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hello everyone thank you for your interest in the connecticut partnership for long-term care program my name is aldo piantano and i work for the state's office of policy and management where we oversee this special program called the connecticut partnership for long-term care more than 60 000 people in connecticut have purchased partnership policies and in the next 40 minutes or so i'll tell you everything that i can about the connecticut partnership and how it can help connecticut residents protect their assets should we need long-term care due to a long-lasting disease or disability i'm going to show the slides so that we can follow the presentation we have a problem in connecticut paying for long-term care and in the rest of the country as well and that's especially because there are so many misunderstandings and misconceptions now the first misunderstanding is around what long-term care is and what long-term care is not if you fall down and break a leg you end up in the hospital you have doctors and nurses providing skill care x-rays mris cat scans the primary purpose is to help fix what's broken and send us home as quickly as possible long-term care on the other hand also known as custodial care it is help with everyday activities such as eating dressing walking bathing going to the bathroom transferring from bed to chair or from chair wheelchair another way to need long-term care is because of a cognitive impairment such as alzheimer's the primary purpose of long-term care is to help maintain the individual's capabilities without suffering too much and trying to prevent from deteriorating quicker than without long-term care an individual would most of long-term care is provided at home that's where where we rather be but then you also have settings such as adult daycare assisted living and the place where nobody wants to go nursing homes so long-term care has a lot of different options and having a long-term care policy can help tremendously in keeping an individual at home as long as possible and even avoiding the need for staying in a nursing home another misconception is the risk of needing long-term care we may think that long-term care is just for all people but unfortunately you can hit at any age you have many more situations where younger people are diagnosed with alzheimer's age 49 i know i have friends where this terrible condition has taken over and is it is a terrible situation and also extremely expensive if we live to the age of 65 a little bit over 50 percent of us will need some level of long-term care and women are especially a greater risk because women live longer and the longer we live the greater the chance of needing some type of long-term care according to the alzheimer's association every 65 seconds an individual is diagnosed with alzheimer's that's about half a million people a year so we need to find different solutions as far as how we can prepare ourselves to protect our assets our freedom of choice and where we want to receive care and in long-term care policies can help tremendously in achieving these goals another misconception is the cost of long-term care people have no idea how expensive it can be until it's too late especially in the northeast the cost of living is high so the cost of care is also high as as well connecticut is the second most expensive state in the country when it comes to the cost of long-term care the average daily nursing facility cost is 444 dollars a day or close to over 161 thousand dollars a year now as you can imagine most of us would not be able to last too long if we have an expense yearly of 80 100 140 160 000 for expenses that we didn't plan for or didn't think it would happen to us so what you can see here is keeping in mind that many states throughout the country the cost of living is less so the cost of care is also less in some places they may be paying 250 300 a day for their nursing home but the northeast overall is very expensive alaska it's over 900 a day or 350 000 a year so don't move to alaska if you're planning on needing long-term care and then you have hawaii there is also very expensive and again the northeast now i would like to point out here that since 1988 we keep track of inflation and the average has been at 4.8 percent the good news is that over the last eight years and we keep track by doing a survey of nursing homes and home care providers the true cost of increases of long-term care has been close to under two percent it's gradually increasing a little bit and obviously we don't know where the cost of care will be tomorrow 5 10 20 years from now but based on the last 28 years or so someone who had inflation protection a 5 or close to it has been in a pretty good shape where their policies that had such inflation protection kept up with the true cost of care if long-term care is so expensive who's been paying for it so based on this slide we see that about 22 has been paid out of pocket this is where people pay for long-term care and eventually become poor because they're investing their income and their assets and then you have over 10 million people with private insurance throughout the country that have purchased policies to protect themselves against the expenses associated with long-term care and then we have medicaid here that pays the majority of long-term care throughout the country and over 60 percent however in order to qualify for medicaid you first have to spend down your assets in connecticut for example as a single person to 1 600 and then you're allowed to keep out of your income 60 a month or 60 plus 90 if you're a wartime veteran now if you're married the state doesn't want the community spouse to become poor therefore the community spouse living at home he or she gets to protect the house and the car regardless of value then up to 50 of their other assets but no more than 128 640. then everything else has to be spent down to 1 600 shortly i will tell you how the partnership program can help us protect a lot more of our assets in addition to what the standard medicaid protections are please notice that here we don't even include medicare and because that's a big misconception everybody thinks oh medicare