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Insurance

What Is Long-Term Care Insurance?

30/04/2023
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According to the US Department of Health and Human Services, the typical person who turned 65 in 2020 has about a 70% chance of needing some sort of long-term care or assistance during their older years. And the costs of this type of care are high — the average person needing care at home will spend about $54,000 per year or $4,500 per month, and a person who needs a room in a care facility will pay an average of about $96,000 per year or $8,000 per month according to 2022 data from HCG Secure.

With costs so high, paying for long-term care can quickly drain your savings and limit your options for higher-quality care. Long-term care insurance can play an important role in ensuring you or a loved one spends the last chapters of life in comfort, but you need to know the ins and outs of this product before deciding if it’s right for you.

What is long-term care insurance?

Long-term care insurance can help you cover the expenses associated with getting skilled care for an extended amount of time for chronic health conditions. “What long-term care insurance does is it provides more day-to-day things,” says Peggy Haslach, a certified financial planner at Finity Group.

It’s separate from health insurance, including Medicare, which generally doesn’t cover these costs. While Medicaid can cover costs, not all facilities accept Medicaid payments.

You don’t have to move to a facility to gain the benefits of long-term care insurance — it can also cover the cost of care at home, including training for family members and in-home assistance. Long-term care insurance may also cover home modifications that make your living space more accessible and comfortable, such as ramps and shower handles.

How does long-term care insurance work?

Long-term care insurance kicks in when you’re experiencing difficulties living life on your own. Generally, insurance companies classify this according to the six activities of daily living, or ADLs:

Bathing
Continence
dressings
eating
Transferring (getting from a bed to a chair)
Toileting

When someone loses two of these six ADLs, they may be able to trigger their long-term care insurance benefits. In addition, certain cognitive issues associated with Alzheimer’s and dementia can automatically put your policy’s benefits into effect (although this usually requires a doctor’s evaluation).

After the benefits are triggered, you’ll still spend a certain amount of time (called the elimination period) paying out of pocket. The elimination period varies from policy to policy but is usually either 30, 60, or 90 days. After that period, your insurance will cover the rest of the costs up to a daily limit.

However, many policies have lifetime maximums on how long they will pay out — generally, two to four years of care, though unlimited policies do exist. If there’s a limit on your policy and you exceed it, you’ll need to dip back into your savings to cover costs. A high-yield savings account, such as UFB Premier Savings or Marcus by Goldman Sachs High Yield

Insurance

The insurance limit on your savings has become a hot global debate

29/04/2023
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London
CNN
—

If my bank fails, how much of my savings will I get back?

It’s a scenario no one likes to think about. But in the past 15 years, it has unfolded with particular drama on several occasions — during the 2008 global financial crisis and again since mid-March, as turmoil has gripped the banking sector.

The US Federal Deposit Insurance Corporation insures deposits up to $250,000 per person, per account, using a fund that banks pay into. But last month, when Silicon Valley Bank and Signature Bank failed in rapid succession, the FDIC, backed by Treasury Secretary Janet Yellen, stepped in to insure all deposits. It could do so again if the ailing First Republic Bank implodes despite multiple bailout measures.

That would be controversial. A fierce global debate has erupted over whether regulators should have agreed to reimburse everyone, including those with millions of dollars in their accounts.

The decision has also raised questions about whether current banking rules are sufficient protect individuals, businesses and the broader financial system.

“We have a long history now of protecting all depositors every time a bank gets in trouble,” said William Isaac, who managed hundreds of bank failures as head of the FDIC during the cumulative period in the early 1980s. “I don’t think that’s served us well.”

Some argue the US deposit insurance limit should be 100 times higher. Others claim increasing the cap would lead to much riskier behavior among lenders.

Lawmakers in Washington are discussing reforms, although no clear proposals have emerged so far. The FDIC, which is undertaking a “comprehensive review,” will release policy recommendations by May 1.

Across the Atlantic, Bank of England Governor Andrew Bailey has said regulators are considering changes to the UK deposit insurance program, which protects holdings up to £85,000 ($105,995).

Here’s what you need to know.

