financial inventory
When you buy a long-term care policy, you make a commitment to pay the insurance company a lot of money every year. The premium this year may be $1,200 — but there’s a good chance it will go up in years to come. Even if you have enough income to pay the annual premiums, you might not want to buy LTC insurance unless you have significant assets and would not want to sell them to qualify for Medicaid. This page can help you get a better idea of whether you should buy a policy by giving you a better picture of your income and assets. Start by answering the question below.
Do you now receive SSI (Supplemental Security Income) or Medicaid?
YES NO If you checked YES you should not buy a long-term care policy. If you checked NO use the steps below to figure your monthly budget.
Monthly income Monthly expenses Mortgage or rent Utilities (phone, electric, heat, etc.) Groceries Auto (loan, gas, insurance, etc.) Medical & health insurance Taxes (estimated income & property) Entertainment Other Total expenses $_____________ $_____________ $_____________ $_____________ $_____________ $_____________ $_____________ $_____________ $_____________
Wages Social Security Pension Annuities Interest/dividends Other income Total income
$_____________ $_____________ $_____________ $_____________ $_____________ $_____________ $_____________
Total income (minus) Total expenses (equals)
$_____________ $_____________ $_____________
The bottom line: this is how much you might be able to spend on premiums for LTC insurance.
Another reminder: The policy will be of no use if you are unable to pay the premiums every year.
25
Sample policy checklist
This checklist will be the first page of your coverage outline. Use it to understand the policy and to compare policies.
Location of Care: This policy will pay for care only when medically necessary in the following locations. Company-approved nursing home Other nursing homes Your own home Adult day care center Assisted living facility ________________ Deductible or Elimination Period: This policy will not pay for benefits until you have paid your own long-term care bills for the following number of days. Nursing home care: _____ days Home health care: _____ days Assisted living: _____ days Daily Benefits: After the deductible or elimination period, this policy will pay (up to) these amounts for each day of care. Nursing home: $_____ Home health: $_____ Adult day: $_____ Assisted living: $_____ Benefit Period: The policy will not pay for benefits longer than these periods of time. Nursing home care: _________ years Home health care: _________ years Benefit Triggers: Before it starts paying, this policy requires the following proof that you need longterm care. Certification by your doctors Certification by the company’s doctor Confirmation you cannot perform specific “activities of daily living” Other _________________ Inflation protection: This policy’s benefits [will/will not] increase to keep up with the cost of longterm care. Benefits increase automatically You will be offered periodic benefit increases Policy Cost: Annual premium if you buy at age ______________ is $ ______________. Premiums will increase as benefits increase Premiums will increase only if rates go up for all policyholders Caution The policy has other benefits and limitations. Read the rest of this outline as well as the policy itself for all the details. The agent or the company must provide you with a copy of a National Association of Insurance Commissioners’ booklet, “A Shopper’s Guide to Long-Term Care Insurance.” Right to Return Policy If you are not satisfied with your policy, you may return it to the company for a refund. If you send it back to us (the insurance company) within thirty (30) days after you receive it, we will treat the policy as if it had never been issued and return all your payments. Insurance Counseling is Available The State of Ohio provides free insurance counseling for senior citizens. Call 1-800-686-1578.
Long-Term Care Insurance Summary of Benefits & Limitations
26
Planning for long-term care costs: other options
• A reverse mortgage is a special loan based on the equity of a home. People age 62 or older can qualify. Reverse mortgages are available from a variety of lenders and may be appropriate for people with poor health because no health screening is needed. • An accelerated death benefit in a life insurance policy pays the benefit in advance to a person who qualifies. People may become eligible for this benefit due to poor health. • A life insurance settlement can be appropriate for older people who may no longer need life insurance. People age 70 and older can generally sell their policies for their current value. Both healthy and unhealthy people may find a life settlement helpful, whether or not the cash is used to pay for long-term care. • A viatical settlement from a life insurance policy may be the choice of one who is terminally ill. A viatical settlement is a way to sell a life insurance policy for cash. It can pay a percentage of the death benefit for funds that can be used right away. • Long-term care annuities can be of two types: immediate and deferred. The type specifies when benefits are paid. The contract creates two separate funds; one fund covers LTC expenses and the other is a regular cash fund. Deferred LTC annuities can be appropriate for people who are older and in good health. People who cannot buy insurance due to poor health might wish to consider an immediate LTC annuity if they have a ready source to fund it.
Why should anyone plan to pay for LTC?
Planning now can help you and your loved ones if you should need LTC in the future.
For example, you will likely have more care options if you plan on how to pay for care than if you never plan. Other ways you and your family would benefit from your ability to pay for your own long-term care might include one or more of the reasons shown below. • You may prefer getting care at home and other less restrictive settings. • You can protect and preserve finances for other uses. • Family members may better maintain emotional and financial quality of life. LTC planning does not necessarily take the place of having family members care for their loved ones. It helps ensure that individuals and their families have other choices.
Financing options
Depending on your situation, financing methods other than LTC insurance may be both available and appropriate. Read the financing options below. Each includes a general description of a person who may want to consider it. Please note: These methods each require some form of equity, and each has potential benefits as well as drawbacks.
How to use the premium charts
All premium charts show...
