Federal Long-term Care Legislation | Long Term Care Insurance as an Employee Benefit

Posts Tagged ‘Federal long-term care legislation’

CLASS Act Myth #4: Coverage Will be the Same as Private Long-Term Care Insurance

Posted on July 8th, 2010 by Em-Power Services

Remember when you were young and you learned what happens when people assume things? You make an a_ _ out of you and me. Well, if people assume CLASS Act coverage is the same as private long-term care insurance, making an a_ _ of themselves could be the least of their problems. Coverage with CLASS is much different than private insurance and it’s in everybody’s interest to understand those differences.

Regulation differences
Private insurance carriers are required to withhold significant reserves based on the amount of insurance sold. Those reserves must be invested and set aside to pay future claims to protect policyholders. Another difference is the process of increasing premiums on existing policyholders in the event it becomes necessary. For insurance companies to increase premiums, they must receive approval separately from each state Department of Insurance individually and premiums must be increased the same for every person that ever purchased that policy series regardless of age, how long they owned the policy or health.

With CLASS Act on the other hand, the power to increase premiums rests completely with the Department of Health and Human Services and reserves are not held to pay claims. Premiums paid into CLASS are credited to a trust account and accrue interest, but the funds are used to pay current bills. In effect, the government holds IOU’s from itself to pay future claims.

The trigger to collect benefits under CLASS Act can be changed
There is more than one way to increase premiums to policyholders. Only the Federal Government allows itself to change the rules of the contract after customers purchase the policy. If you read the CLASS Act where the definition of how you become benefit eligible, it says that “an individual must either require help to perform either 2 or 3 Activities of Daily Living or have a cognitive impairment”. Private insurance requires people to require help with 2 ADL’s. There is no opportunity to change the trigger to 3 ADL’s which would obviously limit the number and size of claims paid.

Five year waiting period
Private insurance is purchased with a waiting period that can be between zero and 365 days depending on the carrier. CLASS Act does not have an elimination period but requires you to pay premiums for 5 years before becoming benefit eligible and you must work for three of those years. What happens if you have an accident within a couple of purchasing coverage?

Flexibility
Planning for long-term care is not a one-size fits all proposition and that’s what CLASS Act offers. Private insurance coverage has a lot of flexibility and options to tailor coverage that fits each persons specific circumstances. And according to current estimates, private coverage will be less expensive for the 85% of people healthy enough to be medically underwritten when they apply at a young age through an employer sponsored program.

Education for employees
It can be argued that education is the most important benefit when companies implement long-term care insurance benefits. People tend to tune out when the discussion of long-term care arises. Some think it’s only for seniors and others choose to ignore the topic because of more pressing financial obligations. CLASS Act limits the amount of money that can be spent on administrative, marketing and administrative costs. Not providing education limits participation and ultimately increases adverse selection as less healthy people will be more inclined to participate.

Empower helps employers of all sizes implement long-term care insurance benefit programs in the workplace and conducts workshops & educational classes concerning LTC and the CLASS Act for employers and employees. If you would like to know more about the CLASS Act and how it might impact your company call us.

We also provide Resources, training, and assistance to brokers looking to educate and help their clients with Long Term Care and understanding the CLASS Act.

For help or more information contact Doug Ross at 800-483-1115, send an email todross@empowerltci.com, or visit our site at www.empowerltci.com.

Tags: Class Program, Community living Services and Supports Act, Education for long-term care, Employee benefits, Employee recruiting strategies, Employer sponsored benefits, Executive benefits, Federal long-term care legislation, group long term care insurance, long term care insurance plan, long term care insurance quote, Long-term care education, Long-term care insurance tax advantages, Long-term care planning strategies, LTC, LTCI, Nursing home insurance, Opt out long-term care insurance, Paying for home health care, Paying for nursing homes, Tax advantages of long-term care planning, Voluntary long-term care insurance, Wealth preservation, worksite Long Term Care Assisted living | Filed under: Class Act, worksite Long Term Care | 1 Comment »

CLASS Act Myth #3: Government Provided Coverage is Less Likely to Have Premium Increases

Posted on June 17th, 2010 by Em-Power Services

The U.S.A. seal of approval is as good as the Good Housekeeping seal of approval for many citizens. After all, the Federal government has never reduced Social Security benefits or Medicare and the country has not shown the political will to curb spending on these politically popular programs. Everything has limits though and if the Federal deficit is not approaching its limit, it be getting close.

