Tuesday, March 30, 2010

What's In It For Me?

I'll be honest. I haven't taken the time to read the 2,000 page health care reform bill. I've had to rely on synopses and analyses from the media and from those organizations directly related to health care issues. I know that there's a lot of misinformation intentionally offered by those who expect to benefit from the distortions and I know there has been some sloppy journalism going on. Still, there have been some sources around I felt I could trust. One of those sources took the time to offer some insight into what the bill has for Medicare beneficiaries.

Dr. Bruce Chernof is president and chief executive of the SCAN Foundation and former director of the Los Angeles County Department of Health Services, and his opinion piece gives Congress credit for setting up the framework for one aspect of health care that did not get much press during the contentious debates: long term care.

Healthcare reform has made seniors, by and large, uneasy. Older Americans heard the words "cuts" and "Medicare" in the same sentence and were more likely to believe healthcare reform would hurt -- not help -- them. Lost in the maelstrom of misinformation, however, is the reality that the newly passed legislation lays the groundwork for greatly improving the full continuum of healthcare services for seniors, includes renovating our nation's nonexistent long-term care system.

...This means creating alternatives to nursing home placement, such as day-service programs, home-care aides, meal programs, senior centers and transportation services. Several provisions in the bill address this aim.

First is the creation of a public, voluntary long-term care insurance program known as the Community Living Assistance Services and Supports program -- CLASS for short. Enrolled individuals who have substantial daily needs would be eligible to receive at least $50 a day (after a five-year vesting period) to be used to defray the costs of services such as home care, family caregiver support, adult day-care or residential care. All actively working adults over 18 could enroll, with the purpose of getting the largest risk pool possible.

Second are programs that will help states expand home and community services so that seniors can avoid placement in a nursing home. A program called Community First Choice provides federal matching dollars for such care. Another increases funding for organizations that help seniors and their families navigate the complex web of our current long-term care services.

Third are impoverishment protections that prevent a healthy husband or wife from being forced to spend all of a couple's shared assets in order to get his or her partner access to community-based services care. Before this legislation, that protection was only available if the person who needed care was in a nursing home.

Dr. Chernof ticks off a few more provisions of special interest to elders, primarily involving tweaking Medicare itself in ways that cut the waste and fraud while improving the training of direct providers in geriatrics, all of which are important. These first three items, however, are crucial parts of what Dr. Chernof refers to as "the health care continuum."

Effective community-based services are an alternative to the far more expensive nursing homes. Many elders in the earlier stages of such conditions as Alzheimer's actually do better living at home than in a nursing home, but the toll on families can be devastating without day care or senior centers to lighten the load. Elders who can't prepare their own meals depend on such services as Meals On Wheels. Elders who need daily medical care, but not around the clock services, benefit from care givers who come in, provide treatment, assess needs, and see that those needs are met.

Dr. Chernof freely admits that the new bill has a long way to go before Congress can claim that elder care has been handled, but at least the framework is now in place upon which a more rational and, yes, less expensive system can be based. As someone who has a year and four months to go for Medicare eligibility and who has several pre-existing conditions, I was somewhat relieved by his recitation of what the bill actually contains.

Now it's back to the fight to get that system refined even further.

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Blogger Scott A Olson said...

The CLASS Act will not be an option for those who are already disabled (and unable to work) or those who are retired and do not want to work. The law requires that in order to qualify for benefits, one must pay premiums for 5 years AND must be working for at least 3 of those 5 years.

The CLASS Act's $50 per day "average benefit" will only cover a small portion of the $75,000+ per year most Americans pay for in-home care. Most people who want to protect their savings will still need to purchase long-term care insurance to supplement the CLASS Act benefit.

One of the biggest problems we face is that most Americans still think that Medicare or their medical insurance covers the cost of long term care.

The CLASS Act addresses this problem by making a very clear statement: You have to pay for your own long term care. You either have to pay for your own long term care by using your savings, the $50 per day CLASS Act benefit, long term care insurance, or a combination of these.

Most of the ten million Americans who own long term care insurance, own it because they've seen friends or family have to spend down their assets before qualifying for Medicaid. The CLASS Act will help alert the rest of the country to the fact that they need to financially plan for their future long term care needs.

Scott A. Olson

9:38 AM  
Anonymous Judith said...

$50 a day is nothing. An insulting nothing. All the rest is so much blather intended to look like it does something.

Meals on Wheels is already free, or voluntary pay-what-you-can-afford.

My mother, who died last fall, was home-bound and then bed-bound the last 2+years of her life; she needed help with meal prep, laundry, housekeeping...then with bathing, and dressing...and then to get in and out of bed...a panic line to call for help when she fell--home medical visits (the doctor prescribed the public health nurse to go see her)...then round the clock care, finally including help to the bathroom and with that.

NONE of that is paid for by medicare; $50 a day would cover less than three hours at home here and it's cheap here, comparatively: you try to find home health aides for under $18/hour, that are skilled enough to trust with your ill parent. And once again, cheaper here probably than elsewhere: long term care facilities start at around $5000 a month.

She was almost 80 when she had her first fall, requiring suddenly a walker and a hospital bed, etc--not such a great candidate for getting a job and paying into a scheme that still basically would have netted her nothing.

And if you try to get long term insurance after you are say, 45----don't bother, you can't afford it.

The long term care solution we joke about lamely here: pyres. I have a slash pile, I'll be able to afford that.

Do I sound bitter? Damn straight I do. This should be automatically covered under a national health care system, instead of penalizing people for having the temerity to grow old without being millionaires.

If the Democrats actually cared about humans instead of corporate contributions, we'd have gotten that.

8:24 PM  
Blogger Scott A Olson said...

Here is some simple advice when considering long-term care insurance.

Buy a policy that meets the federal guidelines, that's called a "tax-qualified policy."

Buy a policy that meets your state's guidelines, that's called a "Partnership-qualified policy." (unless you live in NY or CA).

Buy a Daily Benefit that is high enough to cover most of the cost of care in your area.

If home healthcare is important to you, make sure the policy allows for all of the Daily Benefit to be used for care at home.

As a general rule, buy a policy that has a "Maximum Lifetime Benefit" that is close to your net worth.

If you are healthy, you should probably purchase a policy on your own, rather than through your employer.

Lastly, shop around.

LTC insurance premiums vary a lot from one company to the next. Your age, your health history, and your choice of benefits have a big impact in determining the premium. Get quotes from at least 6 of the top companies before choosing your policy.

Scott A. Olson

10:16 PM  

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