LTC: Daily Benefit Vs Monthly Benefit

[scagnt83]

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

First, your panties are almost always in a wad.

Second, she had medicare and the 3 day a week thing was not covered by it... thats why my parents spent thousands of their own money paying for it...

I was younger then, and not in insurance. But I remember my dad complaining about it plenty.


Its funny how you are the only agent on here who has recommended daily over monthly...
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Also, you must qualify for Home Health Care under Medicaid. If care is needed every day you are not eligible if I remember correctly. It also has to be a Medicare "approved" agency to ensure there are no out of pocket costs.

Either way, insurance is for the unforeseen. To me, you want the most flexibility when protecting against the unforeseen. And an extra 6% is worth greater flexibility to me.

 

[VolAgent]

First, your panties are almost always in a wad.

Second, she had medicare and the 3 day a week thing was not covered by it... thats why my parents spent thousands of their own money paying for it...

I was younger then, and not in insurance. But I remember my dad complaining about it plenty.


Its funny how you are the only agent on here who has recommended daily over monthly...

Been there and done that with home nursing visits and home physical therapy visits. Medicare will only pay for so many, after that it is your problem.

 

[Mr_Ed]

First, your panties are almost always in a wad.

Second, she had medicare and the 3 day a week thing was not covered by it... thats why my parents spent thousands of their own money paying for it...

I was younger then, and not in insurance. But I remember my dad complaining about it plenty.


Its funny how you are the only agent on here who has recommended daily over monthly...

it should have been covered by medicare--at least it would have been paid for by Medicare since Medicare's home healthcare benefits have been improved.

my uncle had a stroke and needed 24 care at home. medicare didn't pay for the home health aides who were there bathing, dressing, and feeding him.

but medicare paid for the registered nurse who treated the one bed sore he got. medicare paid for the physical therapist that came 3x per week to help improve his walking. medicare paid for the speech therapist that came 2x per week to help him improve his swallowing. medicare paid for the podiatrist who came every month to clip his toe nails, for pete's sake.

if it's "rehabilitative" then medicare will pay for it at home.

period.


Why am I the only one who recommends a daily benefit most of the time? Maybe it's because I don't swallow the marketing b.s. that comes from the h.o.'s.
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Been there and done that with home nursing visits and home physical therapy visits. Medicare will only pay for so many, after that it is your problem.

That is incorrect.
There is no limit to the amount of physical therapy and skilled nursing visits Medicare will pay for.

 

[Arthur Rudnick]

previously posted by Mr_Ed

it should have been covered by medicare--at least it would have been paid for by Medicare since Medicare's home healthcare benefits have been improved. medicare paid for the registered nurse who treated the one bed sore he got. medicare paid for the physical therapist that came 3x per week to help improve
his walking. medicare paid for the speech therapist that came 2x per week to help him improve his swallowing. medicare paid for the podiatrist who came every month to clip his toe nails, for pete's sake.
if it's
"rehabilitative" then medicare will pay for it at home.
period.

Medicare will pay for skilled care only if certain criteria are met. The therapist, nurse, and the podiatrist are all skilled care professionals. Medicare will not pay for custodial care alone. Skilled care is generally rehabilitative care.

Medicare will only pay for custodial care while at the same time they are providing skilled care. And if Medicare does provide custodial care it's limited to 4 hours per day, 4 days a week. (Not much if you're ADL dependent).

And, Medicare will only pay for a maximum of 100 days, with an out-of-pocket of $145/day from days 20-100, unless the patient has a Medicare-Sup.

Regarding your comments on daily vs monthly; IMO, all things being equal there's no question that monthly is better than daily. The only option better than monthly is a cash-benefit policy that pays on an indemnity basis, rather than reimbursement.

But with that said, if you feel you prefer daily, go sell it even though you're putting your policyholders at a disadvantage.

 

[Mr_Ed]

previously posted by Mr_Ed



Medicare will pay for skilled care only if certain criteria are met. The therapist, nurse, and the podiatrist are all skilled care professionals. Medicare will not pay for custodial care alone. Skilled care is generally rehabilitative care.

