Senior Living Today
Welcome to The Ohio Masonic Communities' podcast Senior Living Today! In this podcast, we will be discussing all aspects of senior living. From debunking myths about senior living to caregiving tips and health and wellness advice for seniors, we are here to answer all of your questions, and what life is like at our communities. We are excited to share our expertise on a variety of senior living topics, with a new podcast every two weeks. We will have a wide variety of guests ranging from experts in the field to those living their best life in one of our communities.
Senior Living Today
Insurance 101: Medicare, Medicaid, and Long-Term Care Insurance
Medicare’s alphabet. Medicaid’s requirements. Long-term care insurance’s restrictions. Insurance for older adults is confusing and it’s hard to know where to turn for information you can trust. Medicare pro Alan Zins is breaking down the basics of what you should know about Medicare, Medicaid, and long-term care insurance. We’re discussing what they are, what they cover, who is eligible, and how you can learn more.
Alan shares a lot of great resources for listeners who want to learn more about their insurance options. Here are some of the resources you may be interested in:
Advice4medicare.com
1-800-Medicare
Benefits.gov
Medicaid.gov
800-324-8680
If you would like more information on the Medicare Resource Center, or would like to schedule an appointment with Alan, you can visit their website at https://www.resourcemedicare.com/locations/beavercreek-ohio or give them a call at 937-416-2991
The Ohio Masonic Communities' Here to Help guides cover everything from what Alzheimer's is to what senior living community and contract types exist and more. You can access your free copy of the guides by visiting omcoh.org/sltguide.
(music) Hi everyone. Welcome back to another episode of Senior Living Today. With us today is Alan Zinz from the Medicare Resource Center. Alan, thank you so much for joining me today. Yes, thank you for having me. It's a privilege to be here and be able to help your listeners better understand their intricacies of today's topics. So since this is your first time on our podcast, would you mind telling our listeners a little bit about yourself and what you do with the Medicare Resource Center? Sure. I'm an independent fiduciary and owner of the Medicare Resource Center in beautiful Beavercreek, Ohio. I'm a local guy. I was born and raised in Ohio. I have a beautiful wife named Hope, whom I adore and have been blessed with for 16 years. And we have a furry son named Ziggy. For nearly 13 years, I've had the privilege and honor of helping people with their Medicare and retirement planning. My niche is wealth preservation. I help my clients by mitigating the risk during retirement with a variety of proven methods that improves the outcomes of them having a solid retirement. Because the way I look at it, a happy retirement is a great retirement. I'm also an educator with a passion to help empower people with knowledge that will benefit them. My team and I at Medicare Resource Center in Beaver Creek are, we give trusted advice and service to over 500 people a year. And we just celebrated four years. Up in, being the site of Medicare resource Center at the Mall of Fairfield Commons. And it's just wonderful to be able to serve the public. We just try to be a valuable asset in any way we can. So thank you again, Alexandria. I'm excited to be here. Absolutely. So today we are going to discuss Medicare, Medicaid and long term care insurance. I know there are so many people who panic with the thoughts of dealing with any type of insurance and understanding what options are all available to them. I've heard people who are confused about what the meaning of Medicare is versus Medicaid and not knowing how to use the two interchangeably. So can you explain just a little bit about each and what the difference between the two is? Sure. Yeah, it is. I, I come across this this subject a lot of times in my office. And what I tell folks is Medicare is a federal health insurance for people age 65 and older, and then some people under age 65 with certain disabilities or conditions. So that's one. But Medicaid is a joint federal and state program that provides health coverage for some people with limited income and resources. Medicaid offers benefits like nursing home care, personal care services, and assistance paying for Medicare premiums and other costs. So let's go ahead and dive into Medicare a little bit more first. So as you mentioned, Medicare begins when we reach the age of 65. So what is the first thing that you recommend people do and when? And should you wait until you're 65 to start doing those things, or do you recommend people start planning earlier? Yeah, first, don't do it by yourself. Work with a trusted and independent fiduciary and start planning 6 to 12 months from turning 65. You know, the importance of that is because, planning and preparing for Medicare is a bit of a tedious process, and everyone is different and there's no two people alike. So getting a jump start ahead in planning and preparing for Medicare and turning 65. And because you have to make a decision when you turn 65, whether it's to get Medicare or