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HEALTH INSURANCE 101

Health Insurance can be confusing. This article explains the basics of Individual & Family Health Insurance. If you are looking to obtain Health Insurance for yourself or your family, you have two primary options:
 

1. The Affordable Care Act (ACA or Obamacare) and

2. Everything that is outside of ACA or Non-ACA Plans.

 

AFFORDABLE CARE ACT (ACA) / OBAMACARE

ACA Plans offer the most comprehensive options available out there. Some highlights of ACA plans are:

 

  • Coverage for Pre-Existing Conditions

  • Maternity Coverage (Pre & Post)

  • Mental Health Coverage

  • Substance & Alcohol Abuse (Rehab) Coverage

  • Prescription Medication Coverage

  • Preventative Care Coverage

  • Doctors, Specialists, Hospitals, ER, etc.
     

If you are in poor health, have pre-existing conditions, and need comprehensive coverage, ACA is the way to go. As far as cost goes, if you qualify for Advance Premium Tax Credit (APTC) or subsidy ACA might be a good option even if you are in excellent health.

 

ACA Limitations
 

Network: Insurance carriers have been losing money under ACA plans. So, the networks are limited (Mostly HMO and EPO plans). We see providers dropping off the network every year.

Cost: Unless you qualify for the Advance Premium Tax Credit (APTC) or Subsidy, ACA plans are costly. In 2020, the average premium cost in WY $881 / month and NM $345/ month (highest and lowest) per person. “Premium rates have been adjusted 8.4% to reflect the estimated impact of the COVID-19 pandemic and secondary effects on the cost to provide healthcare coverage in 2021." - kff.org

 

Tax Credit: If you do receive a tax credit, you will need to reconcile it during your annual tax filing. You might end up owing IRS money.
 

Tax Penalty: Abolished under President Trump. To learn more about the Affordable Care Act (ACA), visit the US Department of Health & Human Services (DSS) website.
 

State Exchange: Some states have created their exchanges to administer ACA plans. Example: State of Colorado Health Exchange is Connect for Health Colorado.
 

On Exchange Plans: If you reside in a state with a health exchange and qualify for Advanced Premium Tax Credit, you must enroll through the state exchange.
 

Off-Exchange Plans: If you reside in a state with a health exchange and don’t qualify for Advanced Tax Premium Credit, you can enroll through the state exchange or directly with a participating insurance carrier.


 

NON-ACA HEALTH PLANS
 

By-law under the Affordable Care Act, only ACA plans are considered “Health Insurance,” everything outside, considered Health Plans.
 

If you are someone in excellent to fair health and do not qualify for ACA subsidies (make too much money), Non-ACA plans are a perfect way to get coverage.

 

Non-ACA plan options are as follows
 

Short-Term Plans: If you are in good health, short-term plans might be an excellent affordable alternative to ACA. They offer PPO Networks and highly customizable based on your needs and budget. In most cases, Non-ACA plans do not cover pre-existing conditions or have a waiting period for pre-existing conditions. They are now offering 364-day coverage options in most states.
 

Defined Benefit Plans: If you are in good health, a Defined Benefit plan might be an excellent affordable alternative to ACA. You get pre-negotiated network rates, plus a defined benefit amount towards a qualified service.
 

Example: Your PCP charges $250 per visit on cash pay (without insurance). Defined Benefit Network pre-negotiated rate for that service is $150. Your plan pays $100 for that benefit. So, every time you visit your PCP, you will pay $50. These plans have defined benefit amounts for all qualified services. These plans typically have a 12-month waiting for pre-existing conditions.
 

Health-Share Ministry: Health-Share Ministry plans are faith-based alternatives to traditional health insurance. They do require adherence to some strict guidelines such as no substance abuse, including smoking, no mental health coverage, no birth control coverage, no coverage for STDs, No coverage for extramarital pregnancies, etc. You must consent to a “Statement of Standard” promising to follow a clean and healthy lifestyle. An example of this is as follows:



Statement of Standards
 

  •  We care for one another.

  •  We keep our bodies clean and healthy with proper nutrition.

  • We believe the use of any form of tobacco, illicit drugs, and excessive alcohol consumption is harmful to the body and soul.

  • We believe sexual relations outside the bond of marriage are contrary to the Bible's teachings and that marriage should be held in honor.

  • We believe abortion is wrong, except in a life-threatening situation to the mother.

