©2010 goldencare usa. agent’s role understand long term care insurance and the industry ...


Agent’s RoleAgent’s Role

Understand Long Term Care insurance and Understand Long Term Care insurance and the industrythe industry

Research insurance companies and policiesResearch insurance companies and policies Represent multiple carriers to offer you Represent multiple carriers to offer you

coverage to fit your individual needscoverage to fit your individual needs

In other words, to look at the thingsIn other words, to look at the thingsyou would when “shopping” for coverage!you would when “shopping” for coverage!


The Steps Of The ProcessThe Steps Of The Process

Can Can youyou qualify qualify for long term care coverage? for long term care coverage? Do Do youyou need long term care coverage?need long term care coverage? Educate Educate youyou about long term care! about long term care! Design an affordable plan for Design an affordable plan for you!you! Start the process for Start the process for you!you!

Does this process sound fair to you?Does this process sound fair to you?May we proceed?May we proceed?


Can You Qualify For Coverage?Can You Qualify For Coverage?

Have you been hospitalized in the last five Have you been hospitalized in the last five years?years?

Are you taking any prescription Are you taking any prescription medications?medications?

Many can’t qualify for coverage!Many can’t qualify for coverage!They waited too long!They waited too long!


Do You Need Coverage?Do You Need Coverage?

State Law requires an agent to determine the State Law requires an agent to determine the suitability of Long Term Care coverage prior suitability of Long Term Care coverage prior recommending the coverage to a client!recommending the coverage to a client!

Suitability is determined by considering your:Suitability is determined by considering your: IncomeIncome AssetsAssets Need for the coverageNeed for the coverage Personal goalsPersonal goals


Doesn’t Health Insurance Pay?Doesn’t Health Insurance Pay?

Health insurance and Medicare protects Health insurance and Medicare protects against the cost of treating illness or injuryagainst the cost of treating illness or injury

Both may cover limited “Skilled Care”Both may cover limited “Skilled Care” Medicare may pay up to 100 days of Skilled Care Medicare may pay up to 100 days of Skilled Care

in a nursing homein a nursing home

Long Term Care insurance covers the on-Long Term Care insurance covers the on-going care required by those unable to care going care required by those unable to care for themselvesfor themselves

Long Term Care Insurance can allow you to be cared Long Term Care Insurance can allow you to be cared for in the comfort of your home!for in the comfort of your home!


Why Is LTCi An Issue Today?Why Is LTCi An Issue Today?

The “Aging Of America” is causing an increased need The “Aging Of America” is causing an increased need for health carefor health care 10,000 Americans turn age 65 every day10,000 Americans turn age 65 every day First baby boomer turned age 65 in 2011First baby boomer turned age 65 in 2011 2007 to 2030 – 89% increase in 65+ population2007 to 2030 – 89% increase in 65+ population

Medicare & Medicaid budgets are in trouble!Medicare & Medicaid budgets are in trouble!The Government simply can’t keep payingThe Government simply can’t keep paying

like they have in the past!like they have in the past!

US Census Bureau US Census Bureau


Legislative ChangesLegislative Changes

2002: Federal Government began offering LTCi 2002: Federal Government began offering LTCi coverage to 22M employees, retirees and their coverage to 22M employees, retirees and their familiesfamilies

Tax Incentives were passed to encourage the Tax Incentives were passed to encourage the rest of Americans to purchase coveragerest of Americans to purchase coverage

States begin to provide tax incentivesStates begin to provide tax incentives Own Your Own Future campaignOwn Your Own Future campaign Deficit Reduction Act of 2005Deficit Reduction Act of 2005


Deficit Reduction Act of 2005Deficit Reduction Act of 2005

Severely tightened Medicaid rulesSeverely tightened Medicaid rules Extended look-back period on transferring assetsExtended look-back period on transferring assets

Increased penalties for transferring assetsIncreased penalties for transferring assets

Authorized State Partnership PlansAuthorized State Partnership Plans Gives people an incentive to buy Long Term Care Gives people an incentive to buy Long Term Care

insuranceinsurance

By offering dollar-for-dollar asset protectionBy offering dollar-for-dollar asset protection


Who Needs Long Term Care?Who Needs Long Term Care?(over age 18)(over age 18)

44% are under age 6544% are under age 65

““Report to the Congress” US Senate Commission on Long Term Care, September 30, 2013Report to the Congress” US Senate Commission on Long Term Care, September 30, 2013

56% are age 65 and 56% are age 65 and olderolder


Where Is Care Provided?Where Is Care Provided?