Besides that, CLASS Act is fundamentally different from Social Security and Medicare because most every American participates in both these programs. CLASS Act on the other hand is voluntary; each person, young, old, healthy and sick will make an individual decision to participate or not. And that’s the problem. As discussed previously, a voluntary program violates the fundamental underpinnings of all insurance; spreading a risk over an entire population.

According the Allen Schmitz, FSA, MAAA from Milliman, and independent and highly respected actuarial firm, CLASS Act premiums are actually more likely to increase than private insurance. He says “there is probably greater risk that CLASS Act will need rate increases than the private market”. There are many reasons for this and several have been discussed in previous posts. Adverse selection, premium subsidies for certain groups, limitations on increasing premiums for certain groups.

Another issue understood by few people without an insurance or actuarial background is the methodology of determining the rates that will be sustainable over a 75 year window. By statute CLASS must set rates to ensure financial viability for 75 years, and after 10 years the Department of Health and Human Services will review pricing to ensure the program enough premiums collected to cover benefits projected for the next ___ years.

The problem with using a 75 year window is that it does not take the “tail” of long-term care into consideration. What I mean by that is at the end of 75 years you have many healthy people who have contributed premiums for 20, 30 and even 50 years. Well when they figure solvency at the end of 75 years, the claims that will come due for all those people who have paid in to the program are not considered.

We also provide Resources, training, and assistance to brokers looking to educate and help their clients with Long Term Care and understanding the CLASS Act.

For help or more information contact Doug Ross at 800-483-1115, send an email todross@empowerltci.com, or visit our site at www.empowerltci.com.

Tags: Class Act, Class Program, Community living Services and Supports Act, Education for long-term care, Employee benefits, Employee recruiting strategies, Employer sponsored benefits, Executive benefits, Federal long-term care legislation, group long term care insurance, long term care insurance plan, long term care insurance quote, Long-term care education, Long-term care insurance tax advantages, Long-term care planning strategies, LTC, LTCI, Nursing home insurance, Opt out long-term care insurance, Paying for home health care, Paying for nursing homes, Tax advantages of long-term care planning, Voluntary long-term care insurance, Wealth preservation, worksite Long Term Care Assisted living | Filed under: Class Act, worksite Long Term Care | 6 Comments »

CLASS Act Myth #2: Your Premiums Will be Held in a Lock Box to Pay Benefits

Posted on June 11th, 2010 by Em-Power Services

Despite our current deficit and the fiscal condition of government programs like Social Security and Medicare, many people believe a Federal program has to be better than private insurance.

I can certainly understand that when you look recent events like government bail outs of banks, automobile manufacturers and homeowners under water with their mortgages. But at some point, bills come due, and the combined effect of America aging and the burden of our current entitlements are the reasons the CLASS Act is to be funded completely by participant premiums.

When you hear your premiums go in to a lock box, do you feel secure? Can you visualize a large box made out of heavy steel with a giant lock? Unfortunately this isn’t how it works. The Federal government uses trust fund accounting. The money coming in from premiums is included with all other revenue collected and used to pay current obligations. At the same time, those premiums are credited to a trust fund that will accumulate interest. The problem is, even the Federal government can’t spend the same money twice.

Anything accumulated in the trust fund becomes an IOU from the general budget and we all know what condition that is in. According to the bi-partisan fiscally conservative Concord Coalition, Congress could have moved the CLASS program entirely out of the budget and invested the premiums in private securities that would have been available to pay claims, but genuinely funding the program would have eliminated money Congress needs to pay for healthcare reform.

In my next blog we look at Myth #3 – CLASS Act premiums are less likely to increase in the future than private insurance.

