Long-term care is a variety of services that includes medical and non-medical care to people who have a chronic illness or disability. Long-term care helps meet health or personal needs. Most long-term care is to assist people with support services such as activities of daily living like dressing, bathing, and using the bathroom. Long-term care can be provided at home, in the community, in assisted living or in nursing homes. It is important to remember that you may need long-term care at any age.

You may never need long-term care. This year, about nine million men and women over the age of 65 will need long-term care. By 2020, 12 million older Americans will need long-term care. Most will be cared for at home; family and friends are the sole caregivers for 70 percent of the elderly. A study by the U.S. Department of Health and Human Services says that people who reach age 65 will likely have a 40 percent chance of entering a nursing home. About 10 percent of the people who enter a nursing home will stay there five years or more.

Medicare and Long-Term Care:

While there are a variety of ways to pay for long-term care, it is important to think ahead about how you will fund the care you get. Generally, Medicare doesn’t pay for long-term care. Medicare pays only for medically necessary skilled nursing facility or home health care. However, you must meet certain conditions for Medicare to pay for these types of care. Most long-term care is to assist people with support services such as activities of daily living like dressing, bathing, and using the bathroom. Medicare doesn’t pay for this type of care called “custodial care”. Custodial care (non-skilled care) is care that helps you with activities of daily living. It may also include care that most people do for themselves, for example, diabetes monitoring. Some Medicare Advantage Plans (formerly Medicare + Choice) may offer limited skilled nursing facility and home care (skilled care) coverage if the care is medically necessary. You may have to pay some of the costs. For more information about Medicare Advantage Plans, click here Medicare Advantage.

Medicaid and Long-Term Care:

Medicaid is a State and Federal Government program that pays for certain health services and nursing home care for older people with low incomes and limited assets. In most states, Medicaid also pays for some long-term care services at home and in the community. Who is eligible and what services are covered vary from state to state. Most often, eligibility is based on your income and personal resources.

Choosing Long-Term Care:

Choosing long-term care is an important decision. Planning for long-term care requires you to think about possible future health care needs. It is important to look at all of your choices. You will have more control over decisions and be able to stay independent. It is important to think about long-term care before you may need care or before a crisis occurs. Even if you plan ahead, making long-term care decisions can be hard.

“Long Term Care Is Just For The Elderly.”

The need for LTC can arise for anyone, from the elderly to the very young. While the majority of those requiring LTC are certainly older people, numerous cases also arise from severe unexpected illnesses, automobile accidents, or mishaps of various kinds.

“It’s Something That Happens To Other People.”

Of the 12.8 million people that need help with everyday activities almost 40% (5.1 million) are working age adults (ages 18-64). (1)

“Long Term Care Means Nursing Home.”

Surprisingly, health care institutions provide only 22% of long term care. An overwhelming 78% is provided at home or in the community. (2) And 64% of those caregivers have jobs outside the home. (3)

The Issue.

As a national average, one year in a nursing home is estimated to cost $40,000. In some regions, it can easily cost twice that amount. Home care is less expensive but still adds up. Bringing a health care professional into your home just three times a week can easily cost $1,000 each month, or $12,000 each year. (5)

Currently, personal savings and government funding programs may be inadequate to cover the vast majority of long term care expenses. Personal assets of most individuals are often alarmingly inadequate to cover long term care. Clearly, many individuals and families could see their assets quickly disappear.

There is a critical gap that needs to be filled — one you can fill with Unum Life Insurance Company of America’s Long Term Care Insurance.

The vast majority of caregivers are family members. Today, almost one fourth of American households — over 22 million — are providing informal care to a friend or relative. That’s three times the number of caregivers reported ten years ago. (6)

Sources (Statistics are based on projections by the author)
1 Employee Benefit Research Institute Issue Brief No. 163, July 1995.
2 “The Lowdown on Long Term Care,” Business and Health, August, 1995, p. 19.
3 “More Spend Time Caring for Elders,” Karen S. Peterson, USA Today, March 18, 1997, p. 1D.
4 Ibid.
5 HIAA “Consumers Guide to Long Term Care,” 1996.
6 “More Spend Time Caring for Elders,” Karen S. Peterson, USA Today, March 18, 1997, p. 1D.

What is the Donut Hole?

The Donut Hole is a term used to describe the gap in the Medicare Part D plan coverage where the Medicare Part D plan participant (you) must pay 100% of the cost for your prescription drugs.

This break in coverage is also sometimes referred to as the Coverage Gap. The Donut Hole is the phase of your prescription drug plan where the total retail costs of the medication is paid for out of your own pocket.
Important Dates to Remember
When Can I Join a Prescription Drug Plan?

(1) If you currently have Medicare Hospital or Medicare Medical Insurance (Parts A and/or B), you can enroll or re-enroll in a Medicare Part D Prescription Drug Plan (PDP) or Medicare Advantage Plan with Prescription Coverage (MA.PD) starting on November 15 through December 31 of each year.

This tIme period is called the Annual Election Period and your newly chosen Medicare Part D plan begins on January 1 of the following year.

TIP Please note, to ensure the smoothest possible transition into your new Medicare Part D plan, try to enroll well before the middle of December – this allows the insurance companies, CMS and Social Security time for the processing of your enrollment application.

So, for the 2007 Medicare Part D Plans, you can enroll between November 15 2007 and December 31, 2007. Your 2007 Plan will begin January 1, 2008.

Insurance companies can only sell you a “standardized” Medigap policy. These Medigap policies must all have specific benefits so you can compare them easily.

You may be able to choose up to 12 different standardized Medigap policies (Medigap Plans A through L). Medigap policies must follow Federal and State laws. These laws protect you. A Medigap policy must be clearly identified on the cover as “Medicare Supplement Insurance.” Each plan, A through L, has a different set of basic and extra benefits.