““Medicaid and Long Term Care Services and Supports” Medicaid and Long Term Care Services and Supports” Kaiser Commission , June 2012Kaiser Commission , June 2012

1.6M in Nursing Homes1.6M in Nursing Homes 8.4M in Community8.4M in Community

84% receive care in the community!84% receive care in the community!


Two reasons people need Long Term CareTwo reasons people need Long Term Care

First – Acute NeedsFirst – Acute Needs

Medicare uses Diagnostic Related Groups (DRG’s)

Hospitals get paid a set fee depending on diagnosis

Examples: Cardiac arrest – 3

days Hip fracture – 6 days

Remember: Most health policies also use methods

to limit hospital stays!


Two reasons people need Long Term CareTwo reasons people need Long Term Care

Second – Chronic NeedsSecond – Chronic Needs

Alzheimer’s and dementia Chronic arthritis Osteoporosis and/or

broken bones Diabetes, kidney and

circulatory problems Major strokes

Can you see where you could face an Can you see where you could face an acute or chronic situation at some point in your life?acute or chronic situation at some point in your life?


Here Are The Odds…Here Are The Odds…

70% of people over age 65 will require some long 70% of people over age 65 will require some long term care services at some point in their livesterm care services at some point in their lives11

Woman are especially at risk. At age 65, they have a Woman are especially at risk. At age 65, they have a 79% chance of needing care79% chance of needing care22

Married couples have over a 90% chance that one of Married couples have over a 90% chance that one of them will need carethem will need care11

1 “Medicare & You” 1 “Medicare & You” The Official Medicare Handbook, 2013The Official Medicare Handbook, 20132 “”Long Term Care; A Women’s Issue” 2 “”Long Term Care; A Women’s Issue” Kathleen Connell, AARP Website 2012 Kathleen Connell, AARP Website 2012

©2010 Goldencare USA““2012 2012 Cost of Care Survey” Cost of Care Survey” American Association for Long-Term Care, 2012American Association for Long-Term Care, 2012

Average LTC CostsAverage LTC Costs

Nursing Home (Private Bed)Nursing Home (Private Bed) $233 Day/ $85,045 Annually$233 Day/ $85,045 Annually

Nursing Home (Semi-Private)Nursing Home (Semi-Private)$209 Day/ $76,285 Annually$209 Day/ $76,285 Annually

Assisted Living (One bedroom)Assisted Living (One bedroom)$3,350 Month/ $40,200 Annually$3,350 Month/ $40,200 Annually

Home Health Aide (30 hrs week)Home Health Aide (30 hrs week)$21 Hour/ $32,760 Annually$21 Hour/ $32,760 Annually

Remember…these costs could double or

triple by the time you need care


Who Really Pays?Who Really Pays?

MedicaidMedicaid43%43%

Out-of-pocketOut-of-pocket19%19%

Out-of-pocketOut-of-pocket19%19%

Medicare Post Medicare Post Acute Care – 24%Acute Care – 24%

Medicare Post Medicare Post Acute Care – 24%Acute Care – 24%

Other Private Other Private 5%5%

Other Private Other Private 5%5%

Private healthPrivate healthinsurance – 7%insurance – 7%Private healthPrivate health

insurance – 7%insurance – 7%

Veteran benefits – <2%Veteran benefits – <2%Veteran benefits – <2%Veteran benefits – <2%

““Medicaid and Long Term Care Services and Supports” Medicaid and Long Term Care Services and Supports” Kaiser Commission , June 2012Kaiser Commission , June 2012


3 Ways to Pay for LTC!3 Ways to Pay for LTC!

Be Be ((VeryVery)) Rich! Rich!

Be Be ((VeryVery)) Poor! Poor!

Be Insured!Be Insured!

It took a lifetime to build your nest egg…It took a lifetime to build your nest egg…

Why lose it?Why lose it?


Fire or tornado?Fire or tornado?Homeowners insuranceHomeowners insurance

Fire or tornado?Fire or tornado?Homeowners insuranceHomeowners insurance

Car accident?Car accident?AutoAuto

insuranceinsurance

Car accident?Car accident?AutoAuto

insuranceinsurance

Heart attack?Heart attack?Major Major

medicalmedicalinsuranceinsurance

Heart attack?Heart attack?Major Major

medicalmedicalinsuranceinsurance

Long term care?Long term care?You pay?You pay?