We also provide Resources, training, and assistance to brokers looking to educate or help their clients with and Long Term Care and understanding the CLASS Act.

For help or more information contact Doug Ross at 800-483-1115, send an email todross@empowerltci.com, or visit our site at www.empowerltci.com.

CLASS Act Myth #1: CLASS Benefits Solve the Long-Term Care Problem

Posted on May 28th, 2010 by Em-Power Services

Without crossing into the realm of political opinion of big government vs. small government and the correctness of our entitlement programs, the fact is many Americans believe the Federal government programs come with an official seal of approval. In other words, many people will participate in CLASS Act without fully understanding the issue or the difference between private and the CLASS Act. If it’s run by the government it must be better, right?

Well sometimes reality isn’t pleasant, but CLASS won’t solve the long-term care problem for most people. First, CLASS Act will not enroll its first participant until around 2013, and once enrolled, five years of premiums must be paid in before benefits can be collected. That means anyone older than 57 cannot be eligible to receive benefits until they reach age 65. Considering that 40% of people currently using long-term care services are under the age of 64, CLASS will be too late for you?

CLASS Act will pay a cash benefit of no less than $50 per day based on the number of ADL’s you cannot perform without assistance. That means the minimum annual benefit is pegged at $18,250 per year. Have you looked at the cost of care lately? It varies by the type of care you need or desire and there are large differences depending on the region of the country you live in.

In 2008, the average cost of home care throughout the United States was $20 an hour according to the Metlife Market Survey of Home Care Costs, but if you live in the northeast or other high cost states, the cost is as high as $28 per hour. And if you are in a high cost state like MA nursing homes and assisted living facilities average over $100,000 and $50,000 respectively.

Without education many Americans participating in CLASS will not understand the true nature of the problem and think they are covered with the nominal benefit they’ll be eligible for.

We also provide Resources, training, and assistance to brokers looking to educate or help their clients with and Long Term Care and understanding the CLASS Act.

For help or more information contact Doug Ross at 800-483-1115, send an email to dross@empowerltci.com, or visit our site at www.empowerltci.com.

4 Reasons CLASS Act Will Be More Expensive than Private Coverage

Posted on May 21st, 2010 by Em-Power Services

Most of the press on CLASS Act hails the program for solving a problem that has devastated millions of American families. And there are some important benefits, but you almost forget that people will need to actually pay premiums themselves that are projected to be $180-$240 per month. By statute, CLASS Act will be funded exclusively by participant premiums. And those premiums must be set to ensure the program is actuarially sound for 75 years.

Adverse selection
I discussed adverse selection on my previous post as causing more unhealthy people to participate in greater numbers than those of healthy people. I think it’s pretty clear why that would cause premiums to be higher than private insurance carriers who require medical underwriting to control cost. With no underwriting, CLASS is a good thing for the sick people who cannot get less expensive private coverage making CLASS a high risk pool for people uninsurable in the private market.
Subsidized premiums
Under CLASS premiums are only $5 per month for students and poor Americans. Noble intention, but subsidizing premiums for a segment of society creates an entitlement for a segment that is paid for by everyone else. The amount of the subsidy is the difference between $5 and aged based premiums projected to be $180-$240 per month. Do you think this could make premiums higher?
Limits on premium increases
CLASS Act boxes the government in a corner with regard to complying with its own regulations and it will require premiums to be higher. Any person who attains age 65, or who has paid in for 20 years and is not working, cannot have their premiums increased. This is good if your premium can’t be increased and not so good if an increase is needed and it must be spread over a smaller number of participants.
Limitation of money that can be spent on marketing and administration
CLASS specifies that 97% of all premium collected must be used to pay benefits. On the surface this sounds like a good thing. Let’s eliminate corporate excess and let the government deliver more bang for the buck. Hmmm. How has the government done with its Social Security and its own budget?

According to the American Society of Actuaries, reviewing claims alone often costs private insurers more than this – and administrative cost of enrollment, premium collection, marketing and education, the last of which is very important if CLASS is to gain widespread participation to avoid adverse selection. Even with extensive educational efforts, private long-term care insurance companies have sold only about 8% of the market to date.

