View Full Version : Long-term care coverage can augment Tricare

12-19-06, 02:23 PM
December 25, 2006
Long-term care coverage can augment Tricare

By Gayle S. Putrich
Staff writer

Although Tricare covers skilled nursing care in certain situations, beneficiaries are on their own when it comes to long-term care coverage.

And while the end of the calendar year typically marks “open enrollment” season for most commercially available long-term care insurance options, most current and former military members are eligible for a federal program that has no enrollment deadlines.

The Federal Long-Term Care Insurance Program is available to active-duty members, National Guard members on full-time duty for more than 30 days, active members of the Selected Reserve, Navy Personnel Command nonappropriated fund employees, retirees who are also entitled to retired or retainer pay, and “gray area” reservists who have retired but don’t yet get their retired pay.

A range of family members are also eligible, including spouses, parents, in-laws, children and adult children.

But the fact that FLTCIP is not bound by traditional open enrollment schedules is no reason to put off getting coverage, said Jesse Sloame, executive director of the American Association for Long-Term Care Insurance.

More than half of applicants over age 80 are denied coverage because of health problems, Sloame said.

“The biggest mistake that people make, because we are procrastinators, is saying, ‘Oh, I can worry about this tomorrow.’ The longer you wait, the more likely you are to be denied coverage, no matter how much you are willing to pay,” he said.

And the earlier you take care of this, the less you may have to pay. Of applicants between the ages of 50 and 59, more than 40 percent qualify for coverage and “good health” discounts. Those between 60 and 69 qualify for a discount about 30 percent of the time, according to actuarial studies.

A partnership between the government and two insurance companies provides the program.

“There are many reasons to take advantage of a group plan such as the federal offering,” Sloame said. “It has simplified underwriting ... meaning that it’s easy to qualify.”

But shopping around before buying is always a good idea. John Hancock, MetLife and other providers offer plans similar in coverage to the federal group plan, but when you buy on your own through an agent, more discounts might be available, Sloame said, such as up to 20 percent off for good health or for enrolling a spouse. And some commercially available plans offer partial or full refunds on premiums if the insurance is never used.

Tricare does not pay for long-term care. But it does provide coverage for patients who are hospitalized for three or more consecutive days or readmitted to a hospital within 30 days of being discharged, if a doctor determines rehabilitation and skilled nursing services are needed and if the facility where the care will be given is a Medicare-certified Tricare provider.

While at a skilled nursing facility — not always the same as a nursing home — Tricare-covered patients pay cost shares and deductibles set by their Tricare plan, as well as 100 percent of the cost of noncovered services. When a patient needs help with activities such as bathing, eating or walking, it’s time to look into long-term care options, Tricare officials say.

But as long-term care insurance plans become more popular and more diverse, “looking into long-term care options” does not have to mean picking out a nursing home.

Most people who use their long-term care insurance benefit opt to get care a few days a week in their own home, Sloame said, with some eventually moving on to assisted living or nursing homes as they get older or their health declines.

When choosing a plan, the important thing is picking one that gives you choices, he said.

“Long-term care insurance can be very complex,” Sloame said. “Today’s plans have all kinds of bells and whistles. But the truth is that most people really just need a fairly simple core of benefits.”

More information on the FLTCIP can be found online at www.opm.gov/insure/ltc/.