  • We care for our families, and physical, mental, or emotional abuse of any kind to a family member or anyone else is morally wrong.

 

As you can see, this option is not for everyone. These plans do have some basic qualifications such as height, weight, pre-existing conditions, etc. Most health-share programs have waiting periods for pre-existing conditions and limited to no serious illness coverage such as cancer, HIV, etc. It’s a great concept; members pay their dues to health-share to an escrow account. When members use services, they negotiate the rates and pay the bills from the escrow account. These plans are considered self-pay programs, meaning if Health-Share does not pay for a service, members are ultimately responsible for the bills. Since they are not insurance carriers, insurance laws do not apply, and no legal actions can be taken against them. Some Health-Share requires certifications from your local church minister.


If you enroll in such plans, you must be patient. As they negotiate every bill, it might take months before they reconcile a bill.


 

Insurance Definitions
 

Annual Deductible: Pre-set dollar amount you must pay out of pocket before insurance kicks in. Example: Plan deductible is $1,000 person and $2,000 family. If you are on an individual plan, you pay the first $1,000 out of pocket before your insurance kicks in. If you are on a family plan (more than one person), you (family) pay the first $2,000 out of pocket.
 

Copay: Set a dollar amount for certain services. Example: PCP Copay $25. In this case, you pay the copay $25, and that is it. In most plans, you do not have to meet the deductible first to use the copay benefit. However, this is something you must pay attention to. Co-pays do not count towards the annual max out of pocket or deductible.
 

Co-insurance: Services that do not have a co-pay will have a co-insurance. Usually, it ranges from 10%-50%. Co-insurance kicks in after you met your deductible.
 

Example: Your plan deductible is $1,000, co-insurance 25%. Let us assume you got injured and went to the ER. Your ER total cost is $10,000. In this case, you pay the first $1,000 (deductible), then your 25% coinsurance on the balance of $9,000, which is $2,250. So, your total cost in this example would be $1,000 (deductible) + $2,250 (co-insurance) or $3,250.
 

Annual Max Out of Pocket: This is the worst-case scenario for a calendar year. (Year always starts on Jan 1 ends on December 31st) Example: Your plan has Deductible $1,000, Co-Insurance 25%, Max Out of Pocket $6,000. Let us assume you got hospitalized on your coverage day one, and your total bill is $75,000. In this scenario your deductible is $1,000, your co-insurance 25% on the balance of $74,000 is $18,500. Since your Annual Max out of pocket is $6,000, you are only responsible for the first $6,000 bill. You reached your max out of pocket for the year. Anything else that comes up will free for the rest of the year. You will still need to pay for co-pays for any services that have co-pay.


In-Network: You should check if your providers are in-network under the plan. If they are not, then the plan will not pay if you use the providers' services, not In-Network (out of network).
 

Out-of-Network: Most plans will not pay for out of network service. You must verify coverage (if any) for out of network services. Under ACA plans, you can use out of network in emergencies such as ER and Emergency Medical Transportation.
 

HMO: A Health Maintenance Organization (HMO) plan is one of the cheapest health insurance types. You will have a PCP and will need referrals from your PCP for specialists—no out of network coverage.

EPO: An Exclusive Provider Organization (EPO) Plan. Like HMOs, EPOs cover only in-network care, but networks are generally larger than for HMOs. They may or may not require referrals from a primary care physician. Premiums are higher than HMOs but lower than PPOs.
 

PPO: A Preferred Provider Organization (PPO) has pricier premiums than an HMO or POS. But this plan allows you to see specialists and out-of-network doctors without a referral. Copays and coinsurance for in-network doctors are low. If you know you will need more health care in the coming year and can afford higher premiums, a PPO is the right choice. Almost a nonexistent option in most states ACA.
 

HDHP with HSA: Offset out-of-pocket costs with a health savings account. A High Deductible Health Plan (HDHP) has low premiums but higher immediate out-of-pocket costs. You may also deposit pre-tax dollars in your account to cover medical expenses, saving you about 30%.
 

Here at Healthcare Affairs, we nationally carry both ACA and Non-ACA plans, including Health-Share Ministry plans.

 
 
 

ACA – ADVANCE PREMIUM TAX CREDIT (APTC)

Health insurance can be expensive and often out of reach for lower and moderate-income families.

The Affordable Care Act (ACA) includes provisions to lower premiums and out-of-pocket costs for people with low and modest incomes to make coverage affordable.
 