will pay for it somebody will pay the health plan will pay for it but reality is different is different sorry um an average medicare pays about 25 days in a nursing home or the most you will pay is 100 days the average length of stays in nursing homes is about 2.3 years therefore medicare when a pays is not really paying for much in the first 20 days they pay in full day 21 through 100 you have a deductible that is close to over 170 a day you have to pay if you need help with just activities of daily living such as bathing continents dressing eating toileting transferring medicare will not pay for it if you need care 7 days a week 24 hours a day medicare won't pay for it if you need long-term care because of a cognitive impairment such as alzheimer's medicare won't pay for it so when does medicare pay medicare is very restrictive and selective money pays because it was not designed to help pay for long-term care so if you break a hip you end up in the hospital you have a doctors or nurse providing care and then you need to be in the hospital at least three days without counting the day of discharge then if you need long-term care after that maybe two weeks four weeks medicare will pay for it but again it turns away many people because it is not designed to pay for long-term care now why do we think about long-term care insurance well obviously the risk does not go away it is part of life as we get older chances are we'll need some help in some areas also unfortunately you have car accidents sports injuries long-lasting disease or disability you throw in their ms parkinson's severe depression you just don't know when somebody may need long-term care and we want to think about long-term care because the cost is extremely high and we don't foresee any public solution anytime soon so we individually have to think about long-term care and take responsibility to protect ourselves and our assets should we need long-term care in the future as i mentioned medicare health insurance the affordable care act do not pay for long-term care and with medicaid unfortunately money is not unlimited so medicaid looks to the individual in the family to share some of the expenses when someone applies to medicaid and you have to be poor meet the eligibility rules before we qualify and another another reason why we think of long-term care insurance is especially because of this special program called the connecticut partnership for long-term care now i i would like to take a moment here to point out that connecticut was very innovative and proactive back in 1992 by introducing the first partnership program in the country and then other states also started to offer partnership programs and today we're very glad to see that there are 45 states that offer partnership programs in the five states that don't offer partnership programs are hawaii and alaska mississippi vermont and massachusetts and i'll talk about that a little bit later as we go along here now we didn't want to go there go here the partnership program was established with four goals which are still true today first is to help us connecticut residents to have a better way to plan for long-term care without the risk or fear of becoming impoverished so that's the key behind the partnership is to help us connecticut residents a better way to address long-term care and give us options to to better protect our assets in a guarantee that we will not run out of assets if we purchase a partnership policy another goal is to have the state of connecticut back in 1992 when we were entering into a partnership with insurance companies thanks to a grant from the robert wood johnson foundation that's how the partnership was created we wanted to make sure that in order for insurance companies to participate with the partnership they must raise their standards they must meet the requirements that only partnership policies have and i'll explain how those work another goal is to educate the public as much as possible we have been seeing over 1 000 people throughout the state with presentations in libraries rotary clubs associations and so on obviously these days we'll be doing as much education as we can as we're doing now online which also makes it very convenient for you to watch it from the comfort of your own home anytime you wish to do so now the last goal to conserve state medicaid funds since 1992 there's a formula in place that shows that thanks to the partnership the connecticut medicaid program has saved more than 55 million dollars and that's because as more and more people buy insurance then you have less people that have to invest all their assets to become poor and pay for long-term care so the partnership offers a solution an alternative to investing your assets to paying for care how does asset protection work this is an important concept right here and in the next three four slides i would like to spend as much time as i can so that you have a better understanding of why the partnership program has certain powerful and bene very beneficial provision provisions that you can only find in the partnership program when we buy a partnership policy we're buying it from an insurance agent just like we buy any other insurance policy nothing is different there except that the partnership has better value and better protection every insurance policy with the partnership also gets what's called a medicaid asset protection account this account has nothing to do with the insurance company it's something the state is doing for us we're taking responsibilities to prepare for long-term care in the future how does it work medicaid asset protection account starts out at a value of zero and it will continue to stay there until the insurance policy begins to pay insurance benefits then it works like for example a frequent flyer program when you fly with an with a airline company and you have a frequent flyer program there every time you fly you earn miles based on how much distance you're going then after a certain amount of miles 25 30 000 or so maybe you get lucky and you get a free trip somewhere so the more miles you travel the more miles you earn with the partnership you are not earning miles but what you are earning is the right to protect a