• Company information: company name, web site address, policy form number • Phone: where to call for sales information • Elimination period (page 15): the number of days before the policy starts paying benefits — grouped alphabetically in each set of charts by the length of this period, starting with zero days • Tax (page 20): is the policy taxqualified? o T = Tax-qualified o N = Nonqualified o B = Both are available • Inflation protection (page 15): does the policy include this benefit? o Y = Included as priced o N = Not included in premium • Pre-ex (page 18): the number of days before the policy covers your care for pre-existing conditions • Respite care (page 17): does the policy include this benefit? o Y = Included as priced o A = Available, but at a higher premium o N = Not available • Monthly premium for women at purchase age (page 15): premiums were in effect in Fall 2008 and can change at any time; companies quoted premiums for women at ages 55, 60, 65, 70, 75, and 80; find your approximate premium under the age closest to your own age; men may pay less
27
In November 2008, the Ohio Department of Insurance asked LTC insurance companies to provide the monthly premium each would charge a new Ohio customer for sample policies. Pages 28-38 show the results. Use this page to help understand the information.
LTC premium charts show...
Pages 28-37 show two different sets of charts for policies based on benefit period length. Benefit periods (see page 15) • Pages 28-32: policy premiums for a $100 daily benefit over a 2-year benefit period (unless noted) • Pages 33-37: policy premiums for a $100 daily benefit over a 4-year benefit period (unless noted)
Note: expect to pay more for a policy with a longer benefit period!
• Home, day, assisted living (see page 14): in addition to coverage in a nursing home, the policy pays for your care in these places o Y = Included as priced o A = Available, but at a higher premium o N = Not available • Caregiver (see page 18): the policy pays to train a family member to provide your care o Y = Included as priced o A = Available, but at a higher premium o N = Not available
Home health care premium chart shows...
Page 38 shows premiums for home health care policies. Care in a nursing home or an assisted living facility is not covered, but some home health policies will cover adult day care. Check the charts for this coverage.
Remember...
A lot more choices...
Premiums change! Don't expect to see your exact price in our charts.
Our charts are based on very specific coverage. As you consider buying, use the information in this guide to build a plan that suits your needs.
Monthly premiums for sample LTC policies
28
Benefit Period: 2 years / $100 Daily Benefit
Company
AFLAC aflac.com Form # A-27000-OH Assurity Life * assurity.com Form # AL2100P-OH Bankers Life and Casualty * bankerslife.com Form # GR-N550 Berkshire Life * (3-year period) theberkshire.com Form # 71714 Equitable Life & Casualty * equilife.com Form # 2020 Great American Life * gafri.com Form # 4LTCIP0002-OH Minnesota Life * minnesotalife.com Form # ML7500P-OH Mutual of Omaha * mutualofomaha.com Form # LTC04I National States Form # PAL-1(02)R
Phone
1-800-992-3522
Elim Per 0 0
Tax T T
Inflation PreProtect Ex N 0 Y 0
Home Care Y Y
Day Care Y Y
Asstd Care Respite Living Giver Care Y N Y Y N Y
Monthly Premium for a Woman At Purchase Age
55
$44 $104
60
$55 $122
65
$82 $159
70
NA NA
75
NA NA
80
NA NA
1-800-276-7619
0 0
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$40 $114
$67 $141
$91 $172
$134 $225
$268 $423
$402 $603
1-800-231-9150
0 0
B B
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$50 $136
$69 $164
$100 $210
$157 $287
$250 $412
$407 $609
1-800-819-2468
0 0
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$45 $113
$63 $141
$94 $189
$153 $267
$258 $413
$423 $635
1-800-352-5170
0 0
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$43 $124
$60 $153
$88 $190
$131 $247
$209 $340
$329 $479
1-866-830-0607
0 0
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$40 $114
$50 $128
$71 $152
$110 $201
$186 $292
NA NA
1-888-505-9817
0 0
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$46 $121
$62 $146
$93 $186
$143 $243
$261 $392
$404 $586
1-800-775-6000
0 0
B B
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$59 $128
$73 $157
$109 $216
$197 $332
$377 $558
NA NA
1-800-868-6788
0 0
B B
N Y
180 180
A A
Y Y
Y Y
N N
Y Y
$19 $49
$29 $64
$39 $78
$67 $114
$117 $173
$210 $277
* Company is authorized to sell Ohio Partnership policies
Benefit Period: 2 years / $100 Daily Benefit
Company
Physicians Mutual * physiciansmutual.com Form # P146 United Teacher Assocs. utainteractive.com
Form # LTC-020201-UTA-TQ-OH
Phone
1-800-645-4300
Elim Per 0 0
Tax T T
Inflation PreProtect Ex N 0 Y 0
Home Care Y Y
Day Care Y Y
Asstd Care Respite Living Giver Care Y Y Y Y Y Y
Monthly Premium for a Woman At Purchase Age
55
$49 $114
60
$66 $143
65
$96 $184
70
$156 $267
75
$275 $426
80
$401 $581
1-800-880-8824
0 0
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$30 $95
$41 $114
$59 $143
$91 $193
$160 $279
NA NA
