Insurance
Information
about Medicare and Supplemental Policies
The Seniors' Health Insurance
Information Program (SHIIP) helps older people understand the options and
benefits in health insurance products sold in North Carolina. It uses over 1,500
trained volunteers across the state to assist with questions about Medicare,
private Medicare supplement insurance, and private long term care insurance.
Long Term
Care Insurance
- Things
You Should Know Before You Buy Long-Term Care Insurance
- Consumer
Bill of Rights for Buyers of Long Term Care Insurance
- Long
Term Care Insurance Personal Worksheet
- Report
on Long Term Care Insurance
- Things You Should
Know Before You Buy Long-Term Care Insurance
People buy long-term care insurance for a variety of reasons. These reasons
include to avoid spending assets for long-term care, to make sure there are
choices regarding the type of care received, to protect family members from
having to pay for care, or to decrease the chances of going on Medicaid.
However, long-term care insurance can be expensive, and is not appropriate
for everyone. Therefore we offer below some things to think about before
buying long-term care insurance and some questions to help you assess how
suitable a candidate you may be for this type of insurance. These suggestions
are based on information provided by the National
Association of Insurance Commissioners.
- A long-term care
insurance policy may pay most of the costs for your care in
a nursing home. Many policies also pay for care at home or
other community settings (such as adult day care). Because
policies can vary in coverage, you should read the policy carefully
and make sure you understand what it covers before you buy
it.
- You should not buy
an insurance policy unless you can afford to pay the premiums
every year. Remember that the company can increase premiums
in the future. See the Personal Worksheet below for ideas.
- Make sure the insurance
company or agent gives you a copy of a book called the National
Association of Insurance Commissioners' "Shopper's Guide to
Long Term Care Insurance." Read it carefully. If you have decided
to apply for long-term care insurance, you have the right to
return the policy within 30 days and get back any premium you
have paid if you are dissatisfied for any reason or choose
not to purchase the policy.
- Free counseling and
additional information about long-term care insurance are available
through the Seniors'
Health Insurance Information Program (SHIIP) of the North
Carolina Department of Insurance.
- Consumer Bill of
Rights for Buyers of Long Term Care Insurance
The Division of Aging and Adult Services and the Department of Insurance's
SHIIP program are pleased to have developed the following Consumer Bill of
Rights for Buyers of Long Term Care Insurance. This was developed with input
from consumer and trade representatives.
As someone considering
the purchase of long term care insurance, you have the right:
- To know that the
company is licensed by the Office of the North Carolina Insurance
Commissioner to sell long term care insurance in this state
and that the policy being offered has been approved.
- To know whether the
policy qualifies as a medical expense for federal tax purposes.
(Only unreimbursed medical expenses greater than 7.5% of your
adjusted gross income can be deducted.)
- To know that the
insurance agent must give you a copy of the "Shoppers Guide
to Long Term Care Insurance" from the National Association
of Insurance Commissioners. The guide includes a "suitability
worksheet" to help you decide if long term care insurance is
right for you.
- To know what the
premium cost will be and if there are any other out-of-pocket
costs associated with buying and using the policy such as waiting
periods, deductibles or co-payments. You also have the right
to know that your premiums can increase over time. You should
consider this fact when deciding if long term care insurance
is appropriate for you.
- To know the places
where covered benefits will be provided such as at home, in
a nursing home, assisted living facility, or adult day care
center.
- To understand what
benefits are covered, how you will qualify for benefits, and
under what conditions benefits would end.
- To know whether the
policy includes inflation protection and how much this optional
benefit costs.
- To know that your
application for long term care insurance can be denied and
that the company must give you, in writing, the reason (s)
for the denial. At your request, the insurance company will
notify your doctor if the denial is due to a medical condition.
(Denial by one company does not mean that you will be denied
by another company.)
- To cancel the policy
in the first 30 days and receive a full refund. You do not
have to give a reason for canceling the policy. You also have
the right to know what will happen if you cancel the policy
after the first 30 days.
- To get information
and counseling about long term care insurance free of charge
from the Seniors’ Health Insurance Information Program (SHIIP)
of the North Carolina Insurance Commissioners’ Office. Trained
counselors can answer your questions about long term care insurance
and provide written materials, including a questionnaire to
help you decide if you can afford the policy premiums for this
type of coverage over time.
- To know that you
can file a complaint with the Office of the North Carolina
Insurance Commissioner if:
- a claim for
covered care is denied
- you feel harassed
or pressured by a sales agent to purchase a policy
- you have any
other concerns about the insurance or the agent/company
North Carolina Insurance
Commissioner’s Office: 1-800-662-7777
Seniors’ Health Insurance Information Program (SHIIP): 1-800-443-9354.
- Long Term Care
Insurance Personal Worksheet
This worksheet includes some questions to help you determine whether the
long-term care insurance policy you are considering is appropriate for you.
Premium
The premium for the coverage you are considering will be [$ ________ per
month, or $_______ per year, or a one time single premium of $________ .]
Have you considered whether you could afford to keep this policy if the premiums
were raised, for example, by 20%?
Income
Where will you get the money to pay each year's premiums?
- Income -Savings -Family members
What is your annual income?
- Under $10,000 -$10-20,000 -$20-30,000 -$30-50,000 -Over $50,000
How do you expect your income to change over the next 10 years?
-No change -Increase -Decrease
If you will be paying premiums with money received from your own income,
a rule of thumb is that you may not be able to afford this policy if the
premiums will be more than 7% of your income.
Savings and Investments
Not counting your home, what is the approximate value of all of your assets
(savings and investments)?
-Under $20,000 -$20-30,000 -$30-50,000 -Over $50,000
How do you expect your assets to change over the next ten years?
-Stay about the same -Increase - Decrease
If you are buying this policy to protect your assets and your assets are
less than $30,000, you may wish to consider other options for financing
your long-term care.
- Division of
Aging Report on Long Term Care Insurance
The Division of Aging and Adult Services is interested in long-term care
insurance as one means of helping government and families better manage the
growing public and private cost of long term care. We produced a special
report, Increasing
Personal Responsibility for Long Term Care through Private Long Term Care
Insurance, in May 1996.
Date last modified: March 6, 2003
|
 |
Related links
Benefits
CheckUp
Medicaid
Medicare
Medicare
On-Line
Frequently Asked Questions
|