Deposit insurance exists to protect individuals and small businesses from bank failures and to help shield the economy from nasty aftershocks when a lender collapses.

How it works is straightforward: If your bank goes under, you’re guaranteed to get your money back, up to a certain limit.

The system is also designed to avert bank runs. Banks make money by taking in deposits and charging interest to lend them out. However, that means they never have enough cash on hand to pay all depositors at once. When such simultaneous demands come in, the lender is in trouble.

Deposit insurance is aimed at calming fears, giving customers less reason to withdraw their cash out in a hurry. It’s intended to make the entire banking system more stable.

Regulators aren’t sticking to their own rules.

The FDIC insured all deposits at Silicon Valley Bank and Signature Bank last month using a Treasury exemption. FDIC Chair Martin Gruenberg told Congress this step was necessary to stop the alarm spreading across the financial system, and to ensure affected companies could pay staff and honor deals with suppliers.

At both Silicon Valley Bank and Signature Bank, more than

Insurance

Surgeons, Intensivists Earn the Most From Private Insurance

23/04/2023
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General and orthopedic surgeons and intensivists earn the highest net reimbursement from private US insurers, a new report estimates.

On average in 2021, they were paid $5.8 million, $4.9 million, and $3.3 million, respectively, according to figures compiled by AMN Healthcare, a Dallas-based health staffing company.

None of 15 other physician specialties topped $3 million in net reimbursement on average, and three — dermatology, pediatrics, and family medicine — didn’t reach $1 million.

The report doesn’t include data about reimbursement from Medicare and Medicaid, and its numbers assume that 50% of insurance claims are denied. Denial rates differ from practice to practice.

Still, the findings offer a “benchmark tool” to help clinicians understand how they rank against their peers, said Linda Murphy, president of AMN Healthcare’s Revenue Cycle Solutions division, in an interview.

This is the first year that the company has calculated physician reimbursement levels by using claims and clearinghouse data, Murphy said. Previously, a division of the firm compiled data by surveying chief financial officers from hospitals.

The report’s estimate that insurers denying 50% of claims is “conservative,” Murphy said. Miscoding is a significant factor behind that number, she said.

Here are the estimated 2021 net private insurance reimbursement by specialty for direct services, assuming a 50% denial rate:

Anesthesiology: $1,665,510
Cardiology: $1,703,013
Critical Care (intensivist): $3,338,656
Dermatology: $729,107
Family medicine: $697,094
Gastroenterology: $2,765,110
Internal medicine: $1,297,200
Neurology: $1,390,181
Obstetrician/gynecologist: $1,880,888
Otolaryngology: $2,095,277
Pediatrics: $661,552
Psychiatry: $1,348,730
Pulmonology: $1,561,617
Radiology: $1,015,750
Rheumatology: $1,705,140
General surgery: $5,834,508
Orthopedic surgery: $4,904,757
Urology: $2,943,381

Among 18 physician specialties overall, the report estimated that the average net reimbursement in 2021 was $1.9 million.

The report also estimates that the net reimbursement amounts at $875,140 for certified registered nurse anesthetists and $388,696 for nurse practitioners.

Surprisingly, Murphy said, there’s a “really big swing” among reimbursement levels for individual specialties. The quartile of cardiologists with the lowest level of reimbursement, for example, submitted $2.1 million in claims in 2021, netting about $1 million at a 50% denial rate vs the $7.3 million made by those in the highest quartile, netting about $3.6 million.

The gap seems to be due to regional variations, she said, adding that a rural cardiologist will have different billing practices than does one practicing in New York City.

The quartile of general surgeons with the highest reimbursement levels billed for $21.1 million on average in 2021, making about $10.5 million at a 50% denial rate. The lowest quartile billed for $5.5 million, making about $2.7 million at a 50% denial rate.

The report notes that primary care physicians, that is, family medicine, internal medicine, and pediatrics specialists, have much lower levels of reimbursement compared to most other specialties. But the work of primary care physicians “may lead to considerable ‘downstream revenue’ through the hospital admissions, tests and treatment they order,” the report noted.