Allianz Life * allianzlife.com Form # 11-P-Q-OH Combined Insurance combinedinsurance.com Form # 14785-OH Country Life countryfinancial.com Form # LTC500 Genworth Life * Form # 7042 Rev
1-800-950-1962
7 7
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$50 $116
$64 $137
$94 $182
$150 $262
$250 $392
$403 $580
1-800-999-2170
30 30
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$38 $88
$56 $119
$84 $160
$135 $228
$230 $354
$386 $571
1-866-856-4760
30 30
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$50 $140
$65 $158
$98 $189
$163 $265
$266 $377
$400 $497
1-888-436-9678
30 30
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$50 $115
$72 $134
$105 $186
$169 $259
$292 $428
NA NA
Genworth Life * Form # 7044 Rev
1-888-436-9678
30 30
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$54 $125
$76 $144
$113 $199
$181 $279
$313 $458
NA NA
John Hancock Life * johnhancocklongtermcare.com Form # LTC-03-OH Massachusetts Mutual * massmutual.com Form # MM500-P-OH
1-800-377-7311
30 30
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$43 $67
$61 $94
$88 $128
$143 $201
$250 $335
NA NA
1-800-272-2216
30 30
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$41 $101
$57 $127
$83 $166
$137 $239
$236 $372
$335 $505
29
* Company is authorized to sell Ohio Partnership policies
Benefit Period: 2 years / $100 Daily Benefit
Company
MedAmerica Insurance * medamericaLTC.com Form # SPL2-336-OH Prudential Insurance * prudential.com Form # GRP 113308 State Farm Mutual Auto * statefarm.com Forms # 97060 / 97061 United of Omaha * mutualofomaha.com Form # LTC 06UI Northwestern LTC * (3-year period) nmfn.com Form # RS.LTC.(0708) Allianz Life * allianzlife.com Form # 11-P-Q-OH Assurity Life * assurity.com Form # AL2100P-OH Bankers Life and Casualty * bankerslife.com Form # GR-N550 Berkshire Life * (3-year period) theberkshire.com Form # 71714
Phone
1-800-554-0327
Elim Per 30 30
Tax T T
Inflation PreProtect Ex N 0 Y 0
Home Care Y Y
Day Care Y Y
Asstd Care Respite Living Giver Care Y Y Y Y Y Y
Monthly Premium for a Woman At Purchase Age
30
55
$74 $230
60
$105 $276
65
$157 $344
70
$232 $431
75
$407 $637
80
$580 $791
1-800-732-0416
30 30
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$53 $84
$67 $105
$99 $142
$165 $223
$293 $382
N/A N/A
Contact a local agent
30 30
T T
N Y
180 180
Y Y
Y Y
Y Y
Y Y
Y Y
$45 $143
$59 $158
$90 $190
$143 $243
$223 $344
NA NA
1-800-775-6000
30 30
B B
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$43 $96
$54 $118
$80 $162
$145 $249
$277 $418
NA NA
1-877-582-6582
84 84
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$52 $164
$69 $187
$96 $222
$157 $313
$259 $450
N/A N/A
1-800-950-1962
90 90
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$38 $89
$50 $106
$72 $140
$116 $201
$192 $302
$310 $446
1-800-276-7619
90 90
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$35 $81
$48 $101
$65 $123
$96 $161
$191 $302
$287 $430
1-800-231-9150
90 90
B B
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$37 $101
$51 $122
$74 $156
$116 $213
$186 $305
$301 $451
1-800-819-2468
90 90
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$35 $87
$48 $108
$73 $145
$117 $206
$199 $318
$326 $489
* Company is authorized to sell Ohio Partnership policies
Benefit Period: 2 years / $100 Daily Benefit
Company
Combined Insurance combinedinsurance.com Form # 14785-OH Country Life countryfinancial.com Form # LTC500 Equitable Life & Casualty * equilife.com Form # 2020 Genworth Life * Form # 7042 Rev
Phone
1-800-999-2170
Elim Per 90 90
Tax T T
Inflation PreProtect Ex N 0 Y 0
Home Care Y Y
Day Care Y Y
Asstd Care Respite Living Giver Care Y Y Y Y Y Y
Monthly Premium for a Woman At Purchase Age
55
$33 $77
60
$49 $104
65
$74 $140
70
$119 $200
75
$202 $311
80
$347 $500
1-866-856-4760
90 90
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$43 $119
$55 $135
$84 $162
$140 $226
$227 $322
$342 $425
1-800-352-5170
90 90
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$35 $100
$48 $122
$70 $151
$102 $193
$157 $260
$238 $354
1-888-436-9678
90 90
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$42 $96
$59 $112
$88 $155
$140 $216
$243 $357
NA NA
Genworth Life * Form # 7044 Rev
1-888-436-9678
90 90
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$49 $113
$70 $130
$103 $183
$165 $253
$284 $419
NA NA
John Hancock Life * johnhancocklongtermcare.com Form # LTC-03-OH LifeSecure * (2.8-year period) yourlifesecure.com Form # LS-0002 Massachusetts Mutual * massmutual.com Form # MM500-P-OH MedAmerica Insurance * medamericaLTC.com Form # SPL2-336-OH
1-800-377-7311
90 90
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$36 $56
$51 $79
$74 $107
$119 $168
$208 $279
$358 $447
1-866-582-7702
90 90
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$53 $97
$70 $120
$101 $159
$175 $249
$324 $422
$442 $530
1-800-272-2216
90 90
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$35 $84
$48 $106
$70 $138
$114 $199
$197 $310
$279 $420
1-800-554-0327
90 90
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$64 $200
$92 $240
$137 $299
$202 $374
$353 $554
$504 $688
31
* Company is authorized to sell Ohio Partnership policies
32
Benefit Period: 2 years / $100 Daily Benefit
Company