If you are an employer wanting to learn more about how Long Term Care differentiates your benefits or a broker looking to help your clients with Long Term Care, reach out and contact Doug Ross at 800-483-1115 or visit EMpowerLTCI.com.

One Flaw of CLASS Act You Need to Understand

Posted on May 17th, 2010 by Em-Power Services

The primary concern about CLASS Act stems from “adverse selection”. This is a term used by organizations constrained by fundamental rules of business that require financial responsibility. Private insurance companies, for example build products with underwriting to control the cost of their products so they are affordable.

Adverse selection refers to a structural bias that causes a disproportionate number of people to participate who are more prone to need benefits in the future. Adverse selection violates the basic insurance principle of spreading risk over an entire population and will cause claims paid to exceed premiums collected.

Consider the following aspects of CLASS that have caused actuaries to use the term “death spiral” when describing the CLASS Act.

Employees will receive coverage without medical underwriting on a guaranteed issue basis. This concession may also be extended to non-working spouses. Every person who is uninsurable for private coverage will be motivated to participate in CLASS.

Participation is voluntary. Employees can opt-out initially, and opt back in at a later time. Why would a young healthy person participate when they can opt-in at any time?

Premiums are to be set by the Department of Health and Human Services to ensure financial viability for a 75 year period. A nominal benefit of $50-75/day is projected to cost $180-$240/month. With premiums this high participation has been estimated to be as low as 2% of the eligible population.

What is the “death spiral”?

CLASS Act is to be funded exclusively by premiums paid by participants. Participation in the program will be conversely proportionate to the size premiums of the premium. More expensive premiums will depress participation while lower premiums have the opposite effect. The death spiral is that setting premiums high enough to keep the program financially solvent will reduce participation which in turn will also affect the solvency of the program. And the problem is exacerbated the higher the premium is.

The death spiral is a catch 22 situation of sorts. Premiums need to be high enough to make CLASS actuarially sound as defined statute. People with pre-existing conditions will choose the CLASS Act in greater numbers while those who are younger and healthier choose comprehensive private insurance that is more affordable.

The implications of this will be discussed in my next blog.

Three Ways your Health Insurance Coverage is Limited

Posted on May 3rd, 2010 by Em-Power Services

When people appraise different health insurance options, they typically evaluate their premiums and deductibles, but rarely question the limitations of the plan. That’s because it’s difficult (if not impossible!) to speculate on potential health care needs or the duration or severity of future health conditions. Where would a person know where to begin?

In actuality, there are three overlooked limits in almost every health insurance plan out there today. It’s this gap in health care that prompted long-term care insurance (LTCI)–a security plan that plugs the holes of traditional health insurance. LTCI ensures comfortable and quality long-term care, something more than half of us will need in our lifetime.

The three areas where health insurance does not protect a person are

Skilled medical care in a nursing home beyond 100 days
Intermediate care (such as rehabilitation) is limited to a period of time or number of visits
Custodial care is not covered at all.

To understand the limits of traditional health insurance, we need to understand the three levels of healthcare.

Skilled Care: Care provided by doctors and skilled medical professionals to make a person well again. Skilled medically needed care is covered by health insurance.

Intermediate Care: Less frequent skilled care. It also is designed to make a person well again.

Custodial Care: This is help with the activities of daily living like walking, bathing, eating, going to the bathroom, or moving around. Skilled care providers do not provide this type of care. It is not therapeutic or designed to make a person well again, and traditional health insurance generally does not pay for it.

When you approach a company to fulfill its employee insurance options, do you educate them about the current gaps in their tradition coverage? Do you offer them an opportunity to enjoy full protection? Do you feel it is our professional obligation to educate companies to help them (and their employees) make informed decisions?

