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Long-term Care Insurance Basics in Oregon
Long-term Care can be expensive, learning the basics can help Oregon Residents better prepare for LTC needs.
What can Long-term Care look in Oregon?
In Oregon long-term care refers to a range of services and support provided to individuals who have difficulty performing everyday activities due to chronic illness, disability, or cognitive impairment.
7 Types of Long-term Care in Oregon
This involves receiving assistance with daily activities, such as bathing, dressing, meal preparation, and medication management, in the comfort of one's own home. Home care services can be provided by family caregivers, home health aides, or skilled healthcare professionals.
Memory Care Units
Memory care units are specialized facilities within nursing homes or assisted living communities that cater specifically to individuals with Alzheimer's disease, dementia, or other memory-related conditions. They offer a secure environment, structured activities, and specialized care to support individuals with memory impairments.
Assisted Living Facilities
Assisted living facilities are residential communities that provide housing, meals, personal care services, and social activities for individuals who need help with activities of daily living but do not require constant medical supervision.
Continuing Care Retirement Communities
CCRCs provide a continuum of care, including independent living, assisted living, and nursing home care, within one community. Residents can transition between different levels of care based on their changing needs.
Nursing homes, also known as skilled nursing facilities, offer 24-hour medical care and assistance for individuals with significant health and functional needs. They provide services like nursing care, rehabilitation therapies, medication management, and help with daily activities.
Adult Day Care Centers
Adult day care centers offer a safe and supportive environment for individuals who require daytime supervision or assistance. They provide social activities, meals, and sometimes medical and therapeutic services, allowing family caregivers to work or have respite.
Hospice care focuses on providing comfort and support to individuals with terminal illnesses, aiming to enhance quality of life rather than cure the condition. Hospice care can be provided at home, in a hospice facility, or in a hospital.
How do people end up needing Long-term Care in Oregon?
Oregon residents may require long-term care for various reasons, typically resulting from physical, cognitive, or functional limitations that affect their ability to independently perform daily activities.
7 Reasons Oregonians might need LTC
1. Aging and Chronic Conditions: As people age, they become more susceptible to chronic conditions such as arthritis, diabetes, heart disease, or respiratory issues. These conditions can gradually impact mobility, self-care abilities, and overall health, leading to the need for long-term care.
2. Disabilities: Physical disabilities resulting from accidents, injuries, or congenital conditions may require ongoing assistance with daily tasks, mobility, and specialized medical care.
3. Cognitive Impairment: Conditions like Alzheimer's disease, dementia, or other forms of cognitive decline can severely affect memory, thinking, and decision-making abilities. Individuals with cognitive impairment often require long-term care to ensure their safety, well-being, and appropriate support.
4. Stroke or Neurological Disorders: Stroke, Parkinson's disease, multiple sclerosis, or other neurological disorders can cause physical and cognitive impairments that necessitate long-term care.
5. Terminal Illness: Individuals with terminal illnesses, such as cancer or end-stage organ failure, may require palliative care or hospice services to manage pain, provide comfort, and support them through the end-of-life stage.
6. Traumatic Injuries: Severe accidents, spinal cord injuries, or traumatic brain injuries can result in long-term disabilities, requiring ongoing care and rehabilitation.
7. Frailty and Decline in Functional Abilities: General frailty and decline in physical strength and functional abilities can make it challenging for individuals to perform essential activities of daily living independently.
How much does Long-term care cost in Oregon?
Long-Term Care Service
Average Oregon Monthly Price
Private Nursing Home
Provides a higher level of care in a residential facility with 24-hour skilled nursing.
Assisted Living Facility
Provides personal care and limited health services in a residential setting.
Home Health Aide
Provides assistance with personal care and other routine activities in a person’s home
(Based on 30 hours/week)
Adult Day Care
Provides social and supportive services in a community-based setting.
(Based on 6-8 hours, 5 days/week)
Source: AARP Family Caregiving Calculator 07/17/2023
5 Types of Long-Term Care Insurance in Oregon
Traditional LTC Insurance
Traditional LTC insurance policies are the most common type. They provide coverage for a range of long-term care services, such as nursing home care, assisted living, home care, and adult day care. These policies typically offer a daily or monthly benefit amount for a specified period, along with elimination periods and optional riders for additional benefits.