There are two types of subsidies available to ACA enrollees:

(1) Advance Premium Tax Credit (APTC) reduces enrollees’ monthly payments for insurance coverage.

(2) The cost-sharing subsidy; is designed to minimize enrollees’ out-of-pocket costs.


To receive either type of financial assistance, qualifying individuals and families must enroll in a marketplace qualified plan and meet income guidelines.

Calculate your 2021 APTC using the following APTC Calculator:

 

2021 ADVANCE PREMIUM TAX CREDIT (APTC) CALCULATOR

Source: Kaiser Foundation, online at https://www.kff.org/  

 

ACA OPEN ENROLLMENT & SPECIAL ENROLLMENT

ACA Open Enrollment happens ones every year. Typically, around November. If your state has an exchange they will announce their own open enrollment time.  
 

ACA Special Enrollment Period happens when you have a qualifying life event.  
 

You may qualify for a Special Enrollment Period if you or anyone in your household in the past 60 days: 
 

  • Got married. 

  • Had a baby, adopted a child, or placed a child for foster care. 

  • Got divorced or legally separated and lost health insurance. 

  • Death 

  • Changes in residence 

  • Loss of health insurance. 

  • Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder 

  • Becoming newly eligible for Marketplace coverage because you became a U.S. citizen or legally moved to the United States 

  • Leaving incarceration 

  • Starting or ending service as an AmeriCorps State and National, VISTA, or NCCC member 

Medicaid & CHIP: You can enroll year-round if qualify.  

Non-ACA Plans offer year-round enrollment. 

 

DENTAL INSURANCE

Importance of Dental Health

Overall health and dental health are more connected than you may realize. Sometimes oral infections and gum disease can be a precursor to, or a symptom of, more serious health issues. Research and studies have shown oral health is linked to:
 

  • Cardiovascular Disease: People with gum disease were more likely to develop heart disease.  

  • Pregnancy and Birth Issues: Gum disease has been linked to preterm and low birth weight babies.  

 

  • Diabetes: People with gum disease have more difficulty controlling blood sugar. 

 

  • HIV/AIDS: People with AIDS are at special risk for oral health problems. Many of these problems arise because the person’s immune system is weakened and less able to fight off infection.  

 

  • Osteoporosis: Bone loss in the jaw has been linked to osteoporosis. The bone in the jaw supports and anchors the teeth. When the jawbone becomes less dense, tooth loss can occur. 

Dental Insurance FAQ

Why Get Dental Insurance? 
 

You’ve probably heard the saying “an ounce of prevention is worth a pound of cure.” When it comes to your oral health, these words ring true. The basic and preventive care coverage available with our dental plans makes it easier to give your dental health the attention it deserves. During routine cleanings, your dentist checks for various issues such as oral cancer, nutritional deficiencies as well as cavities – catching problems before they become more serious. 

 

Exactly what is dental insurance for Individuals? 
 

Dental plan coverage for individuals is not commonly offered because dental needs are highly predictable. For example, you would not pay premiums for your dental coverage if the premiums were more expensive than the cost of the dental treatment you need. Since this is the case, insurance companies would stand to lose money (spend more on benefits than they receive in premiums) on every individual dental plan they write. 
 

There are, however, a few companies that offer a form of dental benefits for individuals. Most of these plans are "referral plans" or "buyers' clubs." Under these types of plans, an individual pays a monthly fee to a third party in return for access to a list of dentists who have agreed to a reduced fee schedule. Payment for treatment is made from the patient directly to the dentist. The third-party acts only in the capacity of matching the individual to the dentist. The dentist receives no payment from the third-party other than in the form of referral of patients. 

 

My dentist recommends a treatment that my plan will not pay for. Does this mean the treatment isn't necessary? 
 

It is common for dental plans to exclude treatment that is covered under the company's medical plan. Some plans, however, go on to exclude or discourage necessary dental treatment such as sealants, pre-existing conditions, adult orthodontics, specialist referrals, and other dental needs. Some also exclude treatment by family members. Patients need to be aware of the exclusions and limitations in their dental plan but should not let those factors determine their treatment decisions. 

 

My dentist recommends that I get a crown on a tooth, but my dental benefit will only pay for a large filling for that tooth. Which treatment should I have? 
 

Some plans will only provide the level of benefit allowed for the least expensive way to treat a dental need, regardless of the decision made by you and your dentist as to the best treatment. Sometimes, exceptional circumstances may be explained to the third-party payer to request an adjustment to this lower benefit allowance, but there is no guarantee that the third-party payer will alter its coverage. As in the case of exclusions, patients should base treatment decisions on their dental needs, not on their dental benefit plan. 

