ERIE.GOV | Your information resource from the government of Erie County, New York


County Executive Elected Officials County Departments Living In Erie County Visiting Erie County Growing your business in Erie County State and regional municipalities

Long-Term Care Insurance


Topics

Long Term Care Insurance Frequently Asked Questions

What is Long-Term Care Insurance?

Long-term care is provided to people who are unable to perform the basic tasks of everyday living on their own for an extended period due to chronic medical, physical or cognitive conditions, or disabling injuries. Long-Term Care Insurance covers long-term care services provided in a nursing home, at home, in an assisted living facility, or in other community-based settings. Medicare, Medicare supplemental insurance (Medigap), and traditional health and disability insurance plans typically do not cover long-term care services.

What is the Cost of Long-Term Care in New York State?

Today, the cost of staying in a nursing home in New York can be very expensive, often over $90,000 a year. Home care can be very expensive as well. Few people can afford this cost without using their life savings. Long-Term Care Insurance allows you to protect your assets in the event you need long-term care sometime in the future, just like you protect yourself with homeowner and auto insurance.

How can I find information on Long- Term Care Insurance?

You may obtain additional information on Long-Term Care Insurance by calling 1-866-950-PLAN. Someone will be able to help answer your questions and will mail informational materials directly to you on Long-Term Care Insurance. You may also contact your Long-Term Care Insurance Resource Center...In Erie County, the Department of Senior Services at (716) 858-7883.

How Much Does Long-Term Care Insurance Cost?

The Long-Term Care Insurance premium depends on your purchase age and what you choose to cover - the younger you are, the lower the premium. New York State provides an income tax credit for qualified long term care insurance policies to help more people afford long-term care insurance coverage. The premiums charged for tax-qualified Long-Term Care Insurance Policies are treated as medical expenses under Federal tax law which may also qualify you for a more favorable outcome on your tax return. You should check with the insurance carrier to determine if your plan is tax-qualified and consult with an attorney, accountant or tax advisor regarding the tax implications of purchasing a tax-qualified policy.

Do You Have a List of Companies that Sell Long-Term Care Insurance?

New York State does not endorse or recommend any specific insurance product or insurer, but we can provide you with a list of companies licensed to sell Long-Term Care Insurance in New York State.

How Do I Get Information on Long-Term Care Insurance in My Own Community?

Long-Term Care Insurance Resource Centers are located in each county to educate consumers about their choices. They frequently offer education events as well as individual counseling. Call (716) 858-7883.

What Types of Long-Term Care Insurance are Available?

There are two general types of Long-Term Care Insurance in New York State: insurance sold under the New York State Partnership for Long-Term Care and traditional, non-Partnership insurance.

back to topics

 

New York State Partnership for Long Term Care

What is New York State Partnership for Long-Term Care?

New York State Partnership for Long-Term Care is a unique program combining private long-term care insurance and Medicaid Extended Coverage. Its purpose is to help New Yorkers financially prepare for the possibility of needing nursing home care, home care or assisted living services someday. The program allows New Yorkers to protect some or all of their assets (depending on the insurance plan purchased), if their long-term care needs extend beyond the period covered by their private insurance policy. For NYS Partnership Plan information: http://www.nyspltc.org or call the Partnership Office at: 518-474-0662 or e-mail the Partnership at: pltc@nyspltc.org with your questions.

How do I participate in Partnership insurance?

In order to participate in the Partnership you will have to purchase a policy from one of the participating Partnership insurance companies.

How does the Partnership work?

First you purchase a Partnership policy from one of the participating insurance companies. Second, you use the policy benefits. If you need Long-Term Care after policy coverage is exhausted, you are eligible for coverage under New York State Medicaid without having to spend down your assets. The amount of Medicaid asset protection depends on the type of Partnership insurance you purchase. You can choose a policy that offers total asset protection or a policy which offers asset protection up to a defined dollar amount.

Who should I contact if I have a concern or complaint about an insurance agent or broker?

Contact the Department of Insurance Consumer Services Bureau at: 1-800-342-3736.

Who do I contact with my Long-Term Care Insurance Tax Benefit-related Questions?

For State Tax Benefits you should contact the Department of Taxation and Finance and for Federal Tax Benefits you should contact the Internal Revenue Service.

Where can I find answers to questions about New York State Long-Term Care Insurance offerings if I'm a New York State employee or retiree?

You need to contact the New York State Public Employee and Retiree Long-Term Care Insurance Plan (NYPERL) at 1-866-474-5824 or contact them by email on their web site. For complaints or concerns you should contact the New York Civil Service Department.

Who should I call with questions about the Federal Long-Term Care Insurance Program?

You should call 1-800-582-3337 or visit the Federal Long-Term Care Insurance Program web site.

Who should I call for Medicaid Questions?

You should call the Department of Health Medicaid Helpline at 1-800-541-2831.

back to topics

 

Long Term Care Glossary of Terms

(from New York State Department of Insurance 6/1/06)

Activities of Daily Living (ADLs): Everyday actions performed by individuals such as dressing, eating, bathing, toileting, continence and transferring. Most insurance policies covering long term care services base your qualification for benefits on your inability to perform a certain number of ADLs.