greater amount of your assets should you need long-term care in the future and the way it works is that once you apply to the insurance company for a claim and they approve every time the insurance company pays one dollar of insurance benefits you get the equivalent of one dollar value in your medicaid asset protection account so this is not a savings account there's no cash to put in or put out but the more the policy pays the more insurance medicare asset protection you have so if the policy pays ten thousand dollars after one month you have ten thousand dollars of medicaid asset protection fifty thousand dollars paid by the policy you have fifty thousand dollars of medicaid asset protection one hundred thousand dollars paid by the policy you have one 100 000 of medicaid asset protection so so what does this mean well as as we can read here in the next bullet the department of social services will review claims for medicaid and and they pay claims once an individual is deemed eligible so when determining eligibility the department of social services will disregard any assets that you have up to the amount that the partnership policy is paid in benefits so basically this is saying when we apply to medicaid the more the insurance policy is paid out the more assets we can protect in addition to the standard protections that we all have what we're going to do next is we're going to go through a number of examples i'm giving you a lot of information so sometimes it's difficult to digest everything all at once but the beauty of having this video is that you can go back and forth pause it write down numbers listen to the concept over and over again until you're very comfortable and you can always call us should you have any questions we're there to help as as much as we can and we help many people in connecticut and also outside of connecticut because sometimes people move in and out of the state so i just wanted to point that out now we're going to go through the slide here where we have four examples you have four people on the left hand side column then you have assets as the next column that each individual has the third column is how much insurance benefits have been paid through the partnership or not as in the last example person d and then you have countable assets how medicaid determines the financial situation for each individual now alice bob cindy and dave those are the four people we have here alice is based on a true example grandmother had a hundred thousand dollars in assets she had heard about the partnership and in her mind she did not want to do anything creative hiring a lawyer and camouflaging assets which is legal set up a trust different ways to protect assets taking chances as well because nothing sometimes is guaranteed the insurance agent who was certified to sell partnership policies explains to alice that if you want to protect a hundred thousand you must first purchase a policy that pays at least one hundred thousand now these examples here are for all single individuals to keep them things a little bit simpler and so they're all going to be allowed to spend down assets to 1 600 if they have to and let me show you how it works alice buys the 100 000 policy unfortunately two years later she develops alzheimer's files a claim with the insurance company begins to receive insurance payments since it was some time ago it took about a year and a half before she ran out of insurance benefits and the policy paid a total of 100 000 she ran out of insurance applies to medicaid medicaid first says alice you're single you have a hundred thousand dollars in assets um you gotta spend it down to one thousand six hundred dollars however alice submitted a copy of the quarterly medicaid asset protection report which is required by state law to be mailed by the insurance company o the claimant and the family and also send a copy to us at the office of policy management to make sure these reports are being mailed out once medicaid sees and confirms that alice has earned the right to protect a hundred thousand then the formula changes dramatically medicaid says alice you have a hundred thousand in assets your policy paid a hundred thousand therefore from medicaid's perspective she has zero countable assets even though honestly she still has a hundred thousand at this point the protected assets can be handled in many different ways only by alice decides to transfer a hundred thousand dollars to her daughter to help pay for the grandchildren's education and other expenses and then she went on for four more years needing long-term care through medicaid and then passed away but this is a perfect example of how someone can buy a smaller type of policy at one hundred thousand dollars and can go a long way in protecting an individual's assets which would you prefer as a single per person to be a medicaid with one thousand six hundred dollars or would you rather have a hundred thousand dollars in your hands that you can spend slowly buy pizza and and drinks for everybody in the nursing home on friday nights keep everybody happy or you can give a portion away right away you can give it all away or you can keep it medicaid will not tell you what to do with the protected assets bob here is a similar example except bob worked two jobs and managed to have extra assets two hundred thousand dollars buys a policy from a certified agent worth two hundred thousand dollars and and again i'm not including inflation protection in these examples to keep it simpler 10 years later bob files a claim with the insurance company after a year and a half 200 000 has been paid by the insurance policy and bob has 200 000 on medicaid asset protection he runs out of insurance files with medicaid medicaid says bob you have 200 000 in assets you're single however you have 200 thousand in medicaid asset protection then medicaid sees the situation for bob as he has zero countable assets now every year at renewal medicaid will look at the financial situation again for bob and the others if bob is kept 200 000 in his name and there's no change then no action necessary if two hundred thousand is still under bob's name and it increases to two hundred and ten thousand dollars then the difference between