Life Insurance Medicare

Long Term Care Insurance – Women May Need it More than Men

Want to hear something alarming? There are currently more than 36 million Americans who are 65 or older, a number likely to surge to 87 million in the next four decades, and fewer than a third of them – about 8 million – Only about have a long-term care plan as part of their life insurance package. That’s bad for all of them, but worse for the vast number of older women destined to outlive their husbands, especially if they have no children or other relatives unable to provide care.

Recent health care reform legislation does offer some hope. Beginning in January, corporate insurance plans will begin offering CLASS (Community Living Assistance Services and Support), a government-run, voluntary, long-term care insurance program. Participants of any age will pay a month premium, and, after a five-year vesting period can receive $50/day – or more – for in-home care.

The passage of CLASS is a big step, but it still doesn’t negate the need for long-term care insurance. As the American Association for Long-Term Care Insurance(AALTCI) shares, private home health assistance averages $20/hour, which means a senior citizen needing four hours of assistance three days a week would be paying $12,480/year.

The AALTCI has recently completed a study on seniors and long-term care. Among other things, they discovered:

  • 80% of Americans who need private home health care are at least 75 years old.
  • Roughly 10 million American seniors need daily help with basic tasks like eating, dressing, and bathing. Within ten years, that number is expected to reach 12 million – and it will continue to climb.
  • About 90% of seniors would prefer to live out their years in their own homes, rather than being sent to a nursing home, or similar facility.
  • Medicare doesn’t pay for services like basic care that isn’t linked to a serious medical condition.
  • 60-75 percent of the time, women provide family care, or informal care – 50 percent more time than men do.
  • Women outlive men by an average of five years.

What does all this mean? Put simply: consider a long-term care plan now – especially if you’re a woman.

Health Insurance Medicare

Medicare Payments to Decline 0.1%

Modern Healthcare is reporting that under a new rule issued by the CMS, Medicare inpatient payments to acute-care hospitals will decline by about $142 million – or 0.1% – during the 2011 fiscal year.

The new rule addresses payments rates and policies for inpatient services received by Medicare patients in roughly 420 long-term-care, and 3,500 acute-care hospitals. Richard Umdenstock, president and CEO of the American Hospital Association said, in a written statement that members of his organization were, “deeply disappointed with today’s proposal. Plain and simple: this policy will undermine hospitals’ ability to care for patients and communities across the country.”

The CMS is proposing a 2.4% annual inflation increase in Medicare payments in acute-care hospitals, which is only slightly higher than charges in the 2010 fiscal year, but it is also adding a negative adjustment of 2.9 percentage points in order to recoup estimate spending excesses that took place in the 2008 and 2009 fiscal years due to changes in hospital coding practices. With these two adjustments, and other factors that may affect spending, the agency has come up with the estimate of a decrease of 0.1% in 2011.

When researching documentation and coding trends under the Medicare severity diagnoses-related groups (MS-DRGs) earlier this year, the Medicare Payment Advisory Commission found that hospitals were more accurate with their coding procedures with resulted in the receipt of higher payments. However, while hospitals may have been getting more money, the coding changes did not “…reflect increases in patients’ severity of illness,” said the agency, explaining the reasoning behind recouping payments.

Umbdenstock countered with the belief that hospital patients really are getting sicker, saying, “Hospitals supported the move toward a more refined payment system that would better characterize patient severity, yet CMS’ coding offset distorts any improvements to payment accuracy.”

Like acute-care facilities, long-term care hospitals will also receive adjustments, though their inpatient Medicare payments are expected to increase by $41 million, about 0.8%, in the 2011 fiscal year.

It is not yet known whether any kind of coding policy will affect the cost of health care coverage for Medicare patients.