 

My dental plan says that it will pay 100 percent for two dental checkups and cleanings each year. However, I just had my first checkup and cleaning, and the insurance company says I owe for part of the dentist's charge. How can this be? 
 

Plans that describe benefits in terms of percentages, for example, 100 percent for preventive care or 80 percent for restorative care, are generally Usual, Customary, and Reasonable (UCR) plans. The administrators of UCR plans set what the plan considers to be a "customary fee" for each dental procedure. If your dentist's fee exceeds this customary fee, your benefit will be based on a percentage of the customary fee instead of your dentist's fee. 
 

Exceeding the plan's customary fee, however, does not mean your dentist has overcharged for the procedure. These plans pay a set percentage of the dentist's fee or the plan administrator's "reasonable" or "customary" fee limit, whichever is less. These limits are the result of a contract between the plan purchaser and the third-party payer. Although these limits are called "customary," they may or may not accurately reflect the fees that area dentists charge. There are wide fluctuation and a lack of government regulation on how a plan determines the "customary" fee level. 

 

Will my plan cover the care my family will need? 
 

This should be a prime consideration and a major motivation in choosing one plan over another. Look at the exclusions and limitations of the coverage as well as the broad categories of benefits. Ask your agent for help. 

 

Who is covered by my dental benefit plan? What does my dental plan cover? 
 

A summary of benefits will be sent to you after your purchase the policy. So that you and the dentist may be aware of the benefits provided by a dental benefit plan, the extent of any benefits available under the plan should be clearly defined, limitations or exclusions described, and the application of deductibles, copayments, and coinsurance factors explained to you. This should be communicated in advance of treatment. 
 

The plan document should describe the benefit levels of the plan and list any exclusions or limitations to that coverage. This document should also specify who is eligible for coverage under the plan and when that coverage is in effect. 

 

My dentist is not on the list of dentists provided by my employer. Can I still go to him/her for treatment? 
 

You can always go to the dentist of your choice. The question is whether you will have benefit coverage for the treatment you receive if it is provided by a dentist who is not on the plan's list. This depends on contractual agreements between the plan purchaser (often your employer), the dentists on the list, and the plan administrator. Under certain contracts, such as a PPO (Preferred Provider Organization) program, patients are given a financial incentive to go to certain dentists but do receive some level of dental benefit, regardless of the treating dentist. Other plans, such as capitation programs, do not provide any benefit coverage for treatment given by "non-participating" dentists. In all instances where this type of plan is offered, patients should have the annual option to choose a plan that affords an unrestricted choice of a dentist, with comparable benefits and equal premium dollars. 

 

My spouse and I each have a dental benefit plan. Who in our family is covered by these plans? 
 

Your program covers you. Your spouse's program covers him/her. You may have additional coverage from each other's programs if they cover spouses and dependents.  
 

The primary plan for covering your children depends on the regulations in your state. Most plans use the "birthday rule" (spouse with birthday occurring earlier in the calendar year is primary). Others consider the father's plan primary. The American Dental Association has recognized the "birthday rule" as the preferred method for coordinating benefits, but which rule applies to your family depends on the language in your dental plan documents. 
 

If you have two or more potential sources of coverage, check the coordination of benefits language for each plan to determine the benefits available. 

 

Does my dentist have to send a description of my treatment plan to the insurance carrier before I have any dental work done? 
 

Some dental procedures require prior authorization from the insurance carrier. Your dentist’s office will send the request before the completion of the procedure. 


 

How are the benefits determined? 
 

You should know how your plan is designed since this can affect significantly the plan's coverage and your out-of-pocket expense. 
 

To understand and make decisions about your dental benefits, it is important to remember that plans are often very different. To make the best decision for you and your family, you should understand exactly how the various kinds of dental benefit plans work and how they derive their cost savings. 
 

There are many ways to design a dental benefits plan. Although the individual features of plans may differ somewhat, the most common designs can be grouped into the following categories: 
 

Direct Reimbursement programs reimburse patients a percentage of the dollar amount spent on dental care, regardless of the treatment category. This method typically does not exclude coverage based on the type of treatment needed and allows the patients to go to the dentist of their choice. 
 

