WOW features benefits of long-term care insurance

Before the last Woman of Wellness presentation at Fallbrook Library Sept. 6, Fallbrook Regional Health District board member Barbara Mroz presented Fallbrook Library branch manager Kris Jorgensen with a basket of succulents as a thank you to the library for hosting WOW the last three and a half years. Sponsored by FRHD, the event will be moving to the Fallbrook Wellness Center starting Oct. 4.

For the September event, local insurance agent Marc Sigmon talked about long-term care insurance and how to "Make the most of tomorrow by making smart choices today". A Navy veteran, Sigmon became interested in the insurance field when his mother needed help with her Medicare paperwork; he learned about her options and enjoyed helping her.

While the turnout for WOW was below average, there were several newcomers in the audience to hear about long-term care insurance. Sigmon promised that he wasn't going to try to sell anything. He is a member of the VFW and is willing to help veterans with any questions they have about Medicare or insurance.

Sigmon encouraged everyone to "envision your retirement...Think about tomorrow and who's going provide the care and where." He pointed out that things can change; three out of four people will need some sort of long-term care as they age.

According to Sigmon, nationwide, the costs are higher for women; as they live longer, they are more likely to need long-term care than men. He also said that in California right now, rates are the same for men and women. So, now is the time to realize your goals, minimize your risks and provide financial security.

Sigmon explained that long-term care includes a variety of services to help meet both medical and non-medical needs like bathing, eating, dressing, and toileting for 90 days or more. It also includes having someone manage your medications, transport you to appointments or the grocery store, take care of housekeeping, and manage your money.

Available care providers, besides family and friends, include adult daycare facilities, home health care agencies, residential care facilities, skilled nursing and hospice. He said that if you are admitted to a hospital for three days and the doctor then prescribes skilled nursing care, Medicare will pay for the first 20 days and then 80 percent for the next 80 days.

Sigmon reminded everyone that "caring for a loved one takes time, patience, love and money; it may cause emotional and financial stress for you and your loved one." Frequently, he added, the caretaker/survivor dies within a year of their spouse. So, it's a good idea to plan ahead for long-term care.

He reviewed some funding options for that care, usually Medicare or health insurance. In California, Medicaid is known as MediCal, neither of which is intended to pay for custodial care. While MediCal will cover acute care – a three night in-patient hospital stay, MediCal chooses where you get care.

With Medicare Advantage, they pay the bills, but you have to stay in their network. While it has limited home health services, it does pay for durable medical equipment when you are receiving homecare under Part A. Basic care as with help with bathing, dressing and using the toilet is not covered.

Sigmon pointed out that there are financial requirements involved in qualifying for Medicaid/MediCal and officials review five years worth of the applicant's financial history. Self-funding is a default option, carries unlimited risk and means out of pocket expenses and possible taxes, he said.

On the other hand, he continued, "Long-term care insurance will help protect your assets and income, enable you to stay at home for as long as possible, limit the emotional and financial burden on your family, and enable you to control or have options on where you receive care."

Furthermore, LTCi covers home care, adult day care and residential care facilities. It avoids the hospital requirement, income and asset requirements and taxation and total liquidation.

The biggest concern people have is the possibility of running out of money. As the minimum wage goes up over the next four years, Sigmon said, the cost of care is going to go up. Long-term planning gives people choices and can be customized per person with the insurance agent working with their accountant and lawyer especially if they have a trust.

He also said that there are special needs trusts that hold assets so an individual with special needs will still qualify for care paid for by MediCal. LTCi helps protect people while giving them peace of mind.

The average cost per day of care at an assisted living facility is $4-5,000 a month while nursing care can cost as much as $9-12,000 a month. If care ends up costing more than expected, Sigmon said, social security, IRA's and pensions can supplement LTCi.

For more details, individuals should consult their insurance agent.