MedAmerica Insurance Company
Home Office: Pittsburgh, PA
Home Office: Pittsburgh, PA
MedAmerica Insurance Company of New York
Home Office: Rochester, NY
Home Office: Rochester, NY
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Questions and Answers On this page, you will find answers to the most commonly asked questions about long-term care services and insurance. MedAmerica would be happy to answer any other questions you might have. Simply contact us by e-mail or call Customer Service, 1-800-544-0327.
What is Long-Term Care? Long-term care is the personal care you may need on an ongoing basis in the case of a disabling or chronic medical condition. Long-term care is not one service, but many different services aimed at helping people with the essential activities of daily living such as bathing or dressing, or other needs due to an accident, chronic illness, or just due to the frailty of old age. 1 Long-term care is not just nursing home care. There are 1.5 million people in nursing homes and almost 10 million people being cared for in the community, at home, in assisted living facilities, adult day care centers or adult foster homes. 2 Long-term care does not just apply to the elderly. In fact, over 40% of all people who need long-term care are under the age of 65. 3 Younger people may need long-term care for a variety of reasons including accidents, multiple sclerosis, strokes, or other debilitating conditions. What would long-term care insurance cover? Examples of services which are covered by long-term care insurance include the following (benefits vary by state and product):
Top When is Long-Term Care needed? Long-term care is needed when an individual requires assistance to perform at least two of the essential activities of daily living (ADLs). The six ADLs that have been established as the national standard for tax-qualified long-term care programs are: bathing, eating, transferring, continence, toileting, and dressing. (They are described further in the Long-Term Care Glossary of Terms .) Long-term care is also need when an individual suffers from severe cognitive impairment, such as Alzheimer's disease. Individuals with these conditions often need supervision to ensure their safety or the safety of those around them. Top I'm still young, why worry about Long-Term Care NOW? Long-term care is not just for the elderly. That fact is, anyone may need long-term care because of an accident or a debilitating chronic illness. Your current health condition is a consideration to determine if you are accepted for coverage. The older you get, the more the coverage will cost you. At a cost of $120, for example, six months of long-term care may be financially devastating. You can't insure your automobile after you've had a major car accident. Well, the same principle applies to long-term care insurance. Once you develop a chronic condition such as Alzheimer's or rheumatoid arthritis, chances are you will not be eligible to enroll. That's why it pays to purchase a plan now, while you are still eligible. And the earlier you enroll, the more affordable your monthly premium will be. You can get lifetime protection for only a mere fraction of what it would cost you to pay for the care you may need. This is especially true if you secure coverage when you're younger. So it makes sense to protect yourself by purchasing long-term care coverage right away. Consider your future... "If you're middle-aged and have considered purchasing a plan but have been dragging your feet, now may be a good time to take action." - Business Week, 10/14/96 You've worked hard to ensure independence and security. You insisted on sound financial planning to meet your present and future needs such as vacation and retirement. But what about the next step? Are you preparing for the time when you may need personal care and assistance, a time that could come at any age? The right long-term care insurance policy--one designed to meet your needs and financial situation--is an essential part of sound financial planning. And since premiums are based on your age at the time you apply, the younger you are when you apply, the lower your premium payments will be. What is the cost of waiting? Definition: The total cost of premiums paid at one age versus the cost of premiums paid if purchased at a later age. Select one of the rows for sample age 40, 50 or 60 and read across to find the total cost of premiums. The example assumes the insured goes on claim at age 85 so the total cost is the total of all premiums paid to age 85. The cost of waiting is the difference in total premiums paid between the purchase age in the row and the total premium paid if the purchase was delayed to the age shown in the column heading. The chart indicates that the longer your wait, the more it will cost for a policy providing the same level of benefits. This is due to the combined effects of increased age at purchase and benefits that increase by 5% compounded annually. The example is based upon a policy with a $150 daily benefit amount, a 90-day elimination period (deductible), a three year benefit period, 5% compound inflation protection and the assumption that premiums are paid to age 85.
Top Who pays for Long-Term Care? Medicare was designed to pay for hospital acute care costs and pays only about 9% of all long-term care costs nationwide. This 9% is usually for skilled care immediately following hospitalization. 4 Medicare Supplements may help with skilled nursing home care costs, but neither Medicare nor many of the policies designed to supplement Medicare cover the intermediate and custodial care that many people will need. Medicaid does not pay for either nursing home care or other long-term care unless you are at the federal poverty level or until you spend down your assets to meet Medicaid's eligibility requirements. That leaves the responsibility for long-term care costs with you... or possibly with your family. You don't want to rely on others or burden your family with unexpected needs and bills. You want to know that when you need long-term care, you can make that choice and you can pay for it-- because you have planned wisely. Top Won't Medicare cover my Long-Term Care expenses? Medicare was designed as a federal health insurance program for people age 65 and older. Medicare was NOT designed to cover long-term care. In actuality, Medicare pays for less than 9% of long-term care services nationwide. 5 Supplements from Medicare may help with skilled nursing home care costs, but these supplements are not designed to cover intermediate and custodial care that most people will need. Top What is the likelihood I will need Long-Term Care? Long-term care insurance is not just for the elderly. While everyone thinks "it won't happen to me," statistics show that is not the case. Many working-age adults suffer from disabling injuries or illnesses, including arthritis, heart disease, stroke, mental impairment, and trauma that require ongoing care. 40% of Americans receiving long-term care services are between the ages of 18 and 64 due to accidents or failing health. 6 Top Would a person who currently cannot perform 2 of the 6 Activities of Daily Living (ADLs) be issued a policy? No. Top Are benefits paid to the provider of service or to the policyholder? Benefits are traditionally paid to the insured, but may be paid directly to the provider of service at the insured's request. Top What is the effective date of coverage? The effective date of the policy will be determined by MedAmerica when the policy is issued. The policyholder will be notified. In situations when a person has submitted an application and has a birthday between the time the application was signed and the policy is issued, the premium will be based on the age of the person when the application was signed. Top Are benefits coordinated with Medicare? Only skilled services are covered by Medicare or your health insurance plan, depending on the kind of coverage you have. In addition, Medicare does not cover the personal and custodial care covered by the long-term care benefits. Any benefits that may be reimbursable under Medicare will not be reimbursed under your Long Term Care coverage, except for the application of a deductible or coinsurance amount. Top Can I obtain services anywhere in the world? Yes, the benefits provided by MedAmerica are portable worldwide! Top |