Medicare will only pay for custodial care while at the same time they are providing skilled care. And if Medicare does provide custodial care it's limited to 4 hours per day, 4 days a week. (Not much if you're ADL dependent).

And, Medicare will only pay for a maximum of 100 days, with an out-of-pocket of $145/day from days 20-100, unless the patient has a Medicare-Sup.

Regarding your comments on daily vs monthly; IMO, all things being equal there's no question that monthly is better than daily. The only option better than monthly is a cash-benefit policy that pays on an indemnity basis, rather than reimbursement.

But with that said, if you feel you prefer daily, go sell it even though you're putting your policyholders at a disadvantage.

The 100 day maximum does NOT apply to home healthcare. It only applies to nursing home care.


People, this is 1st grade stuff. I can't believe that someone who's been selling LTCi for 15 years doesn't know some of the most basic features of Medicare.

 

[Chuckles21]

it should have been covered by medicare--at least it would have been paid for by Medicare since Medicare's home healthcare benefits have been improved.

my uncle had a stroke and needed 24 care at home. medicare didn't pay for the home health aides who were there bathing, dressing, and feeding him.

but medicare paid for the registered nurse who treated the one bed sore he got. medicare paid for the physical therapist that came 3x per week to help improve his walking. medicare paid for the speech therapist that came 2x per week to help him improve his swallowing. medicare paid for the podiatrist who came every month to clip his toe nails, for pete's sake.

if it's "rehabilitative" then medicare will pay for it at home.

period.


Why am I the only one who recommends a daily benefit most of the time? Maybe it's because I don't swallow the marketing b.s. that comes from the h.o.'s.
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That is incorrect.
There is no limit to the amount of physical therapy and skilled nursing visits Medicare will pay for.

What if the person isn't of age for Medicare? Who's paying for that home care then?

 

[scagnt83]

To qualify for Home Health Care under Medicare, it must be "part time" care, not full time.

It also has to be a Medicare approved provider who has agreed to only accept the "reasonable & customary" payment amounts that Medicare decides on.

You also pay for 20% of any medical equipment up to the "reasonable & customary" amount, and then 100% of anything above R&C.

You also must be completely "homebound" to receive benefits for home care.


Im not saying its bad, or never helps. But its not a cure all.



Back to the OPs question: daily vs. monthly

Ed, why does the company charge more for monthly than they do daily if daily benefits the insured more????
Are you saying their pricing structure designed by actuaries who constantly crunch these numbers and stats are wrong?

 

[CALTCAgent]

Another consideration is,

Will medicare change in the future what it covers for skilled home health care?

 

[Mr_Ed]

Back to the OPs question: daily vs. monthly

Ed, why does the company charge more for monthly than they do daily if daily benefits the insured more????
Are you saying their pricing structure designed by actuaries who constantly crunch these numbers and stats are wrong?

Final post:

Of course, all other benefits being equal AND the premiums being the same, a policy with a $3,100 monthly benefit is always better than a policy with a $100 daily benefit.

But all things are never equal--especially the premiums.

Why would the actuaries charge 6% more for the monthly benefit? I don't know. I suspect the monthly benefit is probably 1%, maybe a 2% greater risk to the insurer than the daily benefit. Why then does it cost about 6%? Because the insurers want to make a profit and they know that the agents will sell whatever they tell the agents to sell.

Do I recommend paying extra for a monthly benefit? Rarely.

What's better: a $6,000 monthly benefit OR for slightly less premium a $210 daily benefit.

The $6,000 monthly will, with most policies, only pay $6,000 on months that have 31 days.

The $210 Daily Benefit will pay an extra $300 on months with 30 days AND an extra $510 on months with 31 days. That's almost 10% MORE benefit--for LESS premium.

But, fortunately for the insurers, most insurance agents are lemmings and will just do whatever they're told to do.

mrs ed

 

[SWM]

Nothing to add here other than relating that this has been a good read. Seems I need to brush up on my own medicare knowledge. I personally have always been a monthly benefit supporter.