Long term care?Long term care?You pay?You pay?

House/Autos, Savings/Investments, Income

House/Autos, Savings/Investments, Income

The Walls Around Your EstateThe Walls Around Your Estate

3 in 4

1 in 2401 in 15

1 in 1,200

“Chances Are You’ll Need Assistance” Randy Watson, San Francisco Examiner, September, 2009


Why People Buy LTC Insurance?Why People Buy LTC Insurance?

1.1. Choice and independenceChoice and independence

2.2. Avoid over-burdening their childrenAvoid over-burdening their children

3.3. Protection of assets and incomeProtection of assets and income

1.1. Choice and independenceChoice and independence

2.2. Avoid over-burdening their childrenAvoid over-burdening their children

3.3. Protection of assets and incomeProtection of assets and income

Planning earlyPlanning earlycan accomplish all three!can accomplish all three!


What Would Be Your Reason?What Would Be Your Reason?

Give Give yourselfyourself a choice of quality care?a choice of quality care?

Maintain Maintain youryour personal independence? personal independence?

Avoid over-burdening Avoid over-burdening youryour children?children?

Protect Protect youryour savings and assets?savings and assets?

Pass on a legacy to Pass on a legacy to youryour heirs? heirs?

Avoid impoverishing Avoid impoverishing youryour spousespouse

Which is most important to you?Which is most important to you?


Long term care insurance is flexible. We can…Long term care insurance is flexible. We can…

Design a plan focused totally on priceDesign a plan focused totally on price

Design a plan focused totally on benefitsDesign a plan focused totally on benefits

Long term care insurance is flexible. We can…Long term care insurance is flexible. We can…

Design a plan focused totally on priceDesign a plan focused totally on price

Design a plan focused totally on benefitsDesign a plan focused totally on benefits

It’s Your Choice!It’s Your Choice!

OR…OR…

Anywhere in between!Anywhere in between!


Progression of CareProgression of CareFamily and Friends - Informal CareFamily and Friends - Informal Care

Pays CASH – Day One – NO Restrictions!Pays CASH – Day One – NO Restrictions! Pay family and friendsPay family and friends Cover additional costs and expensesCover additional costs and expenses Pay bills or use for any other purposePay bills or use for any other purpose No worries about submitting billsNo worries about submitting bills

Premiums are waived when benefits start!Premiums are waived when benefits start!

87% of people needing care87% of people needing carereceive that care from unpaid caregiversreceive that care from unpaid caregivers11

1 “Report to the Congress” US Senate Commission on Long Term Care, September 30, 20131 “Report to the Congress” US Senate Commission on Long Term Care, September 30, 2013


Progression of CareProgression of CareFormal Home Health CareFormal Home Health Care

When your family needs helpWhen your family needs help Covers professional and basic services Covers professional and basic services

Nursing, therapy, specialist and homemaker Nursing, therapy, specialist and homemaker servicesservices

IncludesIncludes Therapeutic devices, medical alert and home Therapeutic devices, medical alert and home

modificationmodification

Let’s keep you out of a facilityLet’s keep you out of a facilityas long as possible!as long as possible!


Progression of CareProgression of CareAssisted Living FacilitiesAssisted Living Facilities

Offers attractive alternatives to the nursing Offers attractive alternatives to the nursing home includinghome including Assisted Living FacilitiesAssisted Living Facilities Congregate Care HomesCongregate Care Homes Alzheimer's Care UnitsAlzheimer's Care Units Personal Care and more!Personal Care and more!

Choice is the key here!Choice is the key here!You decide if and when you want options!You decide if and when you want options!


Progression of CareProgression of CareNursing HomeNursing Home

Covers all levels of care Covers all levels of care Skilled, intermediate, custodial and Skilled, intermediate, custodial and

personalpersonal No prior hospitalizationNo prior hospitalization Alzheimer's is coveredAlzheimer's is covered Guaranteed Renewable for lifeGuaranteed Renewable for life

Protection of assetsProtection of assetsis the key here!is the key here!


Let’s design aLet’s design a

personalized planpersonalized plan

for you!for you!

©2010 goldencare usa. agent’s role understand long term care insurance and the industry ...

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