Minnesota Life * minnesotalife.com Form # ML7500P-OH Mutual of Omaha * mutualofomaha.com Form # LTC04I Prudential Insurance * prudential.com Form # GRP 113308 State Farm Mutual Auto * statefarm.com Forms # 97060 / 97061 United of Omaha * mutualofomaha.com t l f h Form # LTC 06UI United Teacher Assocs. utainteractive.com
Form # LTC-020201-UTA-TQ-OH
Phone
1-888-505-9817
Elim Per 90 90
Tax T T
Inflation PreProtect Ex N 0 Y 0
Home Care Y Y
Day Care Y Y
Asstd Care Respite Living Giver Care Y Y Y Y Y Y
Monthly Premium for a Woman At Purchase Age
55
$33 $87
60
$44 $104
65
$67 $133
70
$102 $174
75
$186 $280
80
$289 $418
1-800-775-6000
90 90
B B
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$42 $92
$52 $112
$78 $155
$140 $237
$269 $398
NA NA
1-800-732-0416
90 90
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$43 $68
$54 $84
$79 $114
$132 $178
$235 $305
NA NA
Contact a local agent
90 90
T T
N Y
180 180
Y Y
Y Y
Y Y
Y Y
Y Y
$37 $118
$49 $130
$74 $157
$121 $204
$193 $302
NA NA
1-800-775-6000
90 90
B B
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$35 $77
$43 $94
$64 $130
$116 $199
$222 $335
NA NA
1-800-880-8824
90 90
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$25 $80
$34 $96
$50 $120
$76 $162
$134 $233
NA NA
Great American Life * gafri.com Form # 4LTCIP0002-OH National States Form # PAL-1(02)R
1-866-830-0607
100 100
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$27 $77
$34 $86
$47 $102
$74 $135
$125 $196
$212 $297
1-800-868-6788
100 100
B B
N Y
180 180
A A
Y Y
Y Y
N N
Y Y
$14 $36
$22 $47
$29 $60
$50 $84
$86 $127
$153 $202
Physicians Mutual * physiciansmutual.com Form # P146 Northwestern LTC * (6-year period) nmfn.com Form # RS.LTC.(0708)
1-800-645-4300
100 100
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$35 $82
$47 $102
$69 $131
$111 $191
$196 $304
$286 $415
1-877-582-6582
175 175
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$47 $149
$63 $170
$87 $202
$142 $285
$236 $409
NA NA
* Company is authorized to sell Ohio Partnership policies
Benefit Period: 4 years / $100 Daily Benefit
Company
Assurity Life * assurity.com Form # AL2100P-OH Bankers Life and Casualty * bankerslife.com Form # GR-N550 Berkshire Life * theberkshire.com Form # 71714 Equitable Life & Casualty * equilife.com Form # 2020 Great American Life * gafri.com Form # 4LTCIP0002-OH Minnesota Life * (5-year period) minnesotalife.com Form # ML7500P-OH Mutual of Omaha * mutualofomaha.com Form # LTC04I National States Form # PAL-1(02)R
Phone
1-800-276-7619
Elim Per 0 0
Tax T T
Inflation PreProtect Ex N 0 Y 0
Home Care Y Y
Day Care Y Y
Asstd Care Respite Living Giver Care Y Y Y Y Y Y
Monthly Premium for a Woman At Purchase Age
55
$69 $162
60
$95 $200
65
$129 $244
70
$190 $319
75
$380 $600
80
$570 $855
1-800-231-9150
0 0
B B
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$70 $199
$98 $242
$142 $310
$226 $428
$366 $621
$606 $933
1-800-819-2468
0 0
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$53 $133
$74 $167
$112 $224
$181 $316
$305 $489
$501 $751
1-800-352-5170
0 0
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$56 $169
$78 $208
$116 $259
$174 $338
$281 $469
$446 $664
1-866-830-0607
0 0
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$56 $157
$69 $176
$97 $211
$153 $278
$257 $403
NA NA
1-888-505-9817
0 0
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$72 $187
$96 $226
$144 $288
$221 $376
$403 $605
$624 $905
1-800-775-6000
0 0
B B
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$74 $160
$92 $197
$136 $272
$237 $400
$475 $702
NA NA
1-800-868-6788
0 0
B B
N Y
180 180
A A
Y Y
Y Y
N N
Y Y
$29 $75
$43 $98
$59 $121
$100 $177
$175 $271
$318 $439
Physicians Mutual * physiciansmutual.com Form # P146
1-800-645-4300
0 0
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$66 $154
$90 $193
$130 $248
$210 $359
$370 $574
$540 $783
33
* Company is authorized to sell Ohio Partnership policies
34
Benefit Period: 4 years / $100 Daily Benefit
Company
United Teacher Assocs. utainteractive.com
Form # LTC-020201-UTA-TQ-OH
Phone
1-800-880-8824
Elim Per 0 0
Tax T T
Inflation PreProtect Ex N 0 Y 0
Home Care Y Y
Day Care Y Y
Asstd Care Respite Living Giver Care Y Y Y Y Y Y
Monthly Premium for a Woman At Purchase Age
55
$39 $127
60
$57 $158
65
$81 $195
70
$125 $265
75
$221 $385
80
NA NA
Allianz Life * allianzlife.com Form # 11-P-Q-OH Combined Insurance combinedinsurance.com Form # 14785-OH Country Life countryfinancial.com Form # LTC500 Genworth Life * Form # 7042 Rev
1-800-950-1962
7 7
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$62 $145
$81 $173
$120 $233
$196 $340
$328 $515
$520 $749
1-800-999-2170
30 30
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$50 $117
$74 $158
$116 $221
$188 $315
$328 $504
$545 $785
1-866-856-4760
30 30
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$65 $188
$85 $214
$131 $256
$219 $363
$359 $520
$537 $680
1-888-436-9678
30 30
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$76 $164
$102 $199
$143 $268
$237 $387
$426 $642
NA NA
Genworth Life * Form # 7044 Rev
1-888-436-9678
30 30
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$81 $176
$108 $213
$154 $288
$254 $416
$456 $690
NA NA
