Possible Deadline to Purchase Long Term Care Insurance in New York State
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New York Long Term Care Trust Act
Otherwise known as, Senate Bill S9082, will establish the New York Long Term Care Trust Program to provide long-term care benefits for eligible residents. New York residents who have paid the required payroll tax withholdings and are in need of assistance with at least three activities of daily living (ADLs) as determined by the department of health will be eligible for the program benefit of $36,500.
Washington State was the first in the nation to establish a Long-Term Care Trust to help offset the high cost of long-term care services in their state. Senate Bill S9082 is New York State’s version of the same program only better. The New York Long Term Care Trust Act eliminates the problems that were in the WA LTC Trust Act initially, correcting the mistakes before signing the bill into law. One very important difference is the requirement for allowing people to be exempt from the program and not pay the payroll tax deduction.
According to the bill, in order to be exempt from the New York Long Term Care Trust Act, you must own long-term care insurance before January 1st of the year in which the law becomes effective. For example, if the law becomes effective anytime in 2023, you must own long-term care insurance before January 1, 2023.
The bill summary explains the New York Long Term Care Trust Act this way:
“Provides for an optional exemption from the obligation to pay premiums (which exemption is coupled with a disqualification of the right to receive benefits) for individuals who have had in place private long-term care insurance continuously for at least the duration of the calendar year to date prior to the effectiveness of the law, for as long as they maintain those policies.”
Act now if you want to avoid paying the new payroll tax deduction.
What is Long Term Care?
There are many different services that would fall under the definition of long-term care. These services include institutional care in nursing facilities or non-institutional care such as home health care, personal care, adult day care, long-term home health care, respite care and hospice care.
- Nursing homes in New York State are licensed under the Public Health Law.
- Home health care consists of services received in your home, and can include skilled nursing care, speech, physical or occupational therapy, or home health aide services.
- Home care (personal care) consists of assistance with personal hygiene, dressing or feeding, nutritional or support functions, and health-related tasks.
- Adult daycare can provide supervision and other social, recreational, and in some cases, health services during the day, in a group setting outside the home, for elderly persons who still live at home.
- Assisted living facilities provide housing and ongoing care and services to those unable to perform activities of daily living or who have a cognitive impairment.
- An alternate level of care is care received as a hospital inpatient when there is no medical necessity for being in the hospital and is for those persons waiting to be placed in a nursing home or while arrangements are being made for home care.
- Respite care is temporary institutional or at-home care of a dependent elderly, ill, or handicapped person, providing relief for their usual caregivers.
- Hospice care is a program of care and treatment, either in a hospice care facility or in the home, for persons who are terminally ill and have a life expectancy of six months or less.
Will I Need Long-Term Care?
The chances of needing some type of long-term care services is high. It is estimated that over 40% of all persons who were 65 years old in 1990 will enter a nursing home during their lifetimes.
The Cost of Long-Term Care in New York
Long-term care is very expensive. Most people cannot afford to privately pay for long-term care services for very long.
Nursing home care costs vary in upstate New York from $264 per day in Central New York to $308 per day in the Rochester area, which is approximately $96,360 per year in Central New York to $112,420 per year in the Rochester area.
Downstate, nursing home costs vary from $340 per day in the Northern Metropolitan area to $390 per day in Long Island, which is approximately $124,100 per year in the Northern Metropolitan area to $142,350 per year in Long Island. It is estimated that persons in nursing homes stay for less than 2½ years on average.
Home health care is also expensive. The average cost of home health care in New York State in 2011 was $20 per hour, according to an industry survey. Assuming 20 hours of care per week, this represents average home health care costs throughout the State reach $21,000 per year.
Is Long-Term Care Covered By Medicare or Health Insurance?
Medicare: Medicare does NOT pay for most long-term care services. Individuals should not rely on Medicare to meet their long-term care service needs. Medicare does not pay for custodial care when that is the only kind of care needed. Skilled nursing facility care is covered by Medicare but only on a very limited basis.
If you need skilled health care in your home for the treatment of an illness or injury, Medicare may pay for some part-time or intermittent home health services furnished by a home health agency. Visit www.medicare.gov and www.cms.gov for more information on what is/is not covered by Medicare.
Medicare Supplement Insurance Plans: These plans are designed to fill in some of the gaps in Medicare coverage, but they do NOT cover most long-term care services.
Private health insurance: that you might already have covers mainly acute conditions and probably does NOT cover long-term care.
Medicaid: In order to qualify for Medicaid coverage, you must meet certain income and asset tests. Because of the high cost of nursing home care, more than half of those who enter nursing homes privately paying for their care deplete their assets to the level required to qualify for Medicaid in less than a year.
In New York State in 2012, if only one spouse needs nursing home care, the married couple is allowed to keep a home, a car and assets up to $113,640. A single person who requires such care may have resources up to $14,250 and still qualify for Medicaid.
Source: New York Department of Financial Services
For further assistance, please contact
Scott A. Olson at 877-727-9582
or email Scott at Scott@LTCShop.com
New York License #: LA-986644