Adult Day Care: Group supervision for elderly persons, including social and recreational services and in some cases health services, in a community facility.

Alternate Level of Care Benefits: Care in a hospital inpatient setting for those persons waiting to be placed in a nursing home or while arrangements are being made for home care.

Assisted Living Facility: A residential facility providing ongoing care and related services for persons needing assistance in the activities of daily living.

Copayment or Coinsurance: The amount you must pay for each medical service, outpatient hospital service or hospital stay.

Custodial Care: Non-medical care that meets your personal needs. For example, custodial care includes help eating, bathing, toileting, taking medication or walking.

Cognitive Impairment: Deterioration in intellectual activity such as thinking, reasoning or remembering.

Daily Benefit Amount: The amount your insurance policy will cover for each day of services provided. Some policies pay a flat daily benefit amount, while others will pay reasonable and customary charges up to the daily benefit amount.

Deductible: The amount you must pay for health care before Medicare or private medical insurance begins to pay.

Dementia: Impairment of intellectual faculties due to a disorder of the brain.

Elimination or Waiting Period: The elimination or waiting period is the number of days you must receive long term care services before benefits will be paid under the policy. During the elimination or waiting period you will have to privately pay for the care you receive. A new elimination or waiting period may be imposed for each period of care. Shorter periods increase the cost of coverage.

Free Look Period: The time period after receipt of the policy during which a policyholder can cancel and get a full refund. In New York State this period is 30 days.

Functional Impairment: The need for assistance to carry out a specific number of activities of daily living.

Guaranteed Renewable: Guaranteed renewable means that you have the right to continue the policy as long as the premiums are paid on a timely basis. An insurer cannot terminate the policy if your health declines. The insurer also cannot make any change in any provision of the policy while the insurance is in force without your agreement. An insurer cannot change the premium charged for the policy unless it is approved by the New York State Insurance Department, and unless it applies to all members of a class covered by the policy.

Home Care (personal care): Assistance with personal hygiene, dressing or feeding, nutritional or support functions and health-related tasks.

Home Health Care: Health services received in your home, including skilled nursing care, speech, physical or occupational therapy or home health aide services.

Hospice Care: A program of care and treatment, either in a hospice facility or in the home, for persons who are terminally ill and have a life expectancy of six months or less.

Inflation Protection Benefit: Increases the daily benefit amount and policy maximums over time to help keep pace with inflation and increased expenses.

Maximum Policy Benefit: The period of time or dollar amount limit for which long term care benefits will be paid under the policy.

Medicaid: A governmental program for low-income individuals and families.

Medicare: A federal program providing hospital and medical insurance to people aged 65 or older and to certain ill or disabled persons.

Medicare Supplement Insurance: Private insurance designed to fill in some of the major gaps in Medicare coverage.

New York City Metropolitan Area: The counties of Bronx, Kings, Nassau, New York, Queens, Richmond, Rockland, Suffolk, and Westchester.

Nonforfeiture Benefit: A benefit designed to ensure that if an insurance policy is lapsed after a specific number of years, some of the benefits from the policy will be retained.

Partnership for Long Term Care: A public-private partnership which combines private long term care insurance with Medicaid Extended Coverage to provide New Yorkers with a lifetime of long term care benefits.

Period of Care: A specified number of days of care either in a nursing home or while receiving home care services without a break in the services for a specified number of days.

Preexisting Condition: A medical condition for which medical advice was given or treatment was recommended by, or received from, a licensed health care provider within six months before the effective date of coverage.

Respite Care: Services to provide family members a rest or vacation from caregiving responsibilities.

Skilled Nursing Care: A level of care that must be given or supervised by registered nurses.

Viatical Settlement: A cash lump sum paid in lieu of a life insurance policy's death benefits.

Waiting Period: See Elimination Period

Waiver of Premium: After a policyholder has received benefits for the specific number of days stated in the policy, no further premiums will be due until they leave the nursing home.

back to topics

 

Some points to keep in mind as you shop for long term care insurance.

Adapted from: A Shopper's Guide to Long term care Insurance, National Association of Insurance Commissioners, 2003
New York State specific information from the NYS Department of Insurance website 3/06
8/10/06 Erie County Dept. of Senior Services

Ask Questions If you have questions about the agent, the insurance company, or the policy, contact the New York State Department of Insurance or the Long Term Care Insurance Education and Outreach Program - 858-7883.

Check with Several Companies and Agents Contacting several companies (and agents) before you buy is wise. Be sure to compare benefits, the types of facilities you have to be in to get coverage, the limits on your coverage, what's excluded, and, of course, the premium. (Policies that have the same coverage and benefits may not cost the same.)

Check Out the Companies' Rate Increase Histories Ask companies about their rate increase histories and whether they have increased rates on long Term Care insurance policies that they sell.

Take Your Time and Compare Outlines of Coverage Never let anyone pressure or scare you into making a quick decision. Don't buy a policy the first time you see an agent, Ask for an outline of coverage. It outlines the policy's benefits and points out important features. Compare outlines of coverage for several policies and make sure the outlines are similar (if not the same) when comparing premiums.