two hundred thousand and two hundred and ten thousand dollars must be spent towards bob's care if bob is transferred 200 000 to a friend a neighbor a companion a spouse anyone a religious organization then medicaid will see that 200 000 is no longer listed under bob's name and no further action will be taken because bob or alice or others protected assets just as it stays protected we can do whatever we wish with those assets medicaid will not dictate how those assets should be spent down as long as they are protected assets now cindy here is an example of the equity of the program she's done very well she has set aside one million dollars meets with an insurance agent and the agent certified to sell partnership policies explained explains cindy if you wish to protect one million dollars you must buy a policy that pays 1 million now you can flat out buy a 1 million dollar policy or you could buy a five hundred thousand dollars partnership policy with five percent compounded automatic inflation protection one million uh when you have half a million dollars with five percent compounded each year it continues to grow until 14 years later it has doubled in value so a policy initially worth half a million fourteen years later will be worth one million dollars however in this situation cindy decides to buy two hundred thousand dollars that's what she was comfortable with and unfortunately for her fifteen years later she needs long-term care if the policy at the time only paid two hundred thousand obviously it would grow with some type of inflation protection but let's just say that her policy pays two hundred thousand dollars she applies to medicaid the difference is eight hundred thousand medicaid says for countable assets of eight hundred thousand you must spend it down to one thousand six hundred dollars before she would be eligible for medicaid david here is an example of someone who says question whatever it will be will be i may have heard that somewhere basically he decides not to take any action as many people do and that's a choice or unfortunately david and never heard about the partnership program so he meets with an agent who is not certified to sell partnership policies and the agent sells david a non-partnership policy that pays two hundred thousand dollars five years later he files a claim with the insurance company the insurance company pays two hundred thousand dollars from the none partnership policy therefore because it's non-partnership david has zero medicaid asset protection when he applies to medicaid medicaid says david you have two hundred thousand dollars in assets you need to spend it down to one thousand six hundred dollars in order to qualify for medicaid i'd like to point out that medicaid asset protection is free the insurance company has nothing to do with this except some reports they need to submit medicaid asset protection is done for us offered by the state of connecticut to give us more incentive to consider long-term care insurance especially through the partnership the only way you can get medicaid asset protection and if you were to compare a policy issued by an insurance company that sells both partnership and non-partnership policies as long as you're comparing apples to apples the premium will be 100 the same so when someone may say or the partnership is more expensive unfortunately they're giving you incorrect information because if you compare a very rich policy to an inferior policy obviously richer coverage more comprehensive coverage will cost less than something inferior another point here about medicaid asset protection is that the state of connecticut is required to try to recover those assets based on how much the state paid for the individual's long-term care in a nursing home after the individual dies however if those assets were protected through the partnership medicaid asset protection then the state will not go and recover from medicaid those assets right so sometimes people move to other states because of family reasons because of business reasons because they possibly wanted to be in 90 degrees temperature with a lot of humidity throughout the year but kidding aside some people may move the state if we look at statistics we are based on age one of the sixth oldest state in the country many many many people don't live here we have a beautiful state and may not realize all the advantages and services that we have here until we move somewhere else so what happens when somebody moves well we won't allow them to come back to connecticut anymore okay so killing aside you must be a connecticut resident with a bona fide address when you purchase a partnership policy that does not mean that you will vote here or pay taxes here or stay forever you could be here three weeks two weeks out of the year and live somewhere else it does not matter what's most important is that on the application you first provide a bona fide address when you first apply so it cannot be a work address it cannot be a po box it would be hard to prove somebody lives there but provide a bona fide address and then nobody is checking up on you if you're moving somewhere else and it is important to remember that partnership policies pay based on the contract that you have with the insurance company anywhere in the country so anywhere you move if unfortunately someday you need long-term care and you qualify for insurance benefits the insurance policy will pay wherever you are if it's important to you to know about the commonwealth territory guam puerto rico virgin islands now you may want to ask the insurance company sometimes they include coverage automatically sometimes they may require a writer for international coverage so ask if that is important to you and keep in mind that sometimes when you buy an international writer benefits may be very limited so it's important for you to understand what you're getting so what happens when we move out of the state we have a reciprocity compact excuse me drink some water here in january of 2009 the federal government came out with a reciprocity compact stating that all the new states and there were 41 of them at that time were automatically part of the reciprocity compact no state has opted out the four first