"Usual, Customary and Reasonable" (UCR) programs usually allow patients to go to the dentist of their choice. These plans pay a set percentage of the dentist's fee or the plan administrator's "reasonable" or "customary" fee limit—whichever is less. These limits are the result of a contract between the plan purchaser and the third-party payer. Although these limits are called "customary," they may or may not accurately reflect the fees that area dentists charge. There are wide fluctuation and a lack of government regulation on how a plan determines the "customary" fee level. 
 

Table or Schedule of Allowance programs determines a list of covered services with an assigned dollar amount. That dollar amount represents just how much the plan will pay for those services that are covered. Most often, it does not represent the dentist's full charge for those services. The patient pays the difference. 
 

Preferred Provider Organization (PPO) programs are plans under which contracting dentists agree to discount their fees as a financial incentive for patients to select their practices. If the patient's dentist of choice does not participate in the plan, the patient will have a reduction or complete loss of benefits. 
 

Capitation programs pay contracted dentists a fixed amount (usually monthly) per enrolled family or patient. In return, the dentists agree to provide specific types of treatment to the patients at no charge (for some treatments there may be a patient co-payment). The capitation premium that is paid may differ greatly from the amount the plan provides for the patient's actual dental care. 


 

What is Direct Reimbursement? 
 

Direct Reimbursement programs reimburse patients a percentage of the dollar amount spent on dental care, regardless of the treatment category. This method typically does not exclude coverage based on the type of treatment needed and allows the patients to go to the dentist of their choice. 

 

How Does Dental Insurance Compare with Discount Dental Plans? 
 

Dental discount plans sound a lot like traditional dental insurance plans, but they’re not. The discount programs promoted all over the Internet that promise you lower prices on dental care function more like using a coupon. They give you a limited discount, on certain treatments, at selected dental offices. 
 

Our dental insurance plans provide you and your family with dental coverage. We don’t hide anything; we tell you what’s covered right at the beginning. Take advantage of the “free look” period and If you aren’t completely satisfied with your coverage, we’ll give you a full premium refund. 
 

Our dental insurance plans can help you keep your family covered. No surprises. No coupons. Just dental coverage from a company you can trust. 

 

DENTAL HELP FOR LOW-INCOME FAMILIES

Local Health Departments: The Bureau of Primary Health Care (1-888-Ask-HRSA) supports federally-funded community health centers across the country that provide free or reduced-cost health services, including dental care. 

 

Find your nearest location http://findahealthcenter.hrsa.gov/ 
 

Medicare: Medicare provides limited dental benefits. If you are enrolled in Medicare, contact your plan provider for details.  
 

Medicaid & CHIP: Some state-run Medicaid programs offer dental coverage.

Check with your local Department of Health & Human Services office for details. 

Free / Low-Cost Dental Clinic for the Uninsured 
 

Dental Schools: (American Dental Association) can be a reliable source of quality, reduced-cost dental treatment. Most of these teaching facilities have clinics that allow dental students to gain experience treating patients while providing care at a reduced cost. Experienced, licensed dentists closely supervise the students. Post-graduate and faculty clinics are also available at most schools. 

 

Search for local dental programs here.  

American Dental Hygienists’ Association may also offer supervised, low-cost preventive dental care as part of the training experience for dental hygienists. 
 

American Dental Hygienists’ Association 
444 North Michigan Avenue, Suite 3400 
Chicago, IL 60611 

Phone: (312) 440-8900 http://www.adha.org/ 

 

Clinical Trials: The National Institutes of Dental and Craniofacial Research (NIDCR) sometimes seeks volunteers with specific dental, oral, and craniofacial conditions to participate in research studies, also known as “clinical trials”. Researchers may provide study participants with limited free or low-cost dental treatment for the condition they are studying. 
 

Online at http://www.clinicaltrials.gov/ 

Clinical Center’s Patient Recruitment and Public Liaison Office at 1-800-411-1222. 

 

United Way: The United Way may be able to direct you to free or reduced-cost dental services in your community. Local United Way chapters can be located on the United Way website. 
 

Online at http://www.unitedway.org/find-your-united-way/ 

 

VISION INSURANCE

Eye exams at every age and life stage can help keep your vision healthy. Many people think their eyesight is just fine, but then they get that first pair of glasses or contact lenses and the world comes into a clearer view—everything from fine print to street signs. 
 

Improving your eyesight is important—about 11 million Americans over age 12 need vision correction—but it’s just one of the reasons to get your eyes examined. Regular eye exams are also an important part of finding eye diseases early and preserving your vision. 
 

