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LONG TERM CARE
What is Long Term Care?
It’s the type of care received either at
home or in a facility, when someone needs assistance with activities of
daily living (bathing, dressing, toileting, transferring, continence or
eating), or suffers cognitive impairment.
With the current high cost of health care,
very few people can afford the extended care that’s often needed with
chronic illness, injury or advancing age. Despite a popular
misconception, the need for long term care isn’t restricted to the
elderly. In fact, many working-age adults have disabling injuries and
illnesses, including arthritis, heart disease and mental impairment, as
well as stroke and trauma, that require ongoing care.
Many people mistakenly believe that
government programs will pay for their long term care, but that isn’t
the case.
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Medical insurance is designed to
reimburse expenses associated with medical care, tests, medicines or
other specific services. It does not cover most costs associated
with long term care.
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Medicare covers only skilled or acute
nursing care for a short period of time to people over age 65.
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Lastly, assets must be depleted to
welfare levels in order to qualify for benefits under Medicaid.
Unexpected events, as well as the aging
process, can leave you in a vulnerable position both personally and
financially. That’s why long term care (LTC) insurance is so important
for anyone concerned about preserving financial security and
independence if a lengthy disability occurs. Long term care insurance
can’t make you invincible, but it can help you meet the financial
obligations of a long term care situation.
WHAT
YOU SHOULD KNOW ABOUT MEDICARE
What is Medicare?
Medicare provides health insurance to people
age 65 and over. It is made up of two components; Part A & B. The
Health Care Financing Administration (HCFA) administers Medicare, the
nation’s largest health insurance program, which covers 39 million
Americans.
Who is Eligible?
Generally, you are eligible for premium-free
Medicare Part A if you or your spouse worked for at least 10 years in
Medicare-covered employment and you are 65 years old and a citizen or
permanent resident of the United States. If you don’t qualify for
premium-free Part A, and you are 65 or older, you may be able to buy it.
Contact the SSA office at 800-772-1213.
What is
Medicare Part A?
Part A pays for hospital expenses (less the
inpatient deductible and applicable co-insurance amounts), home health
care, hospice care and skilled nursing facility care. Your part A of
Medicare is free. Your enrollment in Part A is automatic but
you will need to register with Social Security.
What is
Medicare Part B?
Part B pays for medical expenses (after a
deductible which is $135 in 2008), such as doctor services, laboratory tests, outpatient
hospital services, medical equipment, blood and home health care visits.
You are automatically eligible for Part B if you are eligible for
premium-free Part A. The standard Part B premium is $96.40
per month. Medicare B enrollees with higher incomes
will pay a higher Part B premium based on their income. The
income-related Part B premiums for 2008 will be $80,000 (or
$160,000 for a married couple). Part B is voluntary. If you
choose to have Part B, the monthly premium is deducted from your
Social Security, Railroad Retirement, or Civil Service
Retirement payment. Beneficiaries who do not receive any of
these payments are billed by Medicare every three (3) months.
Do I have to enroll in Part B at age
65?
Not necessarily. If you are employed by a
company who has more than twenty (20) employees and you are covered by a
group sponsored medical plan, you do not have to enroll in Part B. Your
group plan would remain your primary payor and Medicare would be
secondary. Consider the following:
1.
What is your contribution towards the cost of the group policy?
2.
Do you have dependents that still need to be covered under the
group plan?
3.
What benefits would I be losing?
If the company you work for has less than
twenty (20) employees and you are covered by a group sponsored plan,
Medicare would become your primary payor and the group plan would be
secondary. In most cases, the group benefits are diminished and you may
be better served by enrolling in Part B and purchasing a Supplemental
Plan.
If you didn’t take Part B when you were
first eligible, you can sign up during 2 enrollment periods:
What is Medicare Part D?
