New York Long Term Care Insurance Information & Statewide Costs
New York State is one of the areas with the most expensive Long Term Care facilities in the United States. According to the most recent survey conducted by Genworth, the average cost of care for a private room in a nursing home in New York is $123,005 compared to the national average of $81,030. Interestingly, the state’s cost for individual home health aides is not too far from the national average. Average annual expense for a non-Medicare certified aide in New York is $48,620 versus the national average of $43,472. Average annual expense for a Medicare certified aid is actually lower than the national average at $68,565 versus the national average of $105,751.
Of course, costs vary considerably across the state. Facility care in New York City would cost more than in other places in the state, while hourly home health aides are, on average, less expensive than in more rural areas of the state. Below are the median costs for 2012:
|Region||Homemaker Services Hourly Rate
|Home Health Aide Hourly Rate
|Assisted Living Facility Monthly Rate
|Nursing Home Daily Rate
|Nursing Home Daily Rate
|Albany - Schenectady - Troy||$22||$23||$4,340||$326||$340|
|Buffalo - Niagara Falls||$22||$23||$3,585||$282||$301|
|Outer New York City Area||$23||$23||$5,850||$375||$400|
|Poughkeepsie - Newburgh - Middletown||$21||$24||$3,900||$371||$396|
|Utica - Rome||$21||$22||$2,903||$265||$278|
|Rest of State||$22||$23||$3,395||$278||$296|
Given the especially high cost of care in New York many people are turning to private Long Term Care insurance and taking advantage of the state's long-standing Partnership program.
New York Long Term Care Insurance Partnership Program
The New York State Partnership for Long Term Care is a partnership program between private insurance companies and Medicaid to finance Long Term Care of the people of the State of New York. Medicaid program under the Partnership is known as Medicaid Extended Coverage. Under the Partnership program, New Yorkers may be able to apply for Medicaid assistance without exhausting their assets and resources. Medicaid Extended Coverage allows eligible policyholders to protect all of their assets through Total Asset Protection Plan, or some, through Dollar for Dollar Asset Protection Plan. With these alternatives, New Yorkers are assured of their continued care after using up the benefits provided by their private insurance policies, without losing their life savings and their dignity.
Long Term Care Partnership Policies
All insurance companies participating in the Partnership program must include the following basic benefits in the policies that they offer:
- Nursing home care
- Nursing home bed reservation of 20 days per year
- Skilled nursing care
- Assisted living care
- Adult care
- Home care
- Personal care
- Respite care (14 nursing home equivalent days per year)
- Hospice care
- Alternate level of care - in-patient services received in a hospital while waiting to be placed in a nursing home, or while waiting for arrangements for home care.
- Care management - minimum of 2 consultations per calendar year. This is a face-to-face care management consultation done by independent healthcare professionals, to assess the services received by a policyholder and give recommendations to optimize utilization of insurance benefits. Care management benefits depend on the amount of the nursing home daily benefit. For instance, if a policyholder has a $300 nursing home daily benefit, his care management benefits would amount to $600 for one calendar year. If one care management consultation costs $200, then a total of three consultations can be accessed for a year. However, care management benefits, if used, are deducted from the maximum lifetime benefits that a policyholder may receive.
- Inflation protection of 5% compounded annually - Partnership policies issued to qualified policyholders aged 79 and below include a 5% annual compounded inflation protection. This benefit is optional to those aged 80 and above.
- Guaranteed renewable - the insurance company cannot decline should a policyholder wishes to renew a policy, provided that the policyholder pays the premium on time and makes no changes in the provision of the Partnership policy while it is in force.
- Partnership Independent Assessment Benefit - a unique feature of Partnership policies. This allows policyholders who are denied by their Partnership insurance company of benefits (due to failure to meet disability standards) to request for an independent review by the New York State Partnership office.
Additional benefits may be offered by some participating insurance companies but with additional costs in policy premiums. Examples are waiver of premium (payment of premium is waived after care has started), combined home care benefit, independent provider benefit, etc.
Types of Partnership Policies in the New York Long Term Care Partnership Program
1. Total Asset 50 - minimum 3 years Nursing home care OR 6 years Home care with a minimum daily benefit of $218 for Nursing home and $109 for Home care.
2. Total Asset 100 - minimum 4 years Nursing Home care OR 4 years Home care OR 4 years Residential Care Facility. The minimum daily benefit of $218 is provided for Nursing Home and $218 for Home care.
Both Total Asset 50 and Total Asset 100 can have unlimited maximum policy duration and 100 days maximum elimination period.
3. Dollar for Dollar 50 - minimum 1.5 years Nursing home care OR 3 years Home care and maximum 2.5 years Nursing Home or 5 years Home Care. Minimum daily benefits are $218 for Nursing home and $109 for Home care.
4. Dollar for Dollar 100 - minimum 2 years Nursing Home care OR 2 years Home care OR 2 years Residential Care Facility and maximum of 2.5 years for the aforementioned care settings. The minimum daily benefit of $218 is provided for Nursing Home and $218 for Home care.
Both Dollar for Dollar 50 and Dollar for Dollar 100 Plans have 60 days elimination period.
Who Will Qualify for the Medicaid Extended Coverage?
- Anyone who applies for Medicaid Extended Coverage should be a resident of New York when coverage became effective.
- According to the New York State Medicaid as stated in the 18 NYCRR, if a Partnership policy owner's total income exceeds the requirement of Medicaid he will only be eligible for Medicaid Extended Coverage after he has incurred medical expenses that are equal to or more than his income.
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