states that offer partnership programs were connecticut indiana new york and california we were not part automatically of the reciprocity compact we had to apply and the state of connecticut is very much strongly in favor of reciprocity so we apply we're part of it out of the 45 states that have partnership programs 44 have reciprocity with each other the only state that does not have reciprocity is the state of california excuse me which we feel that hurts california residents because if they move out let's say 20 years go by they live in montana nevada connecticut florida anywhere in the country if they need to take advantage of medicare asset protection in california continues not to have reciprocity then these poor people have to move back to california and take advantage of medicare asset protection there so this is the way reciprocity works and keep in mind one thing reciprocity is important important to understand and know how it is today but the most important time for reciprocity is down the road at a time when unfortunately we need a care wherever we lived outside of connecticut and we ran out of insurance and then we need to apply to that state's medicaid program how does it work now let's say i moved to florida and i've lived there 10 years 10 years later i have a connecticut partnership for long-term care policy i file a claim with the insurance company benefits are paid all right so i'm earning medicaid asset protection and let's say that i've run out of insurance benefits in my policy has paid out 250 000 i applied to florida's medicaid program let's say florida and connecticut have reciprocity with each other then the state of florida medicaid program will recognize the 250 000 dollars i earned through the connecticut partnership policy and i will be able to protect 250 000 in addition to whatever excuse me uh medicaid asset protection is available at that time through medicaid that's true for any state who has reciprocity with each other and again 44 states reciprocity with each other now the federal government has the right to allow someone let me state a different way states have the right to opt out of the compact by sending the federal government a letter 60 days in advance to wanting to make that change so tomorrow 5 10 20 years from now we don't know what the reciprocity picture looks like what will look like to date no state is opted out of reciprocity we think it's a huge advantage for people to be able to live anywhere they wish to live and to take advantage of their partnership policies and therefore we strongly support reciprocity reciprocity as stated here will be most important when applying to medicaid at that time so i wouldn't worry so much today to say well this state does not have a partnership program or this state does not have reciprocity we simply don't know if things may change in the future but it's great to know that we have this type of protections okay so you may ask if i am interested in learning more how do i go through getting a quote all right so the marketplace evolves things change over time and we have had from the beginning until today a total of 25 insurance companies that have sell partnership policies that have sold partnership policies obviously we can't control the insurance companies they do things based on their business their strategies and we used to have three initially then five four seven six it changes over time today the three three insurance companies that sell partnership policies are banker's life and casualty gen worth and also transamerica life these three insurance companies offer partnership policies and you can go about it different ways for example you can link in to their website look for long-term care and select to have someone contact you make sure you are specific that you say you want someone who is certified to sell partnership policies otherwise they'll send you anybody and they'll sell you something that you maybe didn't really want to begin with and don't be afraid to ask to give you different quotes so for example we choose a pool of money or also called lifetime maximum could be two hundred thousand one hundred fifty thousand three hundred thousand whatever you think is best for you and we also choose a daily benefit amount if possible we strongly suggest to start out with a higher daily benefit something close to the 444 dollars which is the average for nursing homes however keep in mind somebody receiving care at home they may not incur as many expenses so when you buy 450 daily benefit and you're spending 200 a day for home care or 300 you're not losing the extra dollar value it's staying in your pool of money therefore something labeled that could last one year two years three years in reality it may last much longer because it depends on how much you're spending every day through the insurance benefits so please contact any of these three or call one one of the insurance agents you do a lot of business with and see if they can recommend somebody you can look up brokers online you need to do a little bit of research we can't pinpoint one two five individuals because otherwise everyone will go there and then the it would not be fair to the other people are marketing these products now there are some services available free through the state on our website which is listed below here citypartnership.org select consumer and you will see a wealth of state publications to help you better understand how the partnership works how government programs work things you need to ask yourself before buying a policy and then you can always call us if you have any questions or to request a packet of the partnership publications but again you can download and print everything on your own if you like all right so in closing here is very important to point out that the partnership programs the the partnership program helps us to better protect our assets and it gives us a better approach instead of trying to figure out how much care do i need we can sit back and say how much assets do we wish to protect and then we can get quotes based on different variations to see what we are most comfortable with stay well everybody thanks again for your attention and if anything please let us know take care