Understand the Policies Make sure you know what the policy covers and what is doesn't. If you have any questions, call the insurance company before you buy.

If you receive any information that confuses you or is different from the information in the company literature, don't hesitate to call or write the company to answer your questions. Don't trust any sales presentation or literature that claims you have only one chance to buy a policy.

Some companies sell their products through agents, and others may sell their policies through the mail, skipping agents entirely. No matter how you buy your policy, check with the company if you don't understand how the policy works.

Talk about the policy with a friend or relative. In New York State you may want to contact the state insurance department, or the Erie County Long Term Care Insurance Education and Outreach Program of Senior Services at (716) 858-7883.

Don't be Misled by Advertising Most celebrity endorsers are professional actors paid to advertise. They are not insurance experts.

Medicare does not endorse or sell long term care insurance policies. Be wary of any advertising that suggests Medicare is involved.

Don't trust cards you get in the mail that look like official government documents until you check with the government agency identified on the card. Insurance companies or agents trying to find buyers may have sent them. Be careful if anyone asks you questions over the telephone about Medicare or your insurance. They may sell any information you give to long tem care insurance marketers, who might call you, come to your home, or try to sell you insurance by mail.

Don't Buy More Coverage Than You Need You don't have to buy more than one policy to get enough coverage. One good policy is enough. Also, don't buy more insurance than you need. If you already own a policy and you are considering switching plans or upgrading your coverage investigate your options thoroughly. Be sure that the replacement is effective before you terminate the older policy. Be sure to discuss any change in your coverage with your financial advisor.

Be Sure You Accurately Complete Your Application Don't be misled by long term care insurance marketers who say your medical history isn't important.-it is! Give correct information. If an agent fills out the application for you, don't sign it until you have read it. Make sure that all of the medical information is right. If it isn't and the company used that information to decide whether to insure you, it can refuse to pay your claims and even cancel your policy.

Never Pay in Cash Use a check, money order made payable to the insurance company.

Be Sure to Get the Name, Address, and Telephone Number of the Agent and the Company Get a local or toll-free number for both the agent and the company.

If You Don't Get Your Policy Within 60 Days, Contact the Company or Agent You have the right to expect prompt delivery of your policy. When you get it, keep it somewhere that you can easily find it. Tell a trusted friend or relative where it is.

Be Sure You Look at Your Policy During the Free-Look Period If you decide you don't want the policy soon after you bought it, you can cancel it and get your money back. You must tell the company you don't want the policy within a certain number of days after you get it. How many days you have depends on the free look period. In New York State this period is 30 days for tax-qualified policies and from 10 to 30 days for non-tax-qualified policies. If you want to cancel,

  • Keep the envelope the policy was mailed in. Or ask the agent for a signed delivery receipt when he or she hands you the policy
  • Send the policy to the insurance company along with a short letter asking for a refund.
  • Send both the policy and the letter by certified mail. Keep the mailing receipt.
  • Keep a copy of all letters

It usually takes four to six weeks to get your refund.

Read the Policy Again and Make Sure it Gives You the Coverage You Want Check the policy to see if the benefits are what you expected. If you have any questions, call the agent or company right away. Also read the application you signed. It is part of the policy. If it is not filled out correctly, contact the agent or company right away.

Think About Having the Premium Automatically Taken Out of Your Bank Account Automatic withdrawal may mean that you won't lose your coverage if an illness makes you forget to pay your premium. If you decide not to renew your policy, be sure you tell the bank to stop the automatic withdrawals.

Check on the Financial Stability of the Company You're Thinking about Buying From Several insurer rating services analyze the financial strength of insurance companies. The ratings can show you how some analysts see the financial health of individual insurance companies. Different rating services use different rating scales. Be sure you find out how the agency labels its highest ratings and the meaning of the ratings for the companies you are considering. You can get ratings from some insurer rating services for free at most public libraries.

back to topics

 

Additional Helpful Links:

http://www.nyspltc.org/   The NYSPLTC is a unique program that links private LTC insurance with Medicaid Extended Coverage to provide lifetime LTC coverage to Partnership policyholders. To gather additional information about NYSPLTC policies, as well as other LTC insurance policies available in New York, consumers can also contact the New York State LTC Insurance Helpline at 1-866-950-PLAN.

General long-term care insurance information,http://www.aging.ny.gov/healthbenefits/  or http://www.aarp.org

Plan Ahead NY - Long Term Care Insurance - http://planaheadny.com/

The National Clearinghouse for Long-Term Care Information Web site provides comprehensive information about long-term care planning, services and financing options, along with tools to help people begin the planning process. The Clearinghouse Web site was designed by Administration on Aging(AoA), Centers for Medicare & Medicaid Services (CMS) and the Assistant Secretary for Planning and Evaluation (ASPE).

www.longtermcare.gov

back to topics

 

Note: The information provided by the Long Term Care Insurance Education & Outreach Program is intended for the sole purpose of educating consumers in regard to the choices available for financing their future long term care needs. Particular emphasis is placed on understanding long-term care insurance. Nothing herein is intended nor should it be construed as an endorsement by the State of New York of any specific insurance product or insurer.