Long Term Care Insurance
FAQ
What is long term care?
Who should you consider long term care insurance?
What do long term care services cost?
How much does long term care cost?
Health/Medical Insurance FAQ
What are the principal types of medical expense insurance coverage?
What types of expenditures are commonly excluded under major medical
expense plans?
What are "out-of-pocket" costs?
What is the co-insurance clause in medical expense plans and how
does it work?
What is the difference between co-insurance and co-payment?
What is a pre-existing conditions clause?
How does the medical expense coverage offered by Health Maintenance
Organizations (HMOs) differ from the coverage provided under basic
and major medical expense plans?
Auto Insurance FAQ
How do I get a free insurance quote online?
When can my coverage start?
How long is an auto policy period?
What payment terms are available?
When are installment payments due?
When can premium rates increase?
Will my policy cover me if I am renting a car during vacation?
If my car is damaged, do I have to have it repaired at a shop approved
by the insurance company?
Should I report all accidents and incidents of vehicle damage to
the police?
Where should I keep the title to my car and my insurance policy?
What is long term care?
Long term care covers a range of medical and support services for
people with degenerative conditions such as Parkinson's disease,
or conditions resulting from a stroke, or a prolonged illness like
cancer or a cognitive disorder such as Alzheimer's. While an early
(LTC) long term care policy resembled a basic Medicare supplement
policy, long term care insurance present day has evolved and typically
covers a wide range of services to include: assisted living facilities,
nursing home care, and adult day care. {State} long term care is
not necessarily medical care but rather "custodial care"
that involves providing an individual with assistance in the activities
of routine daily living, or the supervision of someone who is cognitively
impaired. LTC or long term care insurance has been around in one
form or another since the early days of Medicare, but the policies
of years ago bear little resemblance to today's policies. - Back
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Who should you consider long term care
insurance?
Like most insurance products, long term care insurance allows the
insured to pay an affordable premium to protect against the costs
of an unaffordable medical event that could produce tens of thousands
or more in hospital or post care costs. While {State} financial
planners often refer to long term care insurance as a form of "asset
protection", most individuals will need to have assets worth
protecting to justify paying policy premiums. Eventually Medicaid
pays for {State} long term care services once an individual is unable
to pay. In other words, if you can pay long term care insurance
premiums without altering your lifestyle too much, you should consider
transferring the risk to an insurance company who will then cover
the extended medical care services you might require while your
own assets are protected. - Back To Top
What do long term care services cost?
Long term care services are very expensive. The reason being, most
people take for granted the daily activities we perform ourselves
most of our life. Getting out of bed, going to the bathroom, showing
or bathing, fixing meals etc. Compare adult long term care to that
of a parent with a new born baby. Daily activities related to the
care of an adult are even more intensified and as a result become
very expensive. Quality nursing homes in {State} are always filled
to capacity and consequently, have no problem charging higher fees
for their services. One (1) year in a nursing home now averages
$50,000-$100,000 annually, and in some parts of the country even
more! - Back To Top
How much does long term care cost?
If you don't have insurance, long term care can be expensive, depending
upon the amount and type of care needed and the setting in which
it is provided. Currently, the cost of a year in a nursing home
averages about $38,000.¹ This cost is only an average and varies
widely across the country. If you receive skilled nursing care in
your home and are visited by a nurse three times a week for two
hours per visit for the entire year, the bill would come to about
$12,300.¹ If you receive personal care in your home from a
home health aide three times a week for a year, with each visit
lasting two hours, the bill would amount to about $8,400. - Back
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What are the principal types of medical
expense insurance coverage?
Medical expense insurance is broadly classified into two principal
types of coverage: base (or basic) plans and major medical plans.