Hybrid LTC Insurance
Hybrid policies combine long-term care insurance with another type of coverage, such as life insurance or an annuity. These policies can provide a death benefit if the LTC coverage goes unused. Hybrid policies offer individuals the potential to access LTC benefits while still providing a financial return if they don't end up needing long-term care.
Linked Benefit or Asset-Based LTC Insurance
Linked benefit or asset-based policies are similar to hybrid policies but are specifically designed to leverage existing assets. Individuals can use a lump-sum payment or allocate funds from an existing life insurance policy or annuity to create an LTC benefit pool. If LTC coverage is needed, the policy pays out from the benefit pool; otherwise, it functions as life insurance or provides a return of premium.
Group LTC Insurance
Group LTC insurance is often offered through employers, associations, or affinity groups. It allows individuals to purchase LTC coverage at a group rate, which may be more affordable than individual policies. Group LTC insurance typically offers similar coverage to traditional policies but with potentially fewer underwriting requirements.
Short-Term Care Insurance
Short-term care insurance policies provide coverage for a limited duration, typically up to one year. They are designed to bridge gaps in coverage or provide temporary care for specific situations, such as recovery after surgery or rehabilitation. Short-term care insurance policies have lower premiums but may have limitations on benefits and coverage duration.
8 Key components of Long-Term Care Insurance in Oregon
Coverage and Benefits: Long-term care insurance provides coverage for various long-term care services, such as home care, assisted living, nursing home care, and adult day care. The policy typically outlines the specific benefits, including the daily or monthly benefit amount and the maximum duration of coverage.
Eligibility and Waiting Period: To qualify for benefits, individuals usually need to meet certain criteria, such as being unable to perform a specified number of activities of daily living (ADLs), like bathing, dressing, eating, toileting, transferring, or requiring substantial supervision due to cognitive impairment. There may also be a waiting period before benefits become payable after the eligibility criteria are met.
Benefit Triggers: Long-term care insurance policies include benefit triggers, which are conditions that must be met for the policyholder to become eligible for benefits. These triggers are typically based on the individual's functional or cognitive impairment as determined by a licensed healthcare professional.
Premiums and Payment Options: Policyholders pay premiums to maintain their long-term care insurance coverage. Premiums can be paid annually, semi-annually, quarterly, or monthly, depending on the policy and the insurer. Premium amounts are determined based on various factors, including the individual's age, health, desired coverage, and optional policy features.
Elimination Period: Similar to a waiting period, long-term care insurance policies often have an elimination period or deductible period. This is the initial period during which the policyholder is responsible for paying for their long-term care expenses out of pocket before the insurance benefits start.
Inflation Protection: Long-term care insurance policies may offer optional inflation protection, which helps increase the coverage amount over time to account for the rising costs of long-term care services. This ensures that the policy's benefits keep pace with inflation.
Exclusions and Limitations: Long-term care insurance policies may have exclusions and limitations that specify certain conditions, services, or circumstances that are not covered or have limited coverage. It's essential to carefully review these provisions to understand the scope of coverage provided by the policy.
Policy Renewal and Cancellation: Long-term care insurance policies are typically renewable as long as premiums are paid. However, the insurer may have the right to increase premiums for an entire class of policyholders, subject to regulatory approval. Policyholders also have the option to cancel their policy at any time, though they may not receive a refund of premiums already paid.
What's the difference between LTC and Disability Insurance?
Long-Term Care Insurance
Disability Income Insurance protects one of your greatest assets, your income, while you are in your earning years.
Long-term Care Insurance protects your nest-egg by helping you cover the costs you might incur if you end-up needing long-term care.
What are Oregon Insurance Underwriters Looking for on LTC Applications?
Long-term care (LTC) insurance underwriters in Oregon assess various factors when reviewing LTC applications. Their objective is to evaluate the risk associated with providing coverage for long-term care expenses.
8 Key Aspect Underwriters Typically Consider
Age and Health Status: Underwriters assess the applicant's age and overall health condition. Younger and healthier individuals generally receive more favorable underwriting outcomes. Pre-existing health conditions, chronic illnesses, and disabilities may increase the risk profile.
Medical History: Detailed information about the applicant's medical history is crucial. Underwriters examine past and present medical conditions, surgeries, medications, and treatments. Serious health issues or a history of certain conditions may impact the underwriting decision.