Two Benefits of CLASS Act Come With a Caution Sign

Posted on April 23rd, 2010 by Em-Power Services

Have you read anything about the CLASS Act yet? CLASS stands for Community Living Assistance Services and Support and it’s a Ted Kennedy legacy program that slid into healthcare reform with little notice. It’s a voluntary government run long-term care insurance program that will require a decision from employers whether or not to participate. Where employers do participate, their employees will automatically have premiums deducted form their pay checks unless they specifically opt-out.

When does CLASS become effective?
Not later than October 1st, 2012, the Secretary of the Department of Health and Human services, taking into consideration the recommendation of the CLASS Independence Advisory Council will select the final benefit to be provided out of three benefits presented to meet the requirements defined in the statute. Following that date a period for public comment will be provided making a kick off date in 2013 probable.

What is long-term care?
Long-term care is help people need due to accidents or illness that can happen at any age. It is referred to as custodial care and it includes help with dressing, eating, bathing, toileting, continence or just moving around. By definition, long-term care is not intended to make you get well again and it is specifically excluded from traditional health insurance or Medicare when you reach age 65. This care can be very expensive and without insurance protection tens of thousands of Americans have become impoverished.

What’s good about CLASS?

Brings attention to the problem:
Possibly the most important benefit of the CLASS Act is that it finally brings long-term care to the front page of newspapers and the national news. For too long, far too many families with resources to purchase insurance protection have had their lives shattered when a loved one needed long-term care and they didn’t own insurance. Most people don’t understand the consequences that come with needing long-term care until it is too late and they never learned about affordable planning options when they were young.
Allows everyone to receive a nominal benefit regardless of health problems:
The other primary benefit of CLASS is to guarantee every citizen the opportunity to purchase a nominal long-term care insurance policy regardless of pre-existing medical conditions. Unlike private insurance with medical underwriting that excludes high risk individuals to control premiums, government provided coverage will accept virtually every citizen.

So what is the caution sign for?
Government run long-term care insurance stems from noble intentions and it does in fact provide some important benefits to a segment of society, but these benefits come at a price. Stay tuned for information every employer, employee and benefit specialist needs to understand before making decisions on long-term care protection and the CLASS Act.

EM-Power is a unique brokerage in that we:

Work with employers to show them why adding LTC as a employee benefit is a win-win opportunity; and
Work with brokers to teach them how to better educate their clients about LTC to create a win-win opportunity.,

If you are an employer needing help or a broker looking to help your clients with Long Term Care reach out and contact Doug Ross at 800-483-1115

3 Reasons Employers Shouldn't Wait for the Class Act

Posted on April 16th, 2010 by Em-Power Services

Finally, the Federal government has recognized the devastating gap in the safety net caused by long-term care by passing the CLASS Act, a national voluntary long-term care insurance program. Don’t wait to begin a conversation on long-tem care because once CLASS Act becomes operational, employers will need to decide if they should participate or if there are better alternatives. Regardless of what employers choose, employees hearing about CLASS Act will begin bringing questions to work.

There are some important differences between private long-term care insurance and the government run program – and it is in your interest to understand them now – before a decision to participate or opt-out is required. And these differences make it advantageous to offer private coverage to employees today.

Coverage is projected to be more expensive and the risk of future premium increases will be higher with government coverage
One size fits all coverage from the government, when available, is projected by Milliman, a respected independent actuarial firm, to be more expensive and more likely than private insurance to increase in price in later years. Because government provided long-term care has no underwriting requirements, provides subsidies to the poor, and premiums must be set to ensure financial viability for 75 years, the cost will be higher than private insurance.

When CLASS was first introduced, the expected monthly premium was $30. Compare that now to premiums projected to be $180-$240 month for a nominal benefit. The higher the premiums, the lower the participation and the more likely the government will suffer from adverse selection with participants more likely to have pre-existing health conditions that prevent them from being approved for private coverage.
Waiting for CLASS may cause some employees to lose insurability and age based premiums get more expensive each year
Educating employees now and offering private insurance allows employees to submit applications when they are most likely to pass medical underwriting required by private insurance carriers to screen out high risk people that drive up the cost of coverage. Offering coverage today allows employees to lock in both their insurability and rates that are tied to the age coverage is purchased.
Providing employees’ education now will help them to make informed decisions when CLASS becomes available
The CLASS Act does not include sufficient funding to provide extensive marketing or education to employees making it likely participation will be poor. Education provided as part of a private long-term care insurance benefit allows employees to learn about long-term care, how it is paid for and how to make it part of financial planning. Educated employees will be in a position to make an informed when CLASS Act does become available, and those who could not pass medical underwriting will be able to purchase coverage then.