John Hancock Life * johnhancocklongtermcare.com Form # LTC-03-OH Massachusetts Mutual * massmutual.com Form # MM500-P-OH MedAmerica Insurance * medamericaLTC.com Form # SPL2-336-OH
1-800-377-7311
30 30
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$64 $107
$85 $143
$122 $186
$201 $298
$350 $499
NA NA
1-800-272-2216
30 30
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$56 $137
$78 $173
$114 $226
$186 $326
$322 $507
$457 $688
1-800-554-0327
30 30
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$106 $342
$151 $410
$225 $512
$332 $641
$587 $957
$841 $1,193
* Company is authorized to sell Ohio Partnership policies
Benefit Period: 4 years / $100 Daily Benefit
Company
Prudential Insurance * prudential.com Form # GRP 113308 State Farm Mutual Auto * statefarm.com Forms # 97060 / 97061 United of Omaha * mutualofomaha.com Form # LTC 06UI Northwestern LTC * (6-year period) nmfn.com Form # RS.LTC.(0708) Allianz Life * allianzlife.com Form # 11-P-Q-OH Assurity Life * assurity.com Form # AL2100P-OH Bankers Life and Casualty * bankerslife.com Form # GR-N550 Berkshire Life * theberkshire.com Form # 71714 Combined Insurance combinedinsurance.com Form # 14785-OH
Phone
1-800-732-0416
Elim Per 30 30
Tax T T
Inflation PreProtect Ex N 0 Y 0
Home Care Y Y
Day Care Y Y
Asstd Care Respite Living Giver Care Y Y Y Y Y Y
Monthly Premium for a Woman At Purchase Age
55
$69 $109
60
$87 $135
65
$127 $183
70
$213 $287
75
$378 $492
80
N/A N/A
Contact a local agent
30 30
T T
N Y
180 180
Y Y
Y Y
Y Y
Y Y
Y Y
$66 $205
$94 $215
$135 $259
$240 $386
$402 $599
NA NA
1-800-775-6000
30 30
B B
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$61 $136
$77 $167
$114 $231
$197 $339
$395 $597
NA NA
1-877-582-6582
84 84
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$62 $204
$83 $232
$115 $275
$188 $386
$311 $553
N/A N/A
1-800-950-1962
90 90
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$48 $111
$63 $133
$92 $179
$151 $262
$252 $396
$400 $576
1-800-276-7619
90 90
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$49 $116
$68 $143
$92 $174
$136 $228
$271 $428
$407 $610
1-800-231-9150
90 90
B B
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$54 $154
$76 $186
$110 $239
$174 $330
$282 $478
$467 $718
1-800-819-2468
90 90
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$41 $102
$57 $128
$86 $172
$139 $243
$235 $376
$385 $578
1-800-999-2170
90 90
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$44 $103
$65 $139
$102 $194
$165 $276
$287 $442
$478 $689
35
* Company is authorized to sell Ohio Partnership policies
Benefit Period: 4 years / $100 Daily Benefit
36
Company
Country Life countryfinancial.com Form # LTC500 Equitable Life & Casualty * equilife.com Form # 2020 Genworth Life * Form # 7042 Rev
Phone
1-866-856-4760
Elim Per 90 90
Tax T T
Inflation PreProtect Ex N 0 Y 0
Home Care Y Y
Day Care Y Y
Asstd Care Respite Living Giver Care Y Y Y Y Y Y
Monthly Premium for a Woman At Purchase Age
55
$56 $161
60
$73 $183
65
$112 $219
70
$187 $310
75
$307 $445
80
$459 $581
1-800-352-5170
90 90
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$46 $137
$63 $167
$92 $207
$136 $266
$212 $361
$324 $493
1-888-436-9678
90 90
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$63 $137
$85 $166
$120 $223
$197 $322
$355 $535
NA NA
Genworth Life * Form # 7044 Rev
1-888-436-9678
90 90
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$73 $159
$100 $194
$140 $260
$230 $376
$416 $627
NA NA
John Hancock Life * johnhancocklongtermcare.com Form # LTC-03-OH LifeSecure * (4.2-year period) yourlifesecure.com Form # LS-0002 Massachusetts Mutual * massmutual.com Form # MM500-P-OH MedAmerica Insurance * medamericaLTC.com Form # SPL2-336-OH Minnesota Life * minnesotalife.com Form # ML7500P-OH
1-800-377-7311
90 90
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$53 $89
$71 $119
$102 $155
$168 $249
$292 $416
$358 $447
1-866-582-7702
90 90
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$60 $111
$81 $138
$117 $183
$204 $289
$380 $494
$516 $619
1-800-272-2216
90 90
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$47 $115
$65 $144
$95 $189
$155 $272
$268 $423
$381 $573
1-800-554-0327
90 90
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$92 $297
$131 $357
$196 $445
$289 $558
$511 $833
$731 $1,037
1-888-505-9817
90 90
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$51 $134
$69 $161
$103 $206
$158 $268
$288 $432
$446 $647
* Company is authorized to sell Ohio Partnership policies
Benefit Period: 4 years / $100 Daily Benefit
Company
Minnesota Life * minnesotalife.com Form # ML7500P-OH Mutual of Omaha * mutualofomaha.com Form # LTC04I Prudential Insurance * prudential.com Form # GRP 113308 State Farm Mutual Auto * statefarm.com Forms # 97060 / 97061 United of Omaha * mutualofomaha.com t l f h Form # LTC 06UI United Teacher Assocs. utainteractive.com
Form # LTC-020201-UTA-TQ-OH
Phone
1-888-505-9817
Elim Per 90 90
Tax T T
Inflation PreProtect Ex N 0 Y 0
Home Care Y Y
Day Care Y Y
Asstd Care Respite Living Giver Care Y Y Y Y Y Y
Monthly Premium for a Woman At Purchase Age
55
$51 $134
60
$69 $161
65
$103 $206
70
$158 $268
75
$288 $432
80
$446 $647
1-800-775-6000
90 90
B B