A previous analysis by a division of AMN Healthcare found that primary care physicians, on average, generate $2,113,273 a year in net annual revenue for their affiliated

Insurance

Ohio Department of Insurance warns of scam offering new Medicare cards

19/04/2023
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CLEVELAND, Ohio (WOIO) – How closely do you guard your Medicare card?

Scammers are phishing for your Medicare card number, and you might not even know it’s been stolen.

The Ohio Department of Insurance is sounding the alarm about a new tactic from scam artists who are calling Medicard card holders posing as if they’re calling from the Social Security Administration or Medicare, saying you need to be issued a new, plastic card.

They want you to know there are no new Medicare cards.

“What they do is sell that number to somebody who can then bill the Medicare system fraudulently using that number,” said Becky Hayward with the Ohio Senior Health Insurance Information Program.

So the federal government, and tax payers are being scammed, paying out millions in claims from people who aren’t Medicare patients.

“They could have claims on their account and they may have to face some medical bills of things that might happen. And if they don’t pay attention, they may be saddled with the bill for something that didn’t happen,” she said.

Individuals might not know they’re a victim until they need something themselves.

“Maybe you need a wheelchair, and somebody already ordered a wheelchair fraudulently under your account. And you won’t get that wheelchair,” said Hayward.

Those with access to your Medicare card number may also use it to pose as you and get more personal information, in order to steal your identity.

OSHIIP is warning Medicare card holders to protect their cards and their numbers just like you do your social security numbers, credit card and bank account information.

There aren’t any quantitative numbers on how often this is happening, but OSHIIP hotline calls indicate this is trending upwards.

Starting this month, you’ll start to see reminders on your Medicare summary notices, which is an explanation of your benefits, encouraging people to protect their cards and not to share their numbers.

Insurance

Doctor takes patient off lifelong medication due to insurance

19/04/2023
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Dr. Keith Roach

Dear Dr. Roaches: I am a 61-year-old male, and I’m currently taking medication for blood pressure, cholesterol and diabetes. Five years ago, I was diagnosed with deep venous thrombosis (a blood clot in my right leg). I was prescribed Coumadin. After taking Coumadin for six months (I could never get the number right), I went to the emergency room, and the doctor there said that the Coumadin wasn’t working. So, he prescribed Eliquis. He told me that I would be taking a blood thinner for the rest of my life.

Recently, my primary health provider changed my doctor, and now this doctor is taking me off Eliquis. The reason is due to insurance. I guess it’s expensive, and they asked the new doctor if I really needed to be on it.

Should I be concerned about stopping Eliquis after being on it for five years? One doctor said that I’ll be taking it the rest of my life, and now five years later, another doctor is taking me off of it. Something just doesn’t seem right to me. Your opinion on this matter would be sincerely appreciated.

— SF

Dear SF: I would also be very concerned if I thought my necessary medication was being stopped because an insurance company no longer wanted to pay for it, so I understand exactly why something doesn’t seem right. But the issue may be a medical one, not a financial one.

There is always a trade-off between reducing the risk of another clot with medicine and increasing the risk of serious bleeding. A bleed inside the brain is devastating, just as a blood clot in the lung is.

So, it is possible that the first doctor might have made an error in judgment, and the second doctor might be right that you shouldn’t be on an anticoagulant like warfarin (Coumadin) or apixaban (Eliquis). It takes experience to decide the duration of anticoagulation.

Most people with their first diagnosis of DVT should be on anticoagulation for at least three months, while others are treated for six months up to a year. That decision is based on knowing what caused the blood clot (sometimes it’s unknown), how likely it is for the clot to come back, and how likely a person is to have dangerous bleeding on an anticoagulant.

In general, if there is a provoking factor (such as surgery) that has gone away, most people do not need lifelong therapy. However, if the underlying problem is permanent (cancer or a known genetic cause), or if the person has a life-threatening clot, then long-term anticoagulation is almost always recommended.

One blood test that may be helpful in deciding whether you need lifelong treatment is called the D-dimer test. A high D-dimer predicts a greater risk of a recurrent clot. Some experts use this test only in women, as it is less reliable in men, and men are at a higher risk for recurrent clots.

Since I don’t know if there was something