Base plans generally consist of either hospital expense coverage,
surgical expense coverage, or both. Basic hospital and surgical
expense plans generally provide coverage on a first-dollar basis
(i.e., no deductible) and provide 100 percent reimbursement of covered
expenses, up to a relatively low maximum of $10,000, $25,000, $50,000
or $100,000. Major medical plans, in contrast, apply a deductible
to initial expenses, generally ranging from $100 to $500 per calendar
year. After the deductible is satisfied, major medical plans typically
reimburse 80 percent of eligible expenses up to a relatively high
maximum, e.g., $500,000 or $1,000,000. Some major medical plans
reimburse eligible expenses at 70 percent; some plans also provide
unlimited lifetime benefits. Major medical plans typically cover
a broad list of medical expenditures, including hospital expense,
surgical expense, physician (non-surgical) expense, private duty
nursing, diagnostic X-ray and laboratory services, prescription
drug expense, artificial limbs and organs, ambulance services, and
many other types of medical expenses when prescribed by a duly licensed
physician. Thus, in comparison with basic plans, major medical plans
provide much broader coverage, with higher limits, but these plans
require the insured to share in the cost of medical care through
deductibles and co-insurance (i.e., 20 or 30 percent of eligible
expenses above a deductible amount). - Back To Top
What types of expenditures are commonly
excluded under major medical expense plans?
Although providing very broad coverage, major medical plans typically
contain a number of exclusions. Common exclusions include medical
expenditures arising from: (1) convalescent or custodial care; (2)
physical examinations, unless required for the treatment of an injury
or illness (it should be noted that some plans now cover this expenditure);
(3) cosmetic surgery unless required to correct a condition resulting
from an injury or a birth defect; (4) occupational injuries and
illnesses that are otherwise covered under a Workers' Compensation
law; and (5) routine dental and vision care (care required for treatment
of an injury and dental and eye surgery are frequently covered,
however). Other common exclusions relate to benefits provided by
government agencies (e.g., VA hospitals) and expenses paid under
other insurance programs, including Medicare. - Back
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What are "out-of-pocket" costs?
An insured's "out-of-pocket" costs under major medical
expense plans include the deductible, cost-sharing amounts arising
from the operation of the co-insurance clause, and medical expenditures
that are deemed by the plan to be in excess of "reasonable
and customary" charges. Only charges that are "reasonable
and customary" for a specific type of service, in a particular
location or geographic area, are eligible for reimbursement under
medical expense plans. The definition of "reasonable and customary"
may vary somewhat from one medical expense plan to another. - Back
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What is the co-insurance clause in medical
expense plans and how does it work?
Coinsurance, sometimes called "percentage participation,"
requires the insured to share in the cost of medical care. Under
an 80/20 co-insurance provision, the medical expense plan pays 80
percent of eligible medical charges above any deductible. The insured
is required to pay the remaining 20 percent. Other co-insurance
arrangements, e.g., 70/30 or 90/10, are sometimes used. In the event
of large or catastrophic medical expenses, an insured might suffer
severe financial hardship due to the operation of the co-insurance
clause. To compensate for this possibility, many major medical expense
plans contain a co-insurance cap, or stop-loss limit. This provision
places a limit on the insured's out-of-pocket costs in a given year
arising from the operation of the co-insurance clause. The size
of the co-insurance cap generally ranges from $2,000 to $3,000,
depending on the plan, although limits as low as $1,000 are sometimes
used. Once the co-insurance cap has been reached, all eligible expenses
above this amount are paid in full, up to the plan's overall limit
of coverage. - Back To Top
What is the difference between co-insurance
and co-payment?
On occasion, these terms have been used interchangeably. However,
it is preferable to define the two terms differently, despite their
similarity of purpose. Under a co-payment or co pay provision, the
insured usually is required to pay a set or fixed dollar amount
(e.g., $3, $5, or $10) each time a particular medical service is
used. Co pay provisions are frequently found in medical plans offered
by health maintenance organizations (HMOs) where a nominal co-payment
is applied to each office visit and to each prescription that is
filled. - Back To Top
What is a pre-existing conditions clause?