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$53 $114
$66 $140
$97 $194
$169 $286
$339 $502
NA NA
1-800-732-0416
90 90
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$55 $87
$70 $108
$102 $146
$170 $230
$302 $393
NA NA
Contact a local agent
90 90
T T
N Y
180 180
Y Y
Y Y
Y Y
Y Y
Y Y
$58 $170
$83 $178
$120 $221
$214 $343
$355 $534
NA NA
1-800-775-6000
90 90
B B
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$49 $109
$61 $133
$91 $185
$158 $271
$316 $477
NA NA
1-800-880-8824
90 90
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$33 $106
$47 $132
$67 $163
$105 $222
$185 $322
NA NA
Great American Life * gafri.com Form # 4LTCIP0002-OH National States Form # PAL-1(02)R
1-866-830-0607
100 100
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$37 $106
$46 $119
$65 $141
$102 $186
$172 $271
$293 $410
1-800-868-6788
100 100
B B
N Y
180 180
A A
Y Y
Y Y
N N
Y Y
$22 $57
$33 $76
$45 $92
$76 $135
$133 $205
$239 $328
Physicians Mutual * physiciansmutual.com Form # P146 Northwestern LTC * (6-year period) nmfn.com Form # RS.LTC.(0708)
1-800-645-4300
100 100
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$47 $110
$64 $138
$93 $177
$150 $257
$264 $410
$386 $559
1-877-582-6582
175 175
T T
N Y
0 0
Y Y
Y Y
Y Y
Y Y
Y Y
$56 $185
$75 $211
$105 $250
$171 $351
$283 $503
NA NA
37
* Company is authorized to sell Ohio Partnership policies
Monthly premiums for sample home health policies
Benefit Period: 1 years / $50 Daily Benefit
Monthly Premium for a Woman At Purchase Age
38
Company
Bankers Life and Casualty * bankerslife.com Form # GR-N550 Equitable Life & Casualty * equilife.com Form # 820 National States Form # HHC-1(02)R Physicians Mutual * physicians.mutual.com Form # P147 Bankers Life and Casualty * bankerslife.com Form # GR-N500 Equitable Life & Casualty equilife.com Form # 820 Physicians Mutual * physicians.mutual.com Form # P147
Phone
1-800-231-9150
Elim Period 0 0
Tax B B
Inflation Pre- Respite Day Protect Ex Care Care N Y 0 0 Y Y Y Y
55 $11 $24
60 $14 $28
65 $19 $35
70 $27 $44
75 $37 $55
80 NA NA
1-800-352-5170
0 0
N N
N Y
0 0
Y Y
Y Y
$18 $40
$28 $54
$42 $69
$58 $86
$80 $108
$113 $140
1-800-868-6788
0 0
B B T T
N Y N Y
180 180 0 0
N N Y Y
Y Y Y Y
$5 $12 $11 $27
$8 $16 $15 $35
$10 $21 $22 $44
$15 $28 $35 $64
$24 $42 $62 $103
$39 $57 $90 $140
1-800-645-4300
0 0
1-800-231-9150
90 90
B B
N Y
0 0
Y Y
Y Y
$8 $18
$10 $21
$14 $25
$20 $32
$27 $40
$37 $50
1-800-352-5170
90 90
N N
N Y
0 0
Y Y
Y Y
$12 $28
$20 $37
$29 $48
$42 $61
$57 $77
$81 $100
1-800-645-4300
100 100
T T
N Y
0 0
Y Y
Y Y
$8 $20
$11 $25
$15 $32
$25 $46
$44 $74
$65 $100
* Company is authorized to sell Ohio Partnership policies
39
LTC insurance consumer complaints
ODI & complaints
• If your issue requires follow up with the company, we’ll send you a complaint form and instructions for filing a written complaint. • We generally will send the company a copy of your complaint and ask them to resolve it or explain their side of the story. • By law, companies must respond to the Department of Insurance — most companies do so in a timely manner. • We will review all the facts to make sure the company has upheld its contract with you and has followed insurance rules and laws.
Try solving the dispute yourself
Insurance is a very competitive business. If you give the company a chance, you will generally find folks are willing if not eager to straighten out problems. • Start with the agent. • If not satisfied, contact the company’s customer service office; most likely it’s a toll-free number. • If customer service falls short of your expectations, ask to speak with a supervisor about the company’s procedures for appealing decisions.
If you’re still not satisfied, call the Ohio Department of Insurance
If your self-help efforts fail, your next stop should be the Consumer Services Division of the Ohio Department of Insurance (ODI).
Counting complaints
Call toll-free: 1-800-686-1526
In 2007, ODI received a total of 97 complaints about long-term care insurance. • If your complaint raises questions that cause us to contact the agent or company, we will register it in our computer as a “complaint.” • A complaint means a customer has been unhappy with the company or agent. • It does not necessarily mean the law has been broken or that anyone did anything wrong.
• Ask to speak with a long-term care insurance analyst. • The analyst will answer questions over the phone and explain any additional steps you should take to resolve your own problem. • Our staff will give you honest, unbiased answers — if it sounds as if the company has done nothing wrong, we’ll tell you.
Company complaint records — 2007
to file a consumer complaint.
Click here
The next page shows complaint records for LTC insurance companies. The “complaint ratio” column can help you make apples-toapples comparisons. Complaint ratio example: if a company's complaint ratio is 1.0, it had one complaint for every $1 million in written premium, so the lower a complaint ratio the better.
Insurance dispute tip
Provide complete, correct information to your insurance company and file your claims as soon as possible in order to avoid delays.