Part
D pays for prescription drug expenses and is the newest offering in
the Medicare product lines. Part D plans are offered though various
insurance companies in your area; and although HCFA enforces
predetermined benefit levels which may change annually, the
insurance carriers offer a variety of plan options with increased
benefits.
Do I have to enroll in Medicare Part D?
Signing up for Medicare Part D upon your eligibility, while not
mandatory, is a smart idea and could result in large savings on your
prescription drugs. Although part D enrollment is voluntary, there
are financial penalties if you fail to sign up when you are
initially eligible and elect to enroll at a later time.
How does Part D work?
Although Medicare D is a government-sponsored program, the benefits
are offered by and provided through insurance carriers.
You would pay the following costs in a Part D plan:
·
A Monthly premium
which varies by state and plan. Premiums can be paid directly to the
insurance company or you may elect to have them deducted from your
Social Security award.
·
A
yearly deductible
(between $0-$275 in 2008).
·
A portion of the cost of your prescriptions,
including a co-payment or coinsurance.
While costs could vary depending upon which drug plan you choose,
some plans may offer enhanced coverage and additional formulary
drugs
for a higher monthly premium. Annually from November 15 to December
31 you may change plans and/or carriers — this is called
Open Enrollment.
How do I
enroll in Medicare?
Three (3) months before your 65th
birthday* contact your local Social Security Administration office for
specific information about your eligibility and enrollment for part A &
B of Medicare (this is the beginning of your 7 month enrollment period
during which you must file your application).
Social Security Administration Office:
800-772-1213
Monday – Friday from 7 a.m. to 7 p.m.
Make an appointment for a telephone
interviewer to call you at an agreed convenient time. Or, you can make
an appointment to visit them in person (you must take your original
Birth Certificate along).
When the interviewer calls, he/she will
be asking you pertinent questions that will be recorded on the
application over the phone. The completed application will then be sent
to you directly.
Once you have received the paperwork, you
will need to sign, date and return to the Social Security Administration
Office along with your original Birth Certificate and a
self-addressed, stamped envelope.
After SSA approves your
application, they will return your Birth Certificate in the
self-addressed, stamped envelope you provided. Your Medicare is
effective the first day of the month in which your birthday falls.
Enrolling in a Medicare Supplemental
Policy
Although Medicare covers many health care
costs, you will still have to pay Medicare’s coinsurance and
deductibles. There are also many medical services that Medicare does not
cover including expenses out of the United States.
You may want to enroll in a Medicare
supplemental insurance (Medigap) policy. These policies are designed to
help pay your Medicare cost-sharing amounts. There are 10 standard
Medigap policies (A-J) and, each offers a different combination of
benefits.
Once you have enrolled in Medicare A & B, call the
“SHARP” (Senior Health And Retirement Program) Department at Hoffman
Brown Company – 818-986-8200 and ask for Donna.
Complete and return the signed application to Hoffman Brown
Company (in some cases you may need to include a check for the first
month premium). You will receive your Supplemental Insurance policy
and Identification cards within 5-7 days of the approval of your
application.
If you apply within six (6) months of
becoming eligible for Medicare A & B or if you are leaving a group plan,
you cannot be turned down or charged higher premiums because of poor
health if you buy a policy during this period. Once your Medigap open
enrollment period ends, you may not be able to buy the policy of your
choice. You may have to accept whatever policy an insurance company is
willing to sell you.
If you are already receiving retirement
benefits from Social Security or the Railroad Retirement Board when you
turn 65, your Medicare card will automatically be mailed to you about 3
months before your 65th birthday as part of your enrollment
information package.
Things to consider when buying a
Supplemental Policy
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Your yearly out-of-pocket costs for
health care.
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You should think about your future
health care needs. As you get older, your health care costs may
increase.
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Consider your medical history, your
family medical history, and health risks when thinking about future
health care costs.
Call us to learn more about Medicare and
Supplements.
Hoffman Brown Company is here to serve your
insurance needs.
Please click here to contact us
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