LTC: Daily Benefit Vs Monthly Benefit

[Arthur Rudnick]

oozo,
As stated many posts ago, you need to sit with your agent and go over all of your questions & concerns.

Every company offers different policies and different benefits. Keep in mind that if down the road you ever need care, you'll wish that you purchased the best policy available.

 

[Chuckles21]

Chuckles gives this example:


For this hypothetical 30 day month on 20 of those days your care costs $150/day and the other 10 days it costs $300/day due to special treatments happening those days. For those 10 days the client will owe $100/day out of pocket.



... but it's ridiculous.

why would anyone's care at home cost $150 per day 20 days of the month and $300 per day 10 days per month.

That's absurd. TWICE the cost for every third day of care??? That's absolutely ridiculuous.

So you're saying that it's ridiculous that every third day this person may need special medical treatment such as shots or tests that they don't need the other two days? For the days that cost $150 maybe all they need is help eating, dressing, bathing, etc. which means they don't need a specialized medical professional there. Now on the $300 days maybe they do need a medical professional to do what i stated above increasing the cost.

I literally just thought of this example in 30 seconds so tell me if this is completely off thinking, but it makes sense in my mind.

Also say you have a $150/day benefit and do only need care 10 days that month but that care every day costs $200/day. Monthly covers the whole bill, daily is $500 out of pocket. So no fluctuation in what the days cost but they are costing more than your daily covers.

 

[Mr_Ed]

So you're saying that it's ridiculous that every third day this person may need special medical treatment such as shots or tests that they don't need the other two days? For the days that cost $150 maybe all they need is help eating, dressing, bathing, etc. which means they don't need a specialized medical professional there. Now on the $300 days maybe they do need a medical professional to do what i stated above increasing the cost.

I literally just thought of this example in 30 seconds so tell me if this is completely off thinking, but it makes sense in my mind.

Also say you have a $150/day benefit and do only need care 10 days that month but that care every day costs $200/day. Monthly covers the whole bill, daily is $500 out of pocket. So no fluctuation in what the days cost but they are costing more than your daily covers.

a) why would anyone ever need care for only 10 days in one month? (except for possibly the very first or very last month they need care.)

b) if I need shots or medical treatment or physical therapy or speech therapy, why would I charge that to my long-term care insurance company. Why not charge that to my medical insurance policy?

mrsed.

 

[yankee466]

a) why would anyone ever need care for only 10 days in one month? (except for possibly the very first or very last month they need care.)

b) if I need shots or medical treatment or physical therapy or speech therapy, why would I charge that to my long-term care insurance company. Why not charge that to my medical insurance policy?

mrsed.

How about if, after major cuts to Medicare and because you are now over 80 and the government says it is not worth helping you with expensive therapy, or no more than 5 visits and you are done....so you decide to use your LTC policy to pay for the rehab that Medicare used to pay for. How about if, since you are wealthy, you now have a $10,000 Part B deductible, instead of $140, and you want to use your LTC plan to pay for this stuff? Maybe your MAPD plan, if they still exist, will have a $300 co-pay for home rehab.

Just like we don't know what LTCi will look like in 20-30 years, neither do we know what will be available via Medicare coverage. Maybe the vouchers won't work so well?

Else, I really only sell monthly plans unless the client is penny pinching,...and if they are penny pinching, maybe LTC is not that appropriate.

 

[Arthur Rudnick]

previously posted by yankee466

I really only sell monthly plans unless the client is penny pinching,...and if they are penny pinching, maybe LTC is not that appropriate.

Agreed, and for whatever it's worth, I've always thought a monthly benefit is the way to, even @ 6% more.

Mutual of Omaha & MedAmerica offers a monthly benefit within their base policy at no additional premium.

There's no downside on a monthly benefit other than additional premium, but at $3,000/yr, it's only another $180. IMO, well worth it.

 

[Chuckles21]

a) why would anyone ever need care for only 10 days in one month? (except for possibly the very first or very last month they need care.)

b) if I need shots or medical treatment or physical therapy or speech therapy, why would I charge that to my long-term care insurance company. Why not charge that to my medical insurance policy?

mrsed.

Someone does not usually one day go from living on their own to all of a sudden needing care 24/7. This usually comes around gradually and care may not be needed every day. I don't understand why you can't grasp this concept. If we are talking nursing home it's different but I'm talking at home care where the majority of people would like to receive it.

Also since when will Medicare cover Long Term Care? How many seniors do you know that carry private health insurance? Medicare only covers acute care not custodial care. So if the medical treatments needed are only to keep the person going and not to heal them, your out of luck for Medicare covering it. Again, I am far from the most educated on this subject, but it seems you know even less yet have more of an opinion.

just my 2 cents.

 

[Mr_Ed]

Someone does not usually one day go from living on their own to all of a sudden needing care 24/7. This usually comes around gradually and care may not be needed every day. I don't understand why you can't grasp this concept. If we are talking nursing home it's different but I'm talking at home care where the majority of people would like to receive it.

Also since when will Medicare cover Long Term Care? How many seniors do you know that carry private health insurance? Medicare only covers acute care not custodial care. So if the medical treatments needed are only to keep the person going and not to heal them, your out of luck for Medicare covering it. Again, I am far from the most educated on this subject, but it seems you know even less yet have more of an opinion.

just my 2 cents.

if someone does not need care every day, they probably won't qualify for benefits under any tax qualified LTCi policy.

they are called "activities of DAILY living" for a reason.

the idea that someone might need care at home only 2 or 3 days per week, at the early stages of their care, is ludicrous.

someone may only need need to bathe 3x per week, but just needing help with bathing won't trigger any benefits of any LTCi policy.