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2007 Long-Term Care Insurance Complaint Statistics
Total number: In 2007, consumer complaints on long-term care insurance received by the Ohio Department of Insurance... Total number: In 2007, authorized companies that wrote long-term care insurance premiums in Ohio... Total number: In 2007, authorized companies having long-term care insurance complaints... Total number: In 2007, complaints about long-term care insurance involving authorized companies… Total number: In 2007, long-term care companies that had at least one complaint and wrote premium that year…
97
101
29
95
26
Top 10 Reasons for Long-Term Care Insurance Complaints in 2007
Reason Complaints 1. Premium amount, rating or increase issues 29 2. Claim payment / settlement delay 23 3. Denial of claim 12 4. Premium refund due, but not paid 8 5. Coverage / policy cancellation or non-renewal 4 6. Abusive service 4 7. Marketing / sales misrepresentation 3 8. Premium notice / billing 3 9. Coverage questions / disagreement 3 10. Non-Forfeiture issues 2 >> Total complaints represented by the above Top 10 reasons = 91 >> Represents 94% of the 97 total long-term care insurance complaint reasons registered in 2007
2007 Long-Term Care Insurance Complaint Ratios
Notes: Includes every company that received written premium and at least one long-term care complaint in 2007 Market Share is the company's percentage of Ohio's total written long-term care premium in 2007 Complaint Ratio is a comparison of the company's written long-term care premium and complaints in 2007
Long-Term Care Insurers
(in alphabetical order) Aetna Life Ins Co AIG Sunamerica Life Assur Co Bankers Life & Cas Co Cincinnati Life Ins Co Conseco Senior Hlth Ins Co Continental Cas Co John Alden Life Ins Co John Hancock Life Ins Co Life Investors Ins Co Of America Lincoln Benefit Life Co Medamerica Ins Co Medico Life Ins Co Metropolitan Life Ins Co Mutual Of Omaha Ins Co National States Ins Co Penn Treaty Network America Ins Co Pennsylvania Life Ins Co Principal Life Ins Co Prudential Ins Co Of America RiverSource Life Ins Co Stonebridge Life Ins Co Transamerica Life Ins Co Transamerica Occidental Life Ins Co United American Ins Co Unum Life Ins Co Of America Washington National Ins Co Total Above LTC Carriers / 2007 All Ohio LTC Carriers / 2007 Total Above LTC Carriers / 2007 % All
Ohio Written LTC Premium
24,343,347 936,592 13,202,997 793,464 11,963,648 22,116,628 1,106,883 32,358,986 2,995,078 3,239,641 1,443,691 764,479 28,118,001 3,489,438 3,520,341 7,125,240 4,340,774 245,430 4,404,446 12,304,602 1,111,550 2,638,020 2,681,937 929,295 18,016,210 598,786 $204,789,504 $361,497,147 56.7%
Ohio Market Share
6.7% 0.3% 3.7% 0.2% 3.3% 6.1% 0.3% 9.0% 0.8% 0.9% 0.4% 0.2% 7.8% 1.0% 1.0% 2.0% 1.2% 0.1% 1.2% 3.4% 0.3% 0.7% 0.7% 0.3% 5.0% 0.2% 56.7% 100.0%
Complaint Ratio
0.16 1.07 0.53 1.26 3.18 0.18 0.90 0.12 1.00 0.31 0.69 1.31 0.07 0.57 0.85 0.14 0.23 4.07 0.23 0.16 0.90 0.38 1.12 2.15 0.17 3.34 0.44 0.27
Total Complaints
4 1 7 1 38 4 1 4 3 1 1 1 2 2 3 1 1 1 1 2 1 1 3 2 3 2 91 97 93.8%
Long-term care insurance shopping list
Policy features and benefits
Price: How much would you pay each month or year? Daily benefit limits: How much will policy pay for each day of care? (See page 115.) Nursing home
Company
Company
Company
Your Current Policy
$
$
$
$
Home health care Adult day care Assisted living
Inflation protection: How will the benefit keep up with inflation? (See page 15.) Benefit period: How many years will the policy pay? (See page 15.)
What will the daily benefit be 10 years from now? Nursing home Home health care Adult day care Assisted living
Elimination period: How many days would you have to pay your own long-term care bills before the policy started paying? (See page 15.) What is the maximum lifetime benefit ($$$)?
Nursing home Home health care Adult day care Assisted living
Home health care coverage (See page 14.)
What qualifies you for benefits? (See pages 19-20..)
Doctor’s certification Inability to perform activities of daily living (ADLs) Prior hospital stay (Home care) Prior hospital stay (Nursing home)
NO
NO
NO
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Pre-existing condition waiting period in months (See page 18.)
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Health screening: Can the company reject you due to poor health? Exclusions: What’s not covered? (See page 18.)
Alzheimer’s (Not a legal exclusion in policies sold today.) Mental or nervous disorder Others
Miscellaneous benefits (See pages 16-17.)
Respite Care Nonforfeiture Death benefit Restoration of benefits Discount when both husband and wife buy Others
The company
How long has it been selling LTC insurance? Is it licensed to sell in Ohio? (Every company in this guide is Ohio-licensed) Do you know anyone who has bought LTC insurance from this company?
Current cost of long-term care in your area
Nursing home daily charge (Name) (Name) Home health care agency daily charge (Name) (Name) $ $
Choose a company carefully
It’s natural to look for the company with the lowest price, but the least expensive policy may not be the best choice. Here’s why: • Insurance companies need to collect enough in premiums to process and pay claims plus make a profit. If the policies are priced too low now, premiums would likely increase in the future. • Your policy cannot be cancelled as long as you keep paying premiums, even if the company stops selling LTC insurance to new customers. But with no new customers and existing customers starting to file claims, your premium would likely increase.