Eye diseases are common and can go unnoticed for a long time—some have no symptoms at first. A comprehensive dilated eye exam external icon by an optometrist or ophthalmologist (eye doctor) is necessary to find eye diseases in the early stages when treatment to prevent vision loss is most effective. 
 

During the exam, visual acuity (sharpness), depth perception, eye alignment, and eye movement are tested. Eye drops are used to make your pupils larger so your eye doctor can see inside your eyes and check for signs of health problems. Your eye doctor may even spot other conditions such as high blood pressure or diabetes, sometimes before your primary care doctor does. 

Vision Care Change Lives

Early treatment is critically important to prevent some common eye diseases from causing permanent vision loss or blindness: 
 

  • Cataracts (clouding of the lens), the leading cause of vision loss in the United States. 

  • Diabetic retinopathy (causes damage to blood vessels in the back of the eye), the leading cause of blindness in American adults. 

  • Glaucoma (a group of diseases that damages the optic nerve) 

  • Age-related macular degeneration (the gradual breakdown of light-sensitive tissue in the eye). 

Of the estimated 61 million US adults at high risk for vision loss, only half visited an eye doctor in the past

12 months. Regular eye care can have a life-changing impact on preserving the vision of millions of people. 

Vision Insurance FAQ
 

 

My vision is fine. Why do I need an eye exam?
 

Your vision insurance coverage is designed to protect and enhance your eyesight: your most important sense. Thorough eye exams are essential, not just for detecting vision problems, but as an important preventive measure for maintaining overall health and wellness. A vision exam from a doctor does more than just help you see well. It can also help your doctor see signs of common health conditions like high cholesterol, high blood pressure, and diabetes. Caring for your eyes should always be a part of your regular healthcare routine. 

 

How often should I have an eye exam?
 

An eye exam is recommended every year. As a rule, you shouldn’t go longer than two years between eye exams. You may need to have your eyes examined more often if you have a family history of eye diseases, diabetes, you have generally poor health, or you’re taking medications that may have potential side effects on the eye.  

 

Why should my child have his/her first eye exam? 
 

The American Optometric Association suggests that children should have their first regular eye exam at six months of age. Another vision exam should take place when a child is around two or three years of age when their vision undergoes its most rapid development and vision correction is most effective. 

 

After the initial eye exam, how often should children have an eye exam?
 

Children should have an eye exam every two years or more often if there is an eye or vision problem or a family history of eye disease. 
 

School children use their eyes more often than adults to read and perform other activities, so they must have regular eye exams. Eye screening offered at school typically only tests distance and may not detect some vision problems. Your child can have problems with near vision, eye coordination, and focusing and still have 20/20 distance vision. If left untreated, these problems can cause learning disabilities, headaches, and other visual discomforts. 

 

Do I need an especial eye exam as I get close to or past age 40?
 

You don't need a special eye exam over age 40, but you must have a regular eye exam at least every two years. As we get older, we're more susceptible to certain eye diseases such as cataracts, glaucoma, and macular degeneration. A regular eye exam enables your eye doctor to detect the first signs of disease and prescribe the appropriate treatments to prevent vision loss. 

 

 

VISION HEALTH HELP FOR LOW-INCOME

 

Eye Exams & Surgeries
 

EyeCare America, a public service foundation of the American Academy of Ophthalmology (AAO). Provides comprehensive eye exams and care for up to one year, often at no out-of-pocket expense to eligible candidates age 65 or older. Its Glaucoma EyeCare Program provides a glaucoma eye exam. The EyeCare America Children’s EyeCare Program educates parents and primary care providers about the importance of early childhood (newborn through 36 months of age) eye care. Telephone: 1-877-887-6327. Website: https://www.aao.org/eyecare-america  
 

VISION USA, coordinated by the American Optometric Association (AOA), provides free eye-care to eligible uninsured, low-income workers and their families. Telephone: 1-800-766 4466. | Website: https://www.aoa.org/ 

Lions Clubs International is a service organization whose local club members are all volunteers. A local Lions club in or near your community may sponsor a program that may help you buy corrective eyewear or obtain eye health care. https://www.lionsclubs.org/en/start-our-global-causes/vision 

Mission Cataract USA, is a program providing free cataract surgery to people of all ages who have no other means to pay. Surgeries are scheduled annually on one day. Website: http://missioncataractusa.org./ 

InfantSEE® is a public health program designed to ensure early detection of eye conditions in babies. Member optometrists provide a comprehensive eye and vision assessment for infants within the first year of life regardless of a family’s income or access to insurance coverage. Telephone: 1-888-396-3937. Website: https://infantsee.org/ 

 

Free Eye Glasses:
 

Sight for Students is a Vision Service Plan (VSP) program that provides free eye exams and glasses to low income and uninsured children 18 years and younger that qualified for the program.  Telephone: 1-888-290-4964. 

