Long Term Care Insurance South Carolina - Policy Brochures
Long Term Care Insurance South Carolina
Long-term care issues can be complex and confusing. With so many options, services and settings in which care is given, many people delay learning about the issues until they are personally affected. Unfortunately, that is likely to be the time when you are under the most pressure to make a decision, and when time is too short to carefully weigh your options.
Because these long-term care issues deserve your careful attention, don’t wait until it’s too late to find out all you can about this important health care alternative. Don’t wait any longer to find out important information!
What is Long-Term Care?
Long-term care is the day-in, day-out assistance you might need if an illness or disability lasts a long time and leaves you unable to care for yourself. This may or may not include a nursing home stay. In other words it is a continuum of services that can be provided in a variety of settings ranging from one’s own home, assisted living facility, adult day care facility or a nursing home. Long-term care covers a broad spectrum of care and services ranging from basic personal care to medical care.
Long Term Care Insurance South Carolina Shopping Tips
- Shop around for an insurance agent and an insurance company–ask friends, family or neighbors if they recommend their insurance agent or company.
- Ask insurance agents which insurance company’s products they sell; most agents only sell products from a few companies. Compare several different products from several different insurance companies. You might need to talk with several different agents.
- Carefully compare the benefits and restrictions between policies.
- Most LTC insurance premiums increase over time. Carefully evaluate whether premium payments over a long period could be a financial hardship.
- Never pay insurance premiums in cash; do not make checks payable to the insurance agent.
- Read your policy carefully and ask follow up questions.
- Use your 30-day “Free Look” period to return a policy for a full refund if you are not satisfied!
- Understand what a Long Term Care Partnership (LTCPP) policy is, how it differs from non-LTCPP policies, and whether it is affordable for you.
Introduction to the Long Term Care Partnership Program
The Long Term Care Partnership (LTCP) Program is a joint effort between the federal Medicaid Program and Long Term Care (LTC) insurers. The Long Term Care Partnership was developed to encourage people to plan for their future Long-Term Care
(LTC) needs, such as residing in a nursing facility or receiving LTC waivered services in a home or community-based setting.
The LTCP involves private LTC insurers, LTC insurance producers (agents and brokers), the South Carolina Department of Health and Human Services (SCDHHS) and the Department of Insurance (DOI). Although the Partnership is overseen by the federal Centers for Medicare and Medicaid Services (CMS), each state has a great deal of autonomy in its administration. In South Carolina, qualified LTCP policies must provide a specific amount of inflation protection based on the person’s age when the policy is purchased and must meet other requirements determined by the Department of Insurance.
A person who requests Medicaid assistance of LTC services after exhausting some or all benefits of a qualified LTCP policy may have certain assets “disregarded” equal to the benefits paid by the qualified LTCP policy at the time the person is determined eligible for Medicaid. These assets are not counted when the person’s Medicaid eligibility is determined and will not be recovered during estate recovery when the person dies.
Interaction between the Long Term Care Partnership Program and Medicaid Eligibility
1. A LTCP participant in South Carolina is someone who either:
- Requests Medicaid payment of Long Term Care services after exhausting all benefits of a qualified LTCP policy, or
- Exhausts all benefits of a LTCP policy while receiving Medicaid payment of LTC services, or
- Receives Medicaid payment of LTC services and dies before the LTCP policy benefits are exhausted.
2. In determining Medicaid eligibility, SCDHHS will disregard an individual’s assets in an amount equal to the amount of payments made by the individual’s qualifying LTCP policy for services covered under the policy. Documentation of
the amount in benefits paid will have to be provided.
3. A LTCP participant receives the following benefits during his or her lifetime:
- Assets may be designated for protection in an amount equal to the total amount of LTC services paid by the qualified LTCP policy
- Designated assets are not counted toward the Medicaid asset limit
- The designated assets may be transferred to any other person without penalty.
4. After the LTCP participant is deceased:
- Assets which were designated as protected during the person’s lifetime are also protected from estate recovery
- When the amount of assets protected during the person’s lifetime was less than total benefits paid by the LTCP policy, additional assets may be protected in the estate recovery process – up to the total amount paid by the LTCP policy
- If no assets were protected during the person’s lifetime, the personal representative may designate assets to protect from estate recovery equal to the total amount paid by the LTCP policy – even if LTCP policy benefits were not completely exhausted.
5. Owning a LTCP policy does not guarantee eligibility for Medicaid, even if the policy holder exhausts all benefits. Individuals must still meet all other Medicaid eligibility requirements. The LTCP allows policy holders to have a portion of their assets disregarded (not counted) during the eligibility process and subsequently protected from estate recovery. REMINDER: Only SCDHHS can determine whether a person will qualify for Medicaid. Agents should be careful not to advise regarding eligibility requirements or whether a person will be eligible for Medicaid.