UCT has a great lead program

[Frank Stastny]

I just talked to Georgia at Continental Life about their Continental Care policy. This is what she had to say about the "Home Health Care" portion of that policy:

To receive that benefit it must first be certified by a doctor as being medically necesary.

The care MUST be provided by one of the following; a private duty nurse, a registered nurse or a graduate nurse.

The benefit will pay $30.00 per shift for two separate shifts per day. (A "shift" is defined as an eight hour period of time.) In sixteen hours the policy will pay a total of $60.00.

I have called two home health care agencies to find out what the going rate is to have one of the three listed above to come to the home to provide health care. Both places said their rate is $110.00 per hour. This is in a little town in Missouri, not a large metro area.

Thirty dollars per shift isn't going to pay even 1/3 of the first hour. It will cover about the first 16 minutes then the rest of the cost is on the person receiving the care.

Anyone who is selling this policy as a "Home Health Care" policy needs to also explain that it will pay for about 32 minutes of Home Health Care in each 24 hour period provided that there are two separate eight hour shifts of care given during those 24 hours.

That is not a benefit worth paying a premium for, regardless of how much or little the premium is.

Kyle,

We all have problems, some day if I have several hours of nothing to do I will post all of mine. I'm sure other could do the same. It is still not an excuse for misrepresenting information when making a presentation to sell someone, who is on a fixed income, insurance that really isn't going to help them.

It is incumbent upon each agent to throughly know and explain, in detail, the benefits of each policy they sell. Not just make general statements that "this will cover your home health care". It doesn't even come remotely close. Actually, it doesn't cover anything for Home Health Care when you get right down to it.

 

[Guest]

Wow...what a piece of crap product. Research, research, research!

I agree with your remarks Frank. There is no excuse for selling garbage. I just want to make sure Mary understands where we are all coming from...we are not trying to be malicious or pick on her...we just want to protect our field's reputation.

 

[Frank Stastny]

Wow...what a piece of crap product. Research, research, research!

I agree with your remarks Frank. There is no excuse for selling garbage. I just want to make sure Mary understands where we are all coming from...we are not trying to be malicious or pick on her...we just want to protect our field's reputation.

Kyle,

I'm not "picking on anyone". There are a lot of relatively new agents on this forum who are susceptible to believing every thing that is written here, especially by someone who has a lot of posts. The number of times a member posts doesn't mean that person is an expert by any means. Typing may just be easier for them.

I have a real problem with people who say things in general terms especially when talking about the benefits a policy does or does not provide. The only real source for accurate information is the insurance company. Anyone who doesn't take the time to learn the benefits from the company is putting themselves at risk.

Mary has stated that she sells that policy and highly recommends it to clients for Home Health Care and is telling us that it will cover Home Health Care and that Plan F doesn't cover Home Health Care.

I think that is a gross misrepresentation of the benefits of both Plan F and the Continental Care Policy. If she wasn't aware of this then she shouldn't be selling either one until she does the research. If she is aware of it then she is blatantly lining her pockets with more commission at the expense of most seniors who are already struggling financially.

 

[Guest]

I get it Frank and I agree.

I do think we need to clear something up about Home Health Care though. First of all, there are two types of care:

1. skilled care
2. unskilled care

Medicare pays for skilled care only. Unskilled care is coverage for someone to help with ADLs (Activities of Daily Living) and is not covered by Medicare...in this case someone would need a LTC policy because medigap does not pay for it either. The closest medigap comes to coverage for this is plans D and G which cover up to $1600 a year for At Home Recovery.

Medicare pays for skilled HHC under part A:

Home Health Care is skilled nursing care and certain other health care services you receive in your home for the treatment of an illness or injury. Medicare covers some home health care if:

1. Your doctor decides you need medical care in your home, and makes a plan for your care at home, and

2. You need at least one of the following: intermittent (and not full time) skilled nursing care, or physical therapy or speech language pathology services, or a continued need for occupational therapy, and

3. You are homebound. This means you are normally unable to leave home and that leaving home is a major effort. When you leave home, it must be infrequent, for a short time. You may attend religious services. You may leave the house to get medical treatment, including therapeutic or psychosocial care. You can also get care in an adult day-care program that is licensed or certified by a state or accredited to furnish adult day care services in a state, and

4. The home health agency caring for you must be approved by the Medicare program.

 

[arnguy]

Wow, Frank, $110.00 per hour! My brother who died in December had home health care provided by CNAs (Certified Nurse Assistant) in Philadelphia. He was not ambulatory for the last 18 months of his life and my sister-in-law required 12 hour shift 7 days a week to avoid moving him into the nursing facility of their senior citizen residence. He was adamant about not going into the nursing section. The daily charge was $144.00 per day (12.00/hour) for this para-professional assistance. The level went from custodial, to palliative, and finally to hospice care. The $30.00 a shift would have been of very little help. Assuming that the additional four hours of the shift has the $30 prorated to $15 for a daily total of $45. That leaves a faily exposure of $99 or a weekly total of $693. The monthly exposure is just under $3,000 ($2,979.90). This $30 per shift coverage is a joke!