Every other activity IS DAILY: eating, dressing, toileting, transferring, maintaining continence.

that is why I said in an earlier post that the monthly benefit is usually most helpful if someone is going to get "free care" from a relative at least 5 or 6 days per month.

You can't qualify for one of these policies and only need care 2 or 3 times per week.

Regarding your last point, your understanding of what Medicare pays for is lacking.

 

[oozo]

oozo,
As stated many posts ago, you need to sit with your agent and go over all of your questions & concerns.

Every company offers different policies and different benefits. Keep in mind that if down the road you ever need care, you'll wish that you purchased the best policy available.

I know....I am talking with several agents and get various answers...not sure if the agents are good "salesmen" or if they really care about me. Still in that phase - trying to pick an agent.

 

[scagnt83]

Monthly is all I sell. For reasons similar to what Chuckles said.


I have real life experience with someone needing more care on certain days. And it happens often, especially with home care.

- Before my grandmother died of cancer, she required in home care on a daily basis for 8 months. (not hospice, but traditional in home ltc)

- But in addition to that, she had a separate nurse who came 3 days per week to do special treatments. This separate nurse cost double what the regular daily one did (on a daily basis).

She had no LTCI, but those 3 days the separate nurse came could have easily put her over a daily benefit limit.


No two LTC needs are the same. And there is no way to know what your exact need might be.
The monthly benefit gives greater flexibility. And for an unknown financial need, wouldnt you want the most flexibility possible?


There are many different forms of LTC care and many different reasons for it. Imo, you want the greatest flexibility possible for your budget. The monthly benefit gives you that.



Also, think about this:
The greater the benefit/protection; the more the insurance company charges.
There is a reason the daily benefit is cheaper... because it is not as comprehensive. Why else would daily be 6% cheaper than monthly?

After you logistically think it through, the extra 6% should be a no brainer.

 

[Mr_Ed]

Monthly is all I sell. For reasons similar to what Chuckles said.


I have real life experience with someone needing more care on certain days. And it happens often, especially with home care.

- Before my grandmother died of cancer, she required in home care on a daily basis for 8 months. (not hospice, but traditional in home ltc)

- But in addition to that, she had a separate nurse who came 3 days per week to do special treatments. This separate nurse cost double what the regular daily one did (on a daily basis).

She had no LTCI, but those 3 days the separate nurse came could have easily put her over a daily benefit limit.


No two LTC needs are the same. And there is no way to know what your exact need might be.
The monthly benefit gives greater flexibility. And for an unknown financial need, wouldnt you want the most flexibility possible?


There are many different forms of LTC care and many different reasons for it. Imo, you want the greatest flexibility possible for your budget. The monthly benefit gives you that.



Also, think about this:
The greater the benefit/protection; the more the insurance company charges.
There is a reason the daily benefit is cheaper... because it is not as comprehensive. Why else would daily be 6% cheaper than monthly?

After you logistically think it through, the extra 6% should be a no brainer.

It's no wonder that consumers are confused when insurance agents don't even understand the basics of Medicare and how Medicare home healthcare benefits coordinate with LTCi policies.



Medicare pays for rehabilitative home health care services (what you refer to as "special treatments".)

Medicare pays for:

Skilled nursing services are given by either a registered nurse (RN) or a licensed practical nurse (LPN). Examples of skilled nursing care include: giving IV drugs, shots, or tube feedings; changing dressings; and teaching about prescription drugs or diabetes care. Any service that could be done safely by a non-medical person (or by yourself) without the supervision of a nurse, isn't skilled nursing care.

Physical therapy, occupational therapy, and speech-language pathology services.

Note: The home health agency is responsible for meeting all your medical, nursing, rehabilitative, social, and discharge planning needs, as reflected in your home health plan of care. See page 19. This includes skilled therapy services for a condition that may not be the primary reason for getting home health services. Home health agencies are required to perform a comprehensive assessment of each of your care needs when you're admitted to the home health agency, and communicate those needs to the doctor responsible for the plan of care. After that, home health agencies are required to routinely assess your needs.



What isn't covered?
Below are some examples of what Medicare doesn't pay for:
24-hour-a-day care at home. ■■
Meals delivered to your home. ■■
Homemaker services like shopping, cleaning, and laundry when this ■■is the only care you need, and when these services aren't related to your plan of care. See page 19.
Personal care given by home health aides like bathing, dressing, and ■■using the bathroom when this is the only care you need.

http://www.medicare.gov/Pubs/pdf/10969.pdf




Someone mentioned that being an insurance agent is like being a doctor or an accountant or a mechanic--people come to you for advice and to fix the problem they have..

If someone doesn't even understand the basics of what Medicare covers, how the heck can he/she explain how long-term care insurance works!

Not understanding what home healthcare services are paid for by Medicare is like being an accountant and not understanding the difference between an itemized deduction and a standard deduction.

Not understanding what home healthcare services are paid for by Medicare is like being a mechanic and not understanding the difference between metric tools and american standard tools.

Not understanding what home healthcare services are paid for by Medicare is like being a doctor and not understanding the difference between over-the-counter medications and prescription medications.

Yes, my panties are in a wad because I'm shocked at the ignorance from those who should know better.