$ $
Glossary of LTC insurance terms
Accelerated death benefit A feature of some life insurance policies which permits you to use the money before you die to pay for long-term care expenses. Activities of daily living (ADL) Many LTC policies start paying benefits when you are no longer able to perform basic actions without help. These actions are called activities of daily living. Adult day care Care that is typically provided during daytime hours in a local senior or community center. Benefit period The length of time a policy will pay for services. It is usually described in years (one year, two years, etc.). A policy with a “lifetime” benefit period does not limit the number of years it will pay, but it may limit the total amount of dollars it will pay. Benefit trigger The medical condition that qualifies you to begin receiving benefits from the policy. Care management Most insurance companies will have a system for reviewing your medical records and verifying what kind of care you need. The company may contract with a separate “care management” organization.
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Cognitive impairment An inability to take care of yourself as a result of loss of memory or some other mental deterioration. This includes such diseases as Alzheimer’s and Parkinson’s. Contingent benefit upon lapse Ohio law requires this provision to be included in every LTC policy for which the policy owner has declined the nonforfeiture benefit offer. The provision protects the owner in the event of very large increases in premium over the life of the contract. Daily benefit The maximum amount the policy will pay for each day of care. Elimination (deductible) period The number of days you have to pay nursing home bills from your own pocket before the LTC policy starts to pay. Some policies call this the “elimination” period. Others call it the “deductible” period. Free-look period The first 30 days after you receive a new policy. During this period you can cancel for any reason and receive a full refund. Guaranteed renewable You have the right to renew your LTC policy for life, as long as you pay the premiums. The company cannot change the benefits. It can, however, increase premiums for all policies at the same time. Also see noncancellable. Inflation protection A provision in a long-term care policy that permits benefits to increase in the future. There are different kinds and levels of inflation protection.
How does the company define LTC terms?
This glossary gives the most common meanings for LTC words and phrases. Your insurance company may define the terms differently. Read the policy’s definitions section and ask questions about anything you don’t understand.
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Level of care Long-term care is divided into three levels, determined by how much assistance you need. • Skilled care Daily care provided by a nurse or therapist under a doctor’s supervision. Skilled care usually lasts for relatively short periods. • Intermediate care Occasional nursing & rehabilitative care, supervised by medical professionals. It is less specialized than skilled care and often continues much longer. • Custodial care Help with your daily activities (eating, dressing, bathing, etc.). Custodial care does not require medical personnel. Much of nursing home care is custodial. If you need care, this is the most likely level. Noncancellable You have the right to renew your LTC policy for life, as long as you pay the premiums. The company cannot change the benefits or increase premiums. Also see guaranteed renewable. Nonforfeiture Nonforfeiture guarantees you will receive something (such as limited benefits or a return of premium) if you cancel the policy or the company cancels because your payments stop. This feature usually increases the policy premium. Ohio requires every company selling long-term care insurance to offer the nonforfeiture option. Outline of coverage A summary of a policy’s benefits and limitations which is intended to make it easier to understand the policy and compare it with other policies. Pre-existing condition A medical condition which was treated or diagnosed in the six months before you bought the policy. If you need care due to a pre-existing condition, and the care begins during the waiting period, some policies will not pay the claim. Reinstatement A provision to protect you against unintentional (accidental) lapse. Required by Ohio law, reinstatement lets you save your policy from cancellation if you miss payments because of mental impairment (such as Alzheimer’s, senility, etc.). Spend down A process by which you become eligible for Medicaid by using your own money to pay medical bills until you reach the eligible income limits. Your total assets must already qualify under Medicaid rules for spend down to apply. Waiver of premium A “waiver of premium” lets you stop paying premiums once you’re receiving long-term care. It may not take effect until the policy has paid your bills for as long as three months. This is a common, built-in feature of LTC policies.
Please note: your premium is likely to go up!
Unless the policy is labeled “noncancellable,” the insurance company may raise your premium in the future. Ohio law requires the Department of Insurance to approve any rate increase as long as the company can show that more premiums are needed to pay claims.
OSHIIP is the Ohio Senior Health Insurance Information Program
Since 1992, OSHIIP has provided people on Medicare with free and objective health insurance information and oneon-one insurance counseling. A program under the Ohio Department of Insurance, OSHIIP is funded by the state and a grant from the federal Centers for Medicare and Medicaid Services (CMS). OSHIIP staff — along with approximately 600 trained volunteers who live in all parts of our state — educate consumers about Medicare, Medicare supplement insurance policies, Medicare Advantage plans, Medicare prescription drug plans, certain Medicaid issues, long-term care insurance and other health insurance matters.
OSHIIP Counselors can help you:
• Understand how long-term care insurance policies work • Make sense of terms and phrases used in longterm care and LTC insurance • Explain other options you may have to pay for long-term care • Provide counseling and information on health insurance issues for people on Medicare
Want to be an OSHIIP Counselor?
• New volunteers are always needed and welcome. • OSHIIP has sites in most Ohio counties. Call us about training classes • Contact us if you want OSHIIP in your area. You may know of an organization that could serve as a sponsor.
Toll-free 1-800-686-1578 (7:30 a.m. - 5:00 p.m. Monday - Friday) Fax (614) 752-0740 Internet: www.ohioinsurance.gov Email: oshiipmail@ins.state.oh.us
To request consumer publications or ask questions about insurance, please call the Ohio Department of Insurance consumer lines: Medicare issues... 1-800-686-1578 Other types of insurance...1- 800-686-1526 Fax (614) 752-0740 For many Department services and publication updates, please visit our web site... www.ohioinsurance.gov
The Ohio Department of Insurance is an Equal Opportunity Employer. December 2008
50 W. Town Street — Suite 300 Columbus, Ohio 43215
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