 

[arnguy]

P.S. Inasmuch as Medicare didn't cover the levels of care, my brother and his wife had to sell their residence of over 50 years which had appreciated quite a bit and they fortunately had accumulated savings to offset the cost of his home health care. There were a few intermittent periods when he did have to go to the nursing section and received skilled nursing care which was picked up by Medicare. Also, fortunately, his prescription drugs were covered by the VA.

 

[Guest]

Wow, Frank, $110.00 per hour! My brother who died in December had home health care provided by CNAs (Certified Nurse Assistant) in Philadelphia. He was not ambulatory for the last 18 months of his life and my sister-in-law required 12 hour shift 7 days a week to avoid moving him into the nursing facility of their senior citizen residence. He was adamant about not going into the nursing section. The daily charge was $144.00 per day (12.00/hour) for this para-professional assistance. The level went from custodial, to palliative, and finally to hospice care. The $30.00 a shift would have been of very little help. Assuming that the additional four hours of the shift has the $30 prorated to $15 for a daily total of $45. That leaves a faily exposure of $99 or a weekly total of $693. The monthly exposure is just under $3,000 ($2,979.90). This $30 per shift coverage is a joke!

This was custodial, non-skilled, care though it sounds like. Skilled HHC will not require 12 hour shift work, but would be on an as needed basis, usually 1-2 hours a couple times a week...that is what Medicare covers and the Continental Care plans seems to say it covers that as well--although very poorly and probably unnecessarily.

 

[senior-advisor-indiana]

I am glad this can of worms got out. Now we just need to keep the worms from harming the apples and oranges. I need to protect my prunes.

 

[Frank Stastny]

I get it Frank and I agree.

I do think we need to clear something up about Home Health Care though. First of all, there are two types of care:

1. skilled care
2. unskilled care

Medicare pays for skilled care only. There are situations where Medicare will approve and pay for unskilled care like bathing when receiving therapy at home for an injury like a broken hip until the person is ambulatory. I have clients who have received this care. Unskilled care is coverage for someone to help with ADLs (Activities of Daily Living) and is not covered by Medicare...in this case someone would need a LTC policy because medigap does not pay for it either. The closest medigap comes to coverage for this is plans D and G which cover up to $1600 a year for At Home Recovery. I have also discussed the "At Home Recovery" benefit with insurance companies. I have been told that 1% or less of policy holders ever collect on this benefit. It must be ordered as medically necessary by a doctor, it must be something that is not covered by Medicare Home Health Care and must first be approved by Medicare for the policy holder to collect on the benefit. It will not pay for ADL's any more than Home Health Care provided by Medicare will pay.

Medicare pays for skilled HHC under part A: I assume that HHC refers to Home Health Care, if not the following does not apply.

The Skilled Nursing Benefit provided by Part A is actually called, "Skilled Nursing Facility Care" and is not for Home Health Care but facility care only. It is defined in the Medicare Guide book as:

"Skilled Nursing Facility Care - This is a level of care that requires the daily involvement of skilled nursing or rehabilitation staff and that, as a practical matter, can't be provided on an outpatient basis. Examples of skilled nursing facility care include intravenous injections and physical therapy. The need for custodial care (for example, assistance with the activities of daily living, like bathing and dressing) cannot, in itself, qualify you for Medicare coverage in a skilled nursing facility. However, if you qualify for coverage based on your need for skilled nursing or rehabilitation, Medicare will cover all of your care needs in the facility, including assistance with activities of daily living."

In order for a person to continue to be eligible for Skilled Nursing Facility Care the person must be showing daily improvement. If there isn't visible improvement each day Medicare cuts the person off of Skilled Nursing Facility Care and they must leave the facility. NOTE: This benefit will not pay for the first 100 days of care if a person needs to go to a nursing home as I have heard many agents say.

However, some hospitals will contract with a nursing home to provide Skilled Nursing Care for physical therapy providing the nursing home is Skilled Nursing certified. This is not considered nursing home care.

Home Health Care is skilled nursing care and certain other health care services you receive in your home for the treatment of an illness or injury. Medicare covers some home health care if:

1. Your doctor decides you need medical care in your home, and makes a plan for your care at home, and

2. You need at least one of the following: intermittent (and not full time) skilled nursing care, or physical therapy or speech language pathology services, or a continued need for occupational therapy, and

3. You are homebound. This means you are normally unable to leave home and that leaving home is a major effort. When you leave home, it must be infrequent, for a short time. You may attend religious services. You may leave the house to get medical treatment, including therapeutic or psychosocial care. You can also get care in an adult day-care program that is licensed or certified by a state or accredited to furnish adult day care services in a state, and

4. The home health agency caring for you must be approved by the Medicare program.

Kyle, I have responded in the body of your quote in red, I hope you don't mind.

Your definition of the requirements for someone to receive Medicare Home Health Care is excellent.

 

[Frank Stastny]

I am glad this can of worms got out. Now we just need to keep the worms from harming the apples and oranges. I need to protect my prunes.

Senior,

I've heard "seniors" talk alot about prunes. By your name I assume it is a subject you have a lot of expertise in. Aren't they like big raisins?