LONG TERM CARE 4
Personal Resources -
Most people pay long-term care expenses from their own income
and resources. When care is provided by family members and
friends at home, necessary skilled care such as equipment,
transportation and other costs not paid by Medicare are also
paid from the patient’s personal income or savings. People
who use up their assets paying for long-term care are “spending
down” and may become eligible for Medi-Cal as a result.
Long-Term Care Insurance is designed to pay a portion of
long-term care costs. It is available from private insurance
companies selling in California. This type of insurance may
be cost-effective for you if you have sufficient available
income to pay the premiums for the rest of your life. What
Is Long-Term Care Insurance. Long-Term care insurance covers
any of the following:
1) Care in a Facility that is not an acute-care
hospital. Some of the terms used to describe these “facilities”
that can provide long-term care services include nursing
homes, Residential Care Facilities for the Elderly (RCFE)
often called Assisted Living Facilities, convalescent facilities,
extended care facilities, custodial care facilities, skilled
nursing facilities or personal care homes.
2) Home Care including Home Health Care,
Personal Care, Homemaker Services, Hospice Services or Respite
Care. (Some Hospice and Respite care can also be received
in a facility like a nursing home.)
3) Community-Based Care such as Adult
Day Care or Hospice Facility Care. In California, only 3
categories of long-term care insurance policies can be sold.
Each policy is labeled as:
a) Nursing
Facility and Residential Care Facility Only -
These policies cover skilled, intermediate, or custodial
care in a nursing home or similar facility. These policies
also pay for assisted living care in a Residential Care
Facility for the Elderly (RCFE) but Home Care is not covered.
b) Home
Care Only - These policies are required to
pay for: Home Health Care, Adult Day Care, Personal Care,
Homemaker Services, Hospice Services and Respite Care but
care in a facility is not covered.
c) Comprehensive
Long-Term Care - These policies pay for nursing
facility care, assisted living care in an RCFE, and home
and community care. These policies must include at least
8 benefits: a nursing home benefit, an RCFE benefit for
assisted living, and the 6 home care benefits: Home Health
Care, Adult Day Care, Personal Care, Homemaker Services,
Hospice Service and Respite Care.
The California Partnership for Long-Term Care (the Partnership),
a program of the California Department of Health Services
(DHS), is an innovative partnership between consumers, the
State of California and six private insurance companies, plus
the California Public Employees Retirement System (CALPERS).
These insurers offer a special type of long-term care insurance
policy, commonly called “Partnership” policies, that must
meet certain requirements set by the DHS. Insurance companies
participating in the Partnership program must have their Partnership
policies approved by both the.
Department of Insurance and the DHS. Additionally, only agents
who have received special training are:
California Department of Insurance
Protecting California Consumers
Toll Free 800-927-HELP
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