Insurance pays when people need help with activities of daily living

ROBINS AFB, Georgia -- Most people don’t like to think that there might come a time when they won’t be able to take care of themselves. ... when they won’t be able to do everyday things like getting dressed, eating or bathing without assistance. But the reality is that most people will need this kind of care at some point in their life, and when they do, it can come with a hefty price tag.

That’s why Air Force officials are encouraging all members of the Air Force team to consider long-term care insurance. Long-term care is the type of care people need when they can no longer perform activities of daily living by themselves. It also includes the kind of care people would need if they had a severe cognitive impairment like Alzheimer’s disease.

Long-term care isn’t the medical care required to get well from a sickness or injury, and it isn’t short-term rehabilitation from an accident or recuperation from surgery. Long-term care can be received in the home, an assisted-living facility, an adult day care center or a hospice facility.

For members of the Reserve team who are also federal employees, like air reserve technicians and regular civilian employees, the government has its own long-term care insurance program. 

Launched in 2002, the Federal Long-Term Care Insurance Program is the largest employer-sponsored long-term care insurance program and the largest group program in the country. It provides more than 20 million eligible members access to long-term care insurance as a voluntary benefit, where the employee pays all the cost.

“The need for long-term care usually arises from age or chronic illness, injury, or disability,” according to the Federal Long-Term Care Insurance Program Web site. “In fact, approximately 60 percent of us who reach age 65 will need long-term care at some time in our lives.”

But people who believe they can wait until they retire to start thinking about purchasing long-term care insurance might be in for an unpleasant surprise.

“Statistics show that 40 percent of people receiving long-term care services are working-age adults, between the ages of 18 and 64,” the Web site says. In addition, insurance premiums are lower the younger you are when you buy. For example, the bi-weekly premium if you purchase coverage at age 40 for a plan available from the Federal Long-Term Care Insurance Program that covers home and facilities care and keeps pace with inflation is $30.05. At age 50, if you purchase the same plan, it will cost $43.06.

Many people mistakenly believe they are covered by their current health insurance or disability insurance policies in the event they need long-term care. Health insurance plans are designed to cover medical care for illnesses or injuries, such as cancer, a broken arm or a stroke. They won’t pay for long-term assistance with activities of daily living, such as dressing or using the bathroom. Disability insurance is designed to replace the income people lose if they are unable to work because of an accident or injury. It provides no additional benefits for long-term care.

While Medicaid does pay for long-term care, it is designed to protect people with minimal assets. To qualify, most people would have to spend down nearly all their assets. Medicare only pays limited amounts for skilled care following a hospital stay. It does not cover purely custodial care, the type required by most people in nursing homes.

This means that without long-term care insurance, people requiring long-term care are left to pay the bills out of their own pocket. And the bills can be very large. According to the Federal Long-Term Care Insurance Program Web site, the national average cost of a semi-private room in a nursing home is $52,000 a year. And nursing home costs, on average, go up about 5 percent a year. If that trend continues, by the year 2032, a semi-private room in a nursing home will cost $190,600 a year.

Home health care is expensive, too. The national average annual cost of home health care is well over $20,000, the Web site noted. That figure is expected to climb to more than $68,000 by 2030.

“People have very little understanding until they really need it what long-term care is and what long-term care insurance will be able to do for them,” Mary Lou McGuiness, a nurse and director of care coordination/claims for the Federal Long-Term Care Insurance Program, said in a recent American Forces Information Service news article.

“And I think when they have an immediate need for the services, that’s when they tend to try to tap into whatever resources they have to give them the information to answer their questions. The problem is that the need for the knowledge is often very urgent by the time they need it.”

Ms. McGuiness urged federal employees to take a close look at the federal program. The Web site (http://www.ltcfeds.com) is a good place to start. Once they enroll, federal employees have access to the program’s care coordinators — registered nurses with experience in long-term care situations who can provide general information, assessment and approval of the need for long-term care, and help in developing a care plan.

“When you need long-term care services, securing the best type and quality of care can seem daunting,” she said. “That’s why the care coordination services provided by the federal program are truly one of the hallmarks of the program. Care coordination not only provides individuals with information to make a knowledgeable decision, but it also offers emotional support and peace of mind at a very difficult time.”

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