Still think you should wait for details on the CLASS Act before implementing an employer sposnored plan? Click here to see what executives from the respected financial rating agency A.M. Best have to say about CLASS Act.

Bringing the conversation about long-term care to employers and employees addresses a serious planning issue. Offering private insurance provides an opportunity to learn about the problem now and put an affordable solution in place. And when CLASS Act is available, those who cannot pass the underwriting of private insurance will have an option to protect themselves.

3 Reasons Long Term Care Employee Education is a Good Idea

Posted on April 12th, 2010 by Em-Power Services

Options. The world is full of them. When we are young, the world is our oyster. As we age, options and opportunities dwindle. We miss the windows to set up optimum savings, life insurance or health plans, often finding we do too little, too late…often wishing we knew then what we know now.

Helping employers educate their workforce about the benefits of planning for long-term care is a critical new step in financial planning. By offering employees yet another option and educating them on the gaping hole they have in their safety net, employers earn both respect and gratitude from their workforce. Additionally, offering Long Term Care Insurance to their employees doesn’t need to cost the employer any additional money. Why should employers educate their employees about Long Term Care Insurance?

Without education in the workplace, employees may not discover the long-term care dilemma until they have already developed pre-existing health issues.
Premiums are fixed to a person’s age at the point of purchase; so planning young will result in paying the least amount of insurance premium over one’s lifetime.
Understanding the issue and support systems available will be beneficial when a parent, friend, or other loved one needs long-term care. Employees of all ages should learn about long-term care while they are young so they understand the planning challenges they will face in the future. Like all planning, the younger people begin, the more options they will have and generally speaking, the less expensive it will be.

The good news is that with long-term care, there is an additional benefit of planning early. There is a much greater chance of being medically underwritten. When applying for long-term care insurance a person must fill out an extensive application with questions about existing health and medical prescriptions. Industry wide there is about a 30% decline rate for people that apply for coverage.

It should be noted that there are many health conditions like diabetes, arthritis and high blood pressure where a person can still be approved for long-term care coverage. But what happens to those conditions as a person ages? They generally deteriorate until the point where a person can no longer be approved. Learning about long-term care while they are young provides people with an opportunity to purchase protection when they are healthiest and have the best chance of being accepted.

Even when employees don’t purchase coverage, they will understand the issue when they are dealing with a parent or friend who needs care. It’s something that is very likely to happen to us all at one point or another. Do you believe knowledge is power? How much to you know about LTCI?

EM-Power is a unique brokerage in that we:

Work with employers to show them why adding LTC as a employee benefit is a win-win opportunity; and
Work with brokers to teach them how to better educate their clients about LTC to create a win-win opportunity.,

If you are an employer needing help or a broker looking to help your clients with Long Term Care reach out and contact Doug Ross at 800-483-1115

Tags: Assisted living, Class Act, Class Program, Community living Services and Supports Act, Education for long-term care, Employee benefits, Employee recruiting strategies, Employee retention strategies, Employer sponsored benefits, Executive benefits, Federal long-term care legislation, Federal long-term care plan, Financial planning, Government long-term care insurance benefits, group long term care, group long term care insurance, Home health care, long term care insurance, long term care insurance companies, long term care insurance plan, long term care insurance quote, Long-term care, Long-term care education, Long-term care insurance tax advantages, Long-term care planning strategies, LTC, LTCI, Nursing home insurance, Opt out long-term care insurance, Paying for assisted living, Paying for home health care, Paying for nursing homes, Tax advantages of long-term care planning, Voluntary long-term care insurance, Wealth preservation | Filed under: Uncategorized | 1 Comment »

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