not Medicare. So but preparing well ahead of time, like again, I recommend 6 to 12 months from turning age 65. So we know a lot of people have their own health insurance. So if you already have your own insurance and you're 65, do you have to apply for Medicare? You know, how does that work? And could making the change to Medicare, even though you're still working, save someone money? Yeah. Good question. The answer could be yes and no. It depends on the individual's current situation and goals. There are several options for people to consider when planning for Medicare based on the goals of the individual. But an example would be, like many people are still working when they turn 65 and have their employer health plans. Wisdom tells us to go ahead and make sure you check to see what that employer plan looks versus as, Medicare plan that's built specifically for your wants and needs. So that's what I would tell folks to that are navigating that, because that is a question I get asked on on a regular basis. So again, doing your homework and making sure that you check to see what is available when you get if you if you get Medicare, because you can delay that. And we'll talk more about that as we go. But it is important for people to, make sure they know what their options are, because they may or may not have to get Medicare yet. I'm sure that's unique to each individual, depending on their specific situation. Yes, yes. So how does Social Security tie into Medicare? For example, you know, what about people have that have a career that didn't pay into Social Security, such as teaching or being a police officer? Does that make a difference? Yeah. So that's a two part question, Alexandria. The first part is how does Social Security tie in to Medicare? Good question. Social security, is a program that pays retirement, disability, family and survivor benefits. And there even though there are two separate government programs, they're connected in some ways. And some of those ways is Social Security handles original Medicare A and B enrollment applications, they, Social Security handles eligibility, and they also determine the amount of premium that someone pays for part B when they go on to Medicare. And there's more than that, just that. So, so the second part of that answer is, yes, there is a difference when it comes to Social Security for teachers and police and fire. And this is a topic I don't talk with, you know, a great amount. But I do know enough information that I can share some today. Teachers, as a public employee in the state of Ohio. And I'm just going to read this from my notes. If you're a public employee in the state of Ohio, you do not pay into Social Security and do not earn qualified service towards Social Security. In place of Social Security, you contribute 10% of your pay to the SCRS in return for a lifetime pension, which is earned after meeting certain age and ... and service requirements. And that's from the source of SCRS.org. And then for police, it's different. And with police, Social Security and Medicare coverage may be extended to police officers and firefighters whose positions who are not covered by the by their retirement system. And that varies on where they are and what part of the country they are. If police officers and firefighters are covered for Social Security, it's usually because that state in the state of Ohio and all states are covered under the section 218 agreement, which was enacted in 1951 but amended through the years But that gave folks, police officers and firefighters the right to receive Social Security benefits and pay into Social Security benefits instead of having their own retirement system. But this brings up a good point and kind of goes into our next question, but we have only scratched the surface. I feel like today there is so many different facets of Medicare. So who should people contact with questions that they have regarding Medicare and Medicare coverage? Well, that's a great question. So people, our listeners are always welcome to contact me. And they can contact me at (937) 416-2991. Or they can schedule an appointment online, or they can connect through my website at Advice4Medicare.com, which is advice, the number 4, medicare.com all one word. Listeners could also stop by our Medicare resource center six days a week in beautiful Beavercreek, Ohio. And if they wanted to talk to a government official, they could just call 1-800 Medicare. And for all of our listeners, we will be sure to put all of that in the description for this podcast episode so that you can reference those later. So next, we're going to talk a little bit about the phrase eligibility window. What does this mean? Yeah. In Medicare it's called special elections period or SEP. And there are over 40 of them. SEPs are ways of folks enrolling into Medicare Advantage or even prescription drug plans or also Medigap plans. And that's a whole other conversation. But, to answer your question, most commonly, for folks turning age 65 is when they go into their special enrollment period called their IEP, which is called initial election period. This is a period during which the individual is new to Medicare. And these are many times individuals turning age 65 in the