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KAISER LONG TERM CARE

• 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 able to sell you a Partnership policy and to advise you as to whether the Partnership program works for you. Be sure to confirm that your agent has this special certification to sell Partnership policies.

Each Partnership-approved policy includes high quality insurance benefits to cover the care you may need and automatic inflation protection to ensure that the benefits keep pace with the rising cost of care. Partnership policies also include a unique state guaranteed asset protection feature that protects you against impoverishment due to the costs of long-term care, even if you use up all the benefits of your policy.

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