Cognitive and Functional Abilities: Cognitive impairment and functional limitations are evaluated since they can significantly affect a person's ability to perform daily activities independently. Underwriters may consider cognitive assessments, physical evaluations, and reports from healthcare professionals.
Activities of Daily Living (ADLs): ADLs encompass basic self-care tasks such as bathing, dressing, eating, toileting, transferring, and continence. Underwriters review the applicant's ability to perform these activities. Impairments in ADLs may increase the risk of needing long-term care.
Instrumental Activities of Daily Living (IADLs): IADLs involve more complex activities necessary for independent living, including managing finances, shopping, cooking, using transportation, and managing medications. Underwriters consider the applicant's ability to perform these tasks, as limitations can impact their suitability for LTC coverage.
Family History: Underwriters may inquire about family medical history, especially for conditions that have a genetic component or are likely to increase the risk of requiring long-term care.
Lifestyle and Habits: Factors such as smoking, alcohol consumption, drug use, and participation in high-risk activities may be considered during the underwriting process. Unhealthy habits can impact an applicant's insurability and potential claims.
Financial Status: While not directly related to underwriting the health risk, LTC insurance underwriters may evaluate an applicant's financial stability and ability to afford the premiums.
T. Mann Financial can connect you with a LTC underwriter if you have detailed questions.
How T. Mann Financial Can Help Oregon Residents with Long-term Care Insurance
Planning for Long-term care can be difficult, let T. Mann Financial in Springfield Oregon help!
T. Mann Financial Starts with a Conversation
If you or someone you care about needs long-term care, how will you pay for it?
Individuals can use personal savings, investments, and income to cover LTC expenses. This approach is suitable for those who have accumulated significant assets and can afford to pay for care without financial assistance.
LTC insurance policies are specifically designed to cover the costs of long-term care services. Policyholders pay regular premiums, and in the event they require LTC, the insurance company reimburses a portion of the expenses, depending on the policy terms and coverage limits.
Medicare, a federal health insurance program for individuals aged 65 and older, may cover some limited LTC services for a short period, such as skilled nursing care following a hospital stay. However, it does not typically cover long-term custodial care, which includes assistance with daily living activities.
Medicaid is a joint federal and state program that provides health coverage to low-income individuals. Medicaid often covers long-term care services, including nursing home care. Eligibility requirements, such as income and asset limits, vary by state, and individuals must meet specific criteria to qualify.
The U.S. Department of Veterans Affairs offers various benefits that can help eligible veterans and their spouses pay for long-term care. These benefits may include Aid and Attendance, which provides financial assistance for veterans who need help with daily activities.
Life Insurance Conversions
Some life insurance policies have a feature called "accelerated death benefits" or "life settlements." These options allow policyholders to convert a portion of their life insurance death benefit into cash, which can be used to cover LTC costs.
Some individuals rely on personal savings or financial assistance from family members to pay for their long-term care needs. This may involve contributions from children or other relatives to cover expenses.
T. Mann Financial then Assess your Needs
T. Mann Financial will start by conducting a thorough needs assessment to understand the specifics of your situation. We will gather information about your age, health, financial situation, and preferences regarding long-term care.
Educating and Explaining
T. Mann Financial explains the features, benefits, and limitations of LTC insurance policies. We help you understand the different types of coverage, policy options, and any exclusions or waiting periods that may apply.
T. Mann Financial can help Oregonians choose the right LTC policy for their individual needs.
Based on your needs and preferences, T. Mann Financial helps tailor a LTC insurance policy that aligns with their requirements. We provide guidance on selecting appropriate coverage limits, elimination periods, and optional riders or benefits.
T. Mann Financial works with multiple insurance companies, allowing us to compare different policies and providers. We help individuals evaluate various options, considering factors such as premium costs, policy features, company reputation, and financial stability.
T. Mann Financial can help Oregonians apply for Long-Term Care Insurance.
T. Mann Financial's 5 Step LTC Insurance Process
1. Once you have selected the type and amount of LTC insurance you need, T. Mann Financial will request quotes from private insurance companies.
2. We help you narrow down the list and then to run a side-by side comparison of your top LTC choices.
3. Once you decide which LTC policy to purchase we help you complete your application. If testing is required we help get this ordered for you.