eligibility window for that is seven months. So it generally goes three months prior to their birth month and three months after that. However, there is a caveat. If someone was born on January 1st, their Medicare could technically start December 1st of the month previous to that. Okay. That's a question that stumps a lot of new agents, actually. But, this is also these IEPs are initial enrollment are election periods. Excuse me. They're interchangeable words. Election and enrollment. This is also a guaranteed issue stage. So there's folks that are even very sick. Doesn't matter. There's no health questions asked for on these, initial election periods. It's your gift in the Medicare to choose any plan that you wish to have. But then folks to answer the question from earlier. What if they're working and they're like, I don't, I'm turning 65, but I still plan to put a few years in. Well, folks are allowed to do that, too, because it's just delaying their part B so when folks turn, when they, when they get Medicare at age 65, if they qualify, they just also can make it part B an optional thing by if they are working with a with an employer plan that is considered credible. But that's considered a delayed part B when they decide they want Medicare. And that's also another guaranteed issue stage of their Medicare. Thank you for clarifying that for sure. And there's over 40, special enrollment periods that help folks. So if folks are unhappy with their Medicare plan, chances are if they work with a skilled professional, they can find an election period in the middle of the year that may help them get out of that plan and into a plan that's maybe more suitable for them. There are possibilities of that, and most folks don't know about that. Another one of our special enrollment periods coming up October 15th to December 7th, is called the annual election period, which is where folks can shop and enroll into other Medicare plans, and really, no questions asked. All of these companies are at the mercy of someone changing out of their plans, so they all try to impress you. So hopefully some companies do it better than others. So that's what we help people find and discover during their special election periods. Well, that's a great example of why it is important to seek professional advice when you're looking at these things and and considering what type of Medicare coverage would be best for you. So before we move in to Medicaid, is there anything else that I forgot to ask or that you think our listeners should know about Medicare? And just to know that proper Medicare and retirement planning is vitally importance to their overall well-being in life. I certainly take it serious. So they should check it out. And consultations with me are always free and most of the time with other fiduciaries is free also. We welcome your business and we welcome your questions. So contact someone if you have moments where you need information about Medicare to make sure you truly are in the best situation that you can be in because there's a lot of companies that would love to have our listeners as clients so they stri, some companies just strive a little harder than others, and some companies just do it better than others. So it's always important for folks to be able to properly investigate and plan that for their future, so they can be better served. Absolutely. So I know we touched on Medicaid just a little bit at the beginning of this episode, but let's go ahead and start with who is eligible for Medicaid. Yes. So shifting gears to Medicaid, again, Medicaid is based on is it helps folks in mostly in financial need. So, Medicaid provides health coverage to millions, including children, pregnant women, seniors and individuals with disabilities. So folks with that are they're eligible for Medicaid in Ohio. They must meet some criteria, which would be an Ohio resident, a U.S. national citizen, permanent resident, or legal alien in need of health care insurance assistance, and who's their financial situation would be characterized as low income or very low income. There's a lot of qualification that folks need to know about Medicaid, including, you know, what is the Spend-Down program, what is income limits. They can, a lot of times you can find that online at www.benefits.gov. Make sure it's a .gov. Usually that means it's a government organization. Or folks can reach out to their local county department of job and Family services. And if you need help with that some folks just Google it and it'll help you find what, county job and family services that help assist on information to help with people with those questions. Based on your description, this program seems to be based on financial need. Is that correct? Mainly, yes. With other with other things. Yes. And then I heard you also use the term Spend-Down. So is there a certain amount that you can keep and what can it be spent on. Can you explain that a little bit more for our listeners? Yes, yes, yes. And that, that, that's that's another discussion. So Ohio's Medicaid Spend-Down program allows people to qualify for Medicaid by reducing their income and countable assets to a certain level. This is done by using existing medical expenses to pay for necessary expenses, such