It’s important to compare Medigap policies because costs can vary. The benefits in any Medigap Plan A through L are the same for any insurance company. Each insurance company decides which Medigap policies it wants to sell.

Generally, when you buy a Medigap policy you must have Medicare Part A and Part B. You will have to pay the monthly Medicare Part B premium. In addition, you will have to pay a premium to the Medigap insurance company.

You and your spouse must each buy separate Medigap policies. Your Medigap policy won’t cover any health care costs for your spouse.

A healthy workforce, and a healthy budget. Insurance Benefits Services is here to help.

We offer the single solution for your benefits needs. Coordinated health benefits can mean better outcomes for employees, and simplified administration for you. We provide the right medical coverage solutions, without breaking the budget. We offer benefits and insurance plans and products that are:

• Affordable
• Innovative
• Flexible
• Easy to use

Health Care Insurance Carriers that we represent.

• HMAA
• Summerlin
• UHA
• Kaiser

Call us today for an affordable Group Medical Quote.

• Dental Plus Hawaii brings you inexpensive, reliable, easy-to-enroll dental insurance for you and the whole family.
• We’ve created a variety of plans for individuals, seniors, and small to large employer groups.
• We’re confident you will be impressed with the plans, the price, and the ease of enrollment.

To find out more about our Dental Insurance programs please go to our Dental Plus Hawaii website. Or call our office at 808-941-6617

Visit Dental Plus Hawaii online

New 2011 Dental Plus Hawaii Rates

Individual

Superior –Monthly: $61.79
                    Quarterly: $172.87
                    Annually: $666.48

Primary –Monthly: $49.86
                   Quarterly: $137.08
                   Annually: $523.32

Value –  Monthly: $35.39
                 Quarterly: $93.67
                 Annually: $349.68

Individual + 1:

Superior –Monthly: $108.69
                    Quarterly: $313.57
                    Annually: $1,229.28

Primary –Monthly: $86.25
                   Quarterly: $246.25
                   Annually: $960.00

Value –  Monthly: $59.05
                 Quarterly: $164.65
                 Annually: $633.60

Individual + 2:

Superior –Monthly: $140.66
                    Quarterly: $409.48
                    Annually: $1,612.92

Primary –Monthly: $111.07
                   Quarterly: $320.71
                   Annually: $1,257.84

Value –  Monthly: $75.18
                 Quarterly: $213.04
                 Annually: $827.16

Individual + 3:

Superior –Monthly: $172.63
                    Quarterly: $505.39
                    Annually: $1,996.56

Primary –Monthly: $135.88
                   Quarterly: $395.14
                   Annually: $1,555.56

Value –  Monthly: $91.31
                 Quarterly: $261.43
                 Annually: $1,020.72

Plans we have:

— Ohana Health Plan
— AlohaCare
— Humana

What is Medicare Advantage?

Medicare Advantage (formerly called Medicare+Choice) offers several health care alternatives to original Medicare. Original Medicare allows you to visit any doctor, hospital, or health provider that accepts Medicare. Medicare pays for many of the health care services and supplies you receive but doesn’t pay for all costs. You may be required to pay for coinsurance, copayments, and deductibles.
Medicare Advantage plans may offer more benefits and have lower out-of-pocket costs. Medicare Advantage plans are available from private companies that contract with the Center for Medicare and Medicaid Services (CMS), the federal agency that administers the Medicare program. The plans have at least the same benefits as Medicare Part A (hospital coverage) and Part B (medical coverage) and often include additional benefits, such as the Medicare prescription drug coverage (Medicare Part D).
To be eligible to join a Medicare Advantage plan, you must live in the plan’s service area, be enrolled in Medicare Part A and Part B, and not have end-stage renal (kidney) disease. You can typically enroll in a Medicare Advantage plan even if you have existing health problems, except for end-stage renal disease. (You can continue in the Medicare Advantage plan if you develop end-stage renal disease while you are in the plan.) Medicare Advantage special needs plans may be an option for some people with chronic health conditions.
If you enroll in a Medicare Advantage plan, you are still part of the Medicare program. Medicare will pay your Medicare Advantage plan a set amount each month. You pay your monthly Medicare Part B premium in addition to any additional premium the Medicare Advantage plan charges.
Each year, Medicare Advantage plans can decide to join or leave Medicare. If your plan leaves Medicare, you will receive prior notice and have several options to obtain Medicare benefits. You may join another Medicare Advantage plan in your area or return to original Medicare. If you return to original Medicare, you have a right to buy a Medicare supplement insurance policy. Medicare supplement insurance, sometimes called Medigap, pays some of the expenses that original Medicare doesn’t cover. If you apply within 63 days of the date your Medicare Advantage coverage ends, an insurance company must sell you a Medigap policy regardless of your medical history or pre-existing conditions. This protection is called a “guaranteed issue right.” The departing plan will provide you information about this and other rights and options available.
CMS annually publishes its Medicare & You guide that contains information about changes in Medicare and information about Medicare Advantage plans available in the state of Hawaii. Beneficiaries receive copies in the mail, and the guide is available on the Medicare website
For More Information or Assistance
If you have questions about Medicare or what Medicare Advantage options are available in your area, call the Medicare Hot Line or visit the Medicare website. For quality of care information about Medicare Advantage plans and satisfaction survey comparisons, visit the interactive Medicare Health Plan Compare page on the Medicare website
1-800-MEDICARE (633-4227)
1-877-486-2048 (for the hearing and speech impaired)
www.medicare.gov
If you need more information about a Medicare Advantage plan in your community, call your local Area Agency on Aging (AAA) office
1-800-252-9240