4. T. Mann Financial works as an intermediary between you and the LTC insurance company and it's underwriters to help ensure that the policy is processed in a timely manner.
5. If the policy is approved and paid for, T. Mann Financial will provide ongoing support throughout the life of the LTC policy including policy maintenance, premium payments, any necessary updates or changes, and support during claims.
Long-term Care in Oregon
Oregon has several unique aspects related to long-term care (LTC) that set it apart from other states.
6 Ways Oregon Approaches LTC Differently
The following unique aspects of long-term care in Oregon reflect the state's commitment to promoting community-based care, supporting family caregivers, ensuring access to essential services, and protecting the elderly population.
Oregon Health Plan (OHP): Oregon has a state Medicaid program called the Oregon Health Plan (OHP) that provides health coverage to eligible low-income individuals, including long-term care services. OHP offers a variety of long-term care options, such as in-home care, adult foster care, assisted living, and nursing facility care.
Home and Community-Based Services (HCBS): Oregon prioritizes home and community-based services as an alternative to institutional care. Through programs like the Aged and Disabled Waiver, individuals can receive long-term care services in their homes or community settings, promoting independence and supporting aging in place.
PACE: Oregon is among the states that offer the Program of All-Inclusive Care for the Elderly (PACE). PACE provides comprehensive healthcare and long-term care services to eligible individuals who prefer to remain in their communities rather than moving to a nursing home.
Oregon Care Partners: Oregon Care Partners is a unique resource available to unpaid family caregivers. It offers free training and education to help family members develop the necessary skills and knowledge to care for their loved ones at home. The program covers various topics related to dementia, mental health, and aging-related issues.
Advance Directive Registry: Oregon has an Advance Directive Registry, allowing individuals to store their advance healthcare directives securely. This registry makes it easier for healthcare providers to access and honor individuals' end-of-life care preferences.
Elder Abuse Prevention: Oregon has a strong focus on elder abuse prevention. The state has resources and programs dedicated to raising awareness, preventing elder abuse, and providing support to victims. These initiatives aim to safeguard the well-being and rights of older adults.
Oregon Medicaid Estate Recovery Process
Estate recovery is a process where the state seeks reimbursement for the costs of long-term care services provided to Medicaid beneficiaries after their death by making claims against their estates. Here's an overview of how estate recovery works for OHP Medicaid in Oregon:
Estate Recovery Eligibility: Estate recovery applies to individuals who received long-term care services through the OHP Medicaid program, typically in a nursing home or other institutional setting. It does not apply to individuals who only received Medicaid benefits for non-long-term care services, such as doctor visits or prescription drugs.
Claimable Expenses: The state of Oregon has the right to seek reimbursement for the costs incurred by OHP Medicaid for long-term care services provided to eligible individuals. This includes expenses related to nursing home care, assisted living facilities, and home and community-based services.
Triggers for Estate Recovery: In Oregon, estate recovery is triggered when the Medicaid recipient passes away, and they either have no surviving spouse or the surviving spouse is also deceased. The state may initiate the recovery process by filing a claim against the individual's estate.
Estate Recovery Process: Once estate recovery is triggered, the Oregon Department of Human Services (DHS) Estate Recovery Unit is responsible for pursuing reimbursement. DHS reviews available information to determine the value of the estate and whether there are any assets subject to recovery.
Assets Subject to Recovery: The estate recovery process typically involves identifying assets within the individual's estate that are subject to recovery. This may include real estate, bank accounts, investments, and other valuable possessions. However, certain exemptions exist, such as when there is a surviving spouse, minor or disabled children, or when recovery would cause undue hardship.
Notification and Claims: If the estate is subject to recovery, the state will send a notification to the estate's personal representative or executor. The notice outlines the amount owed and provides instructions for resolving the claim. The estate representative has the opportunity to present any necessary documentation or request a waiver or reduction of the claim, if applicable.
It's important to note that estate recovery rules and provisions may vary by state, and the specifics of Oregon's estate recovery process may be subject to change. Individuals seeking more detailed information or guidance on estate recovery for OHP Medicaid in Oregon should consult with the Oregon Department of Human Services or seek legal advice from an attorney specializing in Medicaid and estate planning.