as expenses. Excuse me, such as medical bills, home modifications, or other care related expenses. So who can you be? Who can use the Spend-Down program? Well, people who are 65 or older, are blind or disabled, can use the Spend-Down program. Caseworkers at your local county Department of Job and Family Services help calculate your Spend-Down amounts. So it would be in the best interest of our listeners who feel like they may qualify for this, to reach out to them for, you know, the fair in the final say. In 2024, I do want to mention that the asset limit for a single person in Ohio is $2,000. This does not include most household goods and personal items, but what is included is bank accounts. So they're going to look at this. They're going to ask you about this. Bank accounts, brokerage accounts, real estate, retirement accounts, annuities and some life insurance policies, mostly the small term life insurance policies that generally they don't generally affect Medicaid eligibility. So can the Spend-Down be used on things like pre arranging funeral arrangements or a headstone? The answer is no with an exception. For a prepaid or pre need funeral contract to qualify exempt from the Medicaid spend Spend-Down asset rules. It must be irrevocable. Keyword there is irrevocable and irrevocable means that once you sign the contract you cannot change it or cancel it. So again good people to reach out about this are elder law attorneys are often helpful in these matters. So that leads I feel like right into my next question. This process can be complicated and confusing. So is there someone that people can contact to assist with their specific questions when it comes to Medicaid? Yes. For more Medicaid information, contact your local Department of Job and Family Services. Folks want to go online they can go to medicaid.gov. And if they want a phone number to call, they can call the Ohio Medicaid Consumer Hotline, which is (800) 324-8680. And for our listeners, we will be sure to include that website and phone number in the description for this episode. So, Alan, before we move on to long term care insurance, is there anything else that you would like to share in regards to Medicaid? Yes. Thank you. Alexandria, individuals that qualify for Medicare and Medicaid dual special need plans are offered many benefits to help alleviate worry and stress from their lives. It's more than just health care with those kind of plans with the Medicare Medicaid plans. Some of the examples of the effectiveness of these plans is low to no health care and prescription costs. A lot of them will add of food and utility allowance, transportation, dental, vision, hearing, managed care from the plan, gym memberships, and much, much more actually. So those plans again are to help help with the folks that are already suffering with financial crisis, that that don't necessarily have the means to have the best health insurance. Well in this case it can step in as a nice and adequate health health care provider for them. Well thank you. I appreciate you sharing that bit of information with our listeners. All right. So now we're going to move on to long term care insurance. So can you just explain give an overview of what long term care insurance is and what it covers? I would love to. I have several several key points with long term care. Long term care first involves a variety of services designed to meet a person's health and personal care needs when they can no longer perform everyday activities on their own. Essentially, long term care plans transfer the individuals health and wealth risks to an insurance company. Long term care planning is an integral part of retirement planning that helps prevent a family's estate from being eroded. And long term care overall is a crisis that's not being discussed enough. The general public is uninformed about the extent... about the expenses and the stress that long term care expenses puts on individuals, family, and the public. I say public because it means a large expenses on the Medicaid system and which we just talked about. The Medicaid system right now is currently burdened and is over distressed right now. There's been talks about that since I'm a kid. I'm 47 now, but they've been talking about how the Medicaid systems and Medicare system is going to go out of business. But that's absolutely not true. However, it is stressed. Folks without proper long term care planning can and usually do end up needing Medicaid assistance, which means what we just talked about, Spend-Downs and draining of assets to provide health insurance for folks. It's not the ideal, but if folks would do some long term care planning and we'll talk more about it, it'll it'll benefit them. Just if I could, Alexandria, give you some of the statistics about long term care that I have found. All the sources are reputable. The Ohio Department of Health and Human Services, the Ohio Department of Insurance, this is the Kaiser Family Foundation, and also AARP is where I get these statistics from. But this is alarming. So 70% of, and that's seven out of ten Americans, who reach age 65 will require some long term care service at some point in their lives. 