Older Americans Oppose Approval Process for Home Care Services

Eighty-three percent of seniors oppose a Medicare policy that requires a government contractor to approve claims for physician-prescribed home health care, according to a poll sponsored by Bring The Vote Home. The Centers for Medicare & Medicaid Services (CMS) recently implemented a pre-claim review demonstration that imposes documentation requirements on home health agencies and referring physicians. Doctors have to provide a broad array of eligibility-related documentation and clinical support for review by government contractors. Home health leaders warn that the new requirements could delay care and increase healthcare costs. Seniors say that requiring a government contractor to approve home heath care will have the following results:

  • 80% say it will delay care.
  • 77% say it will increase Medicare costs.
  • 75% say that will increase out-of- pocket costs.
  • 45% say it will decrease fraudulent home health claims.

For more information, visit bringthevotehome.org.

Bill Would Make Home Medicare Program Permanent

Compassion & Choices praised the introduction of Independence at Home Act of 2016 (S. 3130). The bill would convert the Affordable Care Act’s home care pilot program into a permanent, national Medicare program. Under the Independence at Home program, patients with debilitating diseases get primary care at home from coordinated teams of doctors, caregivers, and other healthcare professionals. The program reduces avoidable emergency room visits, hospitalizations, and re-admissions. Mark Dann, federal affairs director for Compassion & Choices said, “A great benefit of providing care in a person’s home is advance care planning conversations seem to happen naturally more often and can be updated as their illness progresses and their care wishes change. If an individual ends up in the hospital, but did not want to be there, the whole team is aware of these wishes and can attempt to quickly correct the situation.”

Home Care Costs Rise Again in California

The cost of long-term care from a home health aide has increased in California and nationally, according to a Genworth study. Long term care costs are up in all care settings in California from 2015. Home is where most Americans get long-term care. “Although home care costs are much less expensive than those in facility-based settings, the costs can add up to as much as $54,912 per year in California, which is why it’s imperative for consumers to begin planning now for how they will pay for that care should they need it,” said Tom McInerney, president and CEO of Genworth. He noted that at least 70% of Americans 65 and over will need some form of long-term care and support. The following are key trends in California’s major metropolitan areas:

  • The cost of care in a semi-private nursing home in Los Angeles is 8.8% less than the state average, at $6,935 per month.
  • Home health aides cost 18.52% more in the San Diego metro area than the national average, at $4,576 per month.
  • The cost of private nursing home care in San Francisco is $15,193 per month, which 97.36% more  than the national average.

Home Care Costs Increase in California

Nationally, there has been a dramatic increase in the cost of care at assisted living facilities and nursing homes while the cost of health aide care is rising more moderately. Nationally, it costs $20 an hour for home health aide services from an agency in 2015; it’s  $23 in California. Home health aide costs have increased 2.3% annually in California over the past five years.

Nationally, the cost of assisted living has increased 2.5% a year over the past five years to reach $43,200. In California, it has grown 1.3% a year to $45,000. The cost of a room in a private nursing home rose 4% a year over the past five years to reach $91,250 nationally. Costs increased 3.5% to reach $104,025 in California.

Long Term Care Claims Reveal Popularity of Home Care

Eight million Americans have purchased long-term care insurance and an increased number are now starting to claim benefits, according to a report by American Association for Long-Term Care Insurance (AALTCI). Most people mistakenly associate LTC with skilled nursing home care, but 51% of all newly opened claims begin with home care. Good coverage can cost about $100-a-month for a 55-year-old healthy male. That’s for roughly $160,000 of benefits, which covers quite a bit of care. Add a flexible inflation growth option and your benefits grow over time,” explains Jesse Slome, director of (AALTCI).

“In 2014 we paid $105 million in claim benefits, a 12% increase over the prior year…This protection is best purchased in your 50s and 60s when you are still able to meet the health qualifications and costs for coverage are lower,” says Bill Naylon, president of MedAmerica Insurance Company.

According to AALTCI, roughly two-thirds of all beneficiaries are women, and 54% of new LTC insurance applicants are 55 to 64. Most insurers charge higher rates for single women, but offer discounts for couples or partners who apply for coverage. While most new claims begin for policyholders who are 70 or older, nearly 9% of claims begin before age 70. The leading causes for home care claims are stroke, Alzheimer’s, arthritis, cancer and injury

Home Care Accounts For Half of New LTC Claims

As of December 31, 2012, 264,000 people were getting long-term care insurance benefit payments, according to a report by the American Association for Long Term Care Insurance (AALTCI). Last year, insurers paid $6.6 billion in benefits to people needing care at home, in assisted living communities, and in skilled nursing facilities, says Jesse Slome, director of AALTCI.

According to the Association, leading causes for long-term care insurance claims include Alzheimer’s disease, stroke, arthritis, and cancer. Female policyholders account for roughly two-thirds of all long-term care insurance claims and benefit dollars. Home care accounts for half of all newly opened individual insurance claims. For more information, visit www.aaltci.org.

Last Updated 08/04/2020

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