A pre-existing condition is often defined as a medical condition
(i.e., an injury or illness) that required treatment during a prescribed
period of time, e.g., 3 or 6 months, prior to the insured's effective
date of coverage under the major medical expense plan. Sometimes,
a pre-existing condition is defined to include medical conditions
that were known to the insured, even though no treatment was provided
during the prescribed period. A pre-existing conditions clause excludes
coverage for pre-existing conditions for possibly as long as 12
months after the effective date of coverage. Because the definition
of a pre-existing condition, and the provisions of the clause itself,
may differ considerably from one plan to another, it is recommended
that newly insured individuals (and prospective insured's) completely
familiarize themselves with this policy provision. - Back
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How does the medical expense coverage
offered by Health Maintenance Organizations (HMOs) differ from the
coverage provided under basic and major medical expense plans?
Basic and major medical expense plans are generally classified as
indemnity contracts. These plans indemnify, or reimburse, the insured
for medical expenses incurred and typically require the completion
and filing of claim forms. In addition, these plans usually contain
deductible and co-insurance cost sharing provisions and may restrict
coverage for certain types of medical care expenditures. Indemnity
plans, however, provide the insured with substantial freedom relative
to the choice of physician, including whether a primary care physician
or a specialist will be seen. In contrast, HMO coverage emphasizes
comprehensive (including preventive) care and typically contains
very few exclusions, no (or small) deductibles, and nominal co-payments.
However, there is much less freedom of choice of physician under
traditional HMO coverage since the patient is typically required
to be under the care of a primary care physician who serves as a
"gatekeeper." In this role the primary care physician
determines whether the services of a specialist are needed, in addition
to determining what other medical services are required for treatment.
Some HMOs today offer a point-of-service option, whereby patients
may opt for indemnity type coverage (with a deductible and co-insurance)
when they desire medical treatment outside the HMO network. - Back
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How do I get a free insurance quote
online?
You can get a free, non binding, comparative insurance quote by
submitting our online form. - Back To Top
When can my coverage start?
The earliest your coverage is effective is after speaking to an
agent once you submit your online quote request. An agent will contact
you with the information you provide on the quote request form and
provide you with a premium cost. - Back To Top
How long is an auto policy period?
Typically, most insurance companies offer six month and twelve month
policies. You receive a declarations page and renewal bill approximately
60 days prior to your renewal date. - Back To Top
What payment terms are available?
Most insurance companies offer annual, and installment plans to
fit your budget. - Back To Top
When are the installment payments due?
The due date will be the day of the policy effective date for each
consecutive month. - Back To Top
When can premium rates increase?
Insurance rates can increase or decrease at different points in
time and for different reasons. Increasing or decreasing rates would
be similar to other insurance carriers in your area who modify rates.
For example: Whenever there is an approved statewide rate change,
rates change for all policyholders at their next policy renewal.
These rate changes usually reflect changes in a company's cost of
paying claims. Your individual policy's premiums can increase or
decrease due to number of factors like the number and type of driving
violations you have, or the number and type of accidents you have.
Changes in the vehicles insured, the coverage's provided or the
drivers insured under the policy may also result in changes to your
policy's premiums.
Also, your premium can increase or decrease if any of the information
you provide in your application is different from the information
you provided when we prepared your quotation. - Back
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Will my policy cover me if I am renting
a car during vacation?
In most cases, your insurance will cover rented vehicles on a short
term basis. Consult with your agent after submitting a quote request
for the details of the policy you ultimately sign up for. - Back
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If my car is damaged, do I have to have
it repaired at a shop approved by the insurance company?
Preferred repair shops in certain geographic locations are used
by many insurance companies. These shops perform quality repairs
that are guaranteed by the company. They also give preferred service
to policy holders in most cases. It is your option to use these
shops. The final choice of repair facility is made by the owner
of the vehicle. - Back To Top
Should I report all accidents and incidents
of vehicle damage to the police?
It is recommended that any accidents and incidents be reported to
the local police department. This provides documentation of the
facts. It also provides the opportunity for the police to investigate.
This investigation can help the company in the handling of the claim.
- Back To Top
Where should I keep the title to my
car and my insurance policy?
These documents should be kept in a secure location such as a safety
deposit box or a fire proof metal filing box at home. They should
not be put in the glove compartment of the car. These documents
could be needed for the settlement of a claim. If the car is destroyed
or stolen, their unavailability could delay the settlement process.
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