70%. That's huge. And the gender is different. So women generally need more long term care for the duration than men. Because women live longer. 14% will need more than two years of paid care. Both assisted living and memory care varies by location, but assisted living costs in Ohio, these are the 2024 numbers, is the average cost for folks that come, this is coming out of their own pocket or a long term care policy, is $5,268 a month. I don't know if most folks know that. Ohio is actually 10% above the national average, which is $4,802. That's 2024 numbers. Assisted living in the median monthly rate is 6750 dollars. That's in Dayton, Ohio. That that boils out to be $81,000 a year for folks. Memory care costs in Ohio are $6,043 per month. And also, long term care costs generally rise every year. So with inflation and everything and anything post-Covid, you can just expect all those those numbers to continue to rise like they have over the last couple of years. Well, Alan, I'm really happy that you shared those stats with our listeners. And hopefully it will encourage some of them to plan a little bit ahead. So that leads into my next question. Can anyone apply for long term care insurance? Yes. But within reason, some won't qualify due to health reasons. Some won’t need it due to personal assets. It's best to sit down with a licensed professional and find out if you need it. The recommended ages for folks to purchase long term care policies are ages 40s through 60s generally is kind of the sweet spot for folks that shouldn't really consider long term care for their future and for the, possibility of keeping their estate in order. And we can help with that. So is long term care insurance considered a medical insurance? I've heard it's purchased through a conventional insurance agent, meaning that it's somebody that sells life insurance. So can you explain that a little bit for our listeners? Sure. I'd be happy to. Long term care helps cover medical expenses, but is not classified as a medical insurance. And it is not covered by Medicare. Long term care policies are sold mostly by life insurance companies through a life licensed, appointed professional. So I'm sure that the answer to this question is going to be no. But let's dive into some of your listeners. Are all policies alike? Yeah, absolutely no. Each company that handles long term care planning have their own unique benefits. It's wise to compare plans based on what you want and what you need. Some traditional policies from the 80s to the early 2000s, they were mostly they use it or lose it type of policies. They were kind of like paying for car insurance. It's use it or lose it, you know, but you don't get any of those premiums back. But since 2010, many new hybrid long term care policies combined coverage from life insurance plans, into a long term care policy. Because really, what a long term care policy can be is built on a life insurance chassis, which is wonderful. And so these hybrid policies now say, let's say that you have,$100,000 death benefit. We're just for ease of numbers, okay? And someone says, hey, I don't necessarily need that $100,000 death benefit. I need long term care before I die. And these new hybrid policies with the right company will say, hey, we'll take that $100,000 instead of pay you later when you're after your deceased. We'll just make it part of your payments for long term care. And it's wonderful. Some of these companies will do a cash indemnity, which means they'll send you a check to your to your bank or home or however you set it up. But, so you use it to spend it on how you see you need it to spend. Because some of these companies, or these clients, you know, with their parents that are aging, it's the kids that are taking off their jobs to try to care for their aging parents. And some of the aging parents want to say, I want...because my daughter, they used to be a full time employee, is now a part time. I want to pay her some money because she helps me with my, my day to day needs. That, those policies are available now where they didn't used to be, so it's always worth it talking with a licensed professional that’s skilled at using these. Absolutely. So we talked a little bit about the differences between policy options. Another question we get is about pricing. Are prices the same regardless of the company or will that vary from company to company. And they'll vary. No. Prices and qualifications and restrictions vary from each provider. Some companies are a little more strict and some are a little more loose. So it really is important to work with an independent fiduciary that is skilled at helping people with these types of not only questions, but with these type of planning. And then also what about your age? Do prices change depending on your age? Yes it does. The younger and healthier you are, the lower the cost would be. So generally the healthier the person, the more robust features offered in their long term care plans they can have. Which is nice. So but yeah. So folks, it's, if you're thinking about it, you ought to look into it. Because again, the generally the younger and the healthier, the lower the cost and the more likely that you'll get a plan, because again, you can be turned down for health reasons. Yeah. So you mentioned health condition. So