The Insurance Advice Every Caregiver Needs
These practical tips can help caregivers assess options for long-term care, life, auto and homeowners insurance.
These practical tips can help caregivers assess options for long-term care, life, auto and homeowners insurance.
When you care for someone with a chronic neurologic condition, you spend a lot of time focusing on questions about health insurance coverage. What's the best policy for your family? Does your neurologist take your insurance plan? Can you get help with the copays or coinsurance costs for your loved one's prescriptions? (For more on all these questions, know what to ask about health insurance.)
But health coverage is only one of several types of insurance that should be on your radar as a caregiver.
If your loved one eventually needs to enter a nursing home, regular health insurance will not pay for that. Medicare does provide some coverage for this kind of care, but it's very limited: up to 100 days of "skilled nursing" are covered for each period of illness associated with a hospitalization. "Skilled nursing" means care delivered on a daily basis, ordered by a physician and delivered by a professional such as a physical therapist, registered nurse, or licensed practical nurse. Very few nursing home residents receive this kind of care.
That's where long-term care insurance comes in. These privately purchased plans cover the cost of care that a person needs in the home or in an assisted living facility or nursing home and may also pay for services like adult day care.
But here's the bad news: if someone has a neurologic condition serious enough that they have a caregiver who's reading this article, it's virtually impossible to get long-term care insurance for that person. "Of course, you'll be declined," says Dee Slavutin, MBA, president of the New York insurance and financial planning agency Stern Slavutin. "In underwriting manuals for long-term care, certain prescription medications and certain conditions are an automatic decline. Long-term care insurance is very hard to get if you are presenting with any kind of symptoms that point to conditions known to require long-term care."
But that doesn't mean you should forget about long-term care insurance entirely. You may not be able to get it for your loved one, but you should certainly consider it for yourself. "Don't think only of the ill spouse or partner; think of the healthy one," says estate planning attorney Martin Shenkman, who practices in New York and New Jersey. "We know that a caregiver's health and life expectancy are significantly impacted by the stress and burdens of caring for someone with a serious neurologic condition like Alzheimer's disease. What if you get sick?"
Even if you think you have enough money for long-term care not only for your loved one but also for yourself, go through the process of researching insurance anyway. "You may be wrong," says Shenkman. "Most people grossly underestimate the cost of long-term care, and it's better to find out ahead of time."
Ask your state insurance department for a list of agencies licensed to sell long-term care insurance in your state. The Deficit Reduction Act, which was signed into law in 2006, established a joint federal-state policy initiative to promote the purchase of private long-term care insurance. The Long-Term Care Partnership Program is intended to expand access to private long-term care insurance policies and pay for long term care services.
"Too many people don't read the fine print with long term care policies," cautions Matt Kudish, MSW, senior vice president of caregiver services for the Alzheimer's Association's New York City chapter. "If your policy pays out for five years, and dementia can last 10, 15, or 20 years, it may not meet your needs."
And paying a regular monthly premium for long-term care coverage doesn't make sense for everyone. If your income is low and you have few assets, you may qualify for Nursing Facility Medicaid, which will pay for nursing home care. Many states have higher Medicaid income guidelines for people who need nursing home care than for those who do not.
But "spending down" your assets in order to qualify an ill spouse for Nursing Facility Medicaid can leave the well spouse with little to live on. And although your house is an "exempt" asset—meaning you can keep your house and still be on Medicaid—the government has the authority to try to recover funds they spent on nursing home care after the person dies. They won't do this while the well spouse is still alive and living in the house, but after both spouses have died, and/or the house is sold, Medicaid may be able to go after the house to help recover what they've spent.
This is all very complicated business and not for amateurs to figure out alone. If you think you may need to use Nursing Facility Medicaid to pay for a nursing home for your loved one or yourself, talk to an elder law attorney about how to protect your income and assets. You can find one through the National Academy of Elder Law Attorneys. Chapters of the Alzheimer's Association also provide information around being a good consumer of legal services, including referrals to elder law attorneys.
"Don't wait until somebody needs a higher level of service to explore what it takes to access that level of service," Kudish says. "Get ahead of this ball and start to access information way ahead of when you think you may need it. Nobody wants to think about nursing homes until they have to, but if you think you can save mom's assets and move her into a nursing home a week from tomorrow, you're in for a rude awakening."
As with long-term care insurance, once someone has already been diagnosed with a serious neurologic condition, it's virtually impossible to get fully underwritten life insurance policies for them. But what's even more important at this point is to make sure you, as the caregiver, have good life insurance coverage, says Marc Nuwer, MD, PhD, a University of California–Los Angeles neurologist who is a leading national expert on health care reform, and a Fellow of the American Academy of Neurology (FAAN).
"What's going to happen to the person you're caring for if you get run over by a truck tomorrow?" he asks. "Many people who are caring for ill family members don't stop to think about their own health, but anyone can have a heart attack at any time. You need to make sure that you yourself have adequate coverage that will protect the people you care for if something happens to you."
If your loved one is still driving, review your auto insurance policy and liability limits. "It may be perfectly fine for them to be driving at this point," says Shenkman (learn more about driving and neurologic conditions.) "But if you have a neurologic condition and you're in an accident, even if it wasn't your fault, the opposing attorney will make hay with it even if it wasn't relevant to the accident. If you have a neurologic condition that's sometimes typified by an attack or exacerbation, they'll ask you to prove that an attack didn't cause the accident. How can you prove that?"
Shenkman recommends having a personal excess liability policy that is large enough to protect you in such circumstances. "Usually they come in increments of millions of dollars, but the cost isn't that significant, in the hundreds of dollars per year."
If you are having anyone come to your house to provide care or help with daily tasks—such as visiting nurses, home health aides, hospice caregivers, or even just a housekeeper—there's always the possibility that they could get hurt in your house.
"First, that person should have medical insurance of their own, either bought by themselves or their agency, or by you," says Dr. Nuwer. "Then you also need liability coverage in your homeowner's policy that addresses caregivers or other visiting health personnel, in case they slip and sue you because the stair was loose."
Liability in your homeowners policy has two components—personal liability coverage and medical payments. The personal liability portion pays a set amount of money to someone injured in your home—usually $100,000, but you may be able to boost this amount for a small premium increase. Medical coverage will pay the reasonable medical expenses for someone injured on your property.
"When you are the caregiver for someone with a significant medical condition, you need to review all of your insurance policies in light of what's going on," advises Shenkman. "Consult an elder law attorney or a qualified financial advisor. It takes an hour or two of your time and can protect you from serious financial consequences."
All long-term care insurance is not created equal. The monthly premium for your policy can vary based on many factors, including how old you are when you purchase the policy, your health, and how much coverage you select. (For example, a policy that pays $100 per day for three years will have a lower premium than a policy that pays $200 per day for five years.)
Every year, the American Association for Long-Term Care Insurance (AALTCI) publishes a price index for long-term care policies. As of early 2014, the Association found that a 55-year-old single male purchasing new long-term care insurance can expect to pay $925 per year for $164,000 of "good" benefits. If you want a higher level of coverage, you might look for a policy that will automatically increase your benefits to account for inflation. Today's average cost for a 60-year-old couple each purchasing $164,000 of immediate coverage—that grows to a combined benefit pool of $730,000 ($365,000 each) at age 85—would be $3,480 per year, or just over $300 per month. (For more information, see the AALTCI's long-term care insurance facts.)