I, I'm assuming that those do have an effect on the acceptance and the price for these policies. Absolutely. You are the person that are applying for long term care. You're essentially asking a large fortune 500 company to take the burden and the risk of your declining health in the future while you pay them a relatively small fraction of the cost, you know, in premiums. But there are several companies. So your small amount that you, that they accept you, because you have to be accepted into a long term care plan, again, meaning being healthy enough and having the financial means to do so. But they're not always all expensive. By the way, there is usually these plans this day, these new hybrid versions usually fit the budget of the people that are trying to apply for them, actually. So that's they're not all just expensive and not just for certain people. They're really for anybody. And but you just got to work with a licensed professional in knowing which ones to work with, because there are several options. And companies have, different health questions during the applications process. So it's again, it's always wise to talk to a skilled and licensed professional. Absolutely. So can you be denied for health reasons alone? Yes. And then what does long term care insurance cover? Will it cover assisted living, skilled nursing, memory care? Yes, but it's all in the long term patient care planning for the individual that they do. These are solid questions and what should be addressed when planning for their future. Most times these type of assisted care can be, and I don't mean as you used assisted care, I mean skilled nursing, memory care, assisted, can be added as riders with certain companies, where other companies sometimes have them already integrated into their plans already and with with caveats sometimes. And then who would you recommend our listeners contact with questions regarding long term care insurance? Yeah, thanks for asking. Listeners are always welcome to contact me. Listeners could contact If not me, they should contact an independent fiduciary that is property, that has properly license and has experience with handling these type of cases. I've been blessed in handling everything we talked about today for nearly 13 years. If listeners would like to contact me, contact me, please do so. Consultations are always free with me and recommended really. I love questions and helping people get ahead. I appreciate you providing my contact information for your listeners, and, we're always welcome. We're our Medicare resource center inside the Mall of Fairfield Commons is open six days a week. So come on in and, feel free. It's a nice, clean environment. It's very inviting. And, it's just a place of of where people can get some service with Medicare or long term care or even Medicaid questions. We get those all the time also. We’ll guide you along wherever we can, and we'll tell you if we have the answer and if we don't have the answer, we'll let you know that too. But we can always find resources for you. And that's what we're here for. That's great. And as I mentioned earlier to our listeners, all of Alan's information will be included in the description for this episode. Alan, before we close out today, what else should our listeners be asking regarding long term care insurance? Yes. With the advancements in science and awareness, people are living longer these days, more than ever in our country's history. Statistics show how Americans who reach age 65, they should plan to live at least another 20 years. So the question you got to ask yourself is, will you outlive your money? Listeners need to make sure that their retirement plans will be with them for the rest of their lives. And they need sometimes need to take action. Listeners also need to make sure they can retire with dignity and with full assurance, talk with a professional and know what's available. Many insurance companies have adapted to a new post-Covid era by creating innovative products to help everyday people, you know, and I want to also just mention in closing if if what I talked about today causes any kind of a stirring feeling within you, act on it by at least getting answers to your questions and finding out what's available for you specifically. It's always free with me. Don't wait before it's too late. People don't plan to fail. They just fail to plan. And today, I hope everybody learned something useful. It's been an honor to be here. And so thank you and bless you. And I appreciate being here. Alan. It was such a pleasure having you with us today. You shared some incredibly helpful information and tips regarding Medicare, Medicaid, and long term care insurance and what the planning process for that looks like. So thank you again for being here. Oh thank you. It's my pleasure. For all of our listeners, please be sure to tune in to our next podcast. In two weeks, we will be talking with a panel of our own residents who will share ways to make the transition of moving into a senior living community smoother, as well as some helpful tips for settling into your new home. As always, be sure to like and subscribe to Senior Living today so you never miss a new episode and we will be back again in two weeks.(music)