Website: https://vspglobal.com/cms/vspglobal-outreach/giftcertificates-nationalpartner.html 
 

New Eyes for the Needy provides vouchers for the purchase of new prescription eyeglasses. 

Website: https://new-eyes.org/  

 

ACCIDENT & GAP INSURANCE

Accident & GAP insurance pays out of pocket expenses NOT covered by primary major medical insurance. These plans are very affordable starting at $18/ month. 

Accident & GAP Insurance FAQ

 

Who should consider an Accident /GAP policy?
 

  • Anyone who has a major medical plan with a significant deductible or large co-payments. 

  • Anyone with limited access to health care providers.  

  • Anyone seeking to reduce their out-of-pocket health care expenses. 

     

What happens if I have an accidental injury? 


This policy reimburses you up to your calendar year maximum benefit for emergency medical services required by the accident. Your deductible must be satisfied before reimbursement. Accident expenses that may be covered include emergency room and urgent care center visits; hospital, surgery and physician charges; physical therapy; ambulance; X-rays, and more.  

 

Would this policy be of any benefit to me?
 

Absolutely. Accident / Gap policy can pay benefits regardless of other coverage you have, it may be of excellent value even if your primary plan has a relatively low deductible. 

 

Can I purchase this policy if I do not have major medical coverage?
 

Although it is always a clever idea to have major medical coverage, this is a stand-alone policy and does not require you to have major medical coverage. Some states, however, require you to own comprehensive medical coverage before applying for or purchasing an accident policy. Ask your agent for details regarding your state of residence.  

 

How much does it cost?  
 

Premiums for accidental injury coverage depend on your age, gender, the benefit amount, and deductible you choose and whether the policy is individual or family coverage. Plans starting at $18/month.  

 

If my major medical plan covers my medical expenses, am I also eligible to receive benefits? 
 

Yes, an Accident / GAP policy can pay benefits under the terms of the contract in addition to any benefits received from your major medical policy. To determine the appropriate claim benefit, an Explanation of Benefits statement (EOB) will be required by the claims department in addition to the medical expense billing. The EOB will be reviewed to account for any adjustments, discounts, or allowances deducted to determine the actual charges from the medical provider. 

 

How difficult is it to qualify for the policy?  
 

There are no medical qualifications for accident coverage. Individuals up to age 64 are eligible for this plan. Qualification for the Critical Illness Rider depends on your answers to a few simple health questions on the application. Qualification for Accidental Disability Income Rider is based on answers to vocational questions.  
 

How does the family deductible work? 
 

With a family plan, once out-of-pocket expenses reach twice the chosen deductible, additional claims for the year are paid from the first dollar. For example, a family of four chooses a $300 deductible. If the husband has a claim for $250 and the wife has a claim for $200, neither has satisfied their $300 deductible. However, if a child then has a covered accident, the family only must pay $150 out of pocket before benefits are paid by the policy since the family’s costs for the year have now reached twice the individual deductible of $300. Since the family deductible has been met, claims made over the rest of the year will be eligible for payment, up to the maximum policy benefit.  

 

How does the optional critical illness rider work? 
 

The Critical Illness Rider pays a lump sum benefit upon initial diagnosis of a covered heart attack, stroke, or invasive cancer. Once you’re paid benefits for a critical illness, the rider will terminate — along with the premium you were paying for that portion of the policy — unless your spouse or children are covered by the rider. In that case, the rider will remain in force.   

 

Is the amount of critical illness protection separate from the accident expense benefit I choose?  
 

Yes. You have the flexibility to choose the amount of critical illness coverage that meets your needs up to $50,000. 

 

If I have a $3,000 deductible on my major medical policy, am I limited to a $3,000 maximum benefit on an Accident / GAP policy?   
 

Not at all. Your Accident / GAP policy is completely independent of other coverage you may have. You may want to purchase a benefit that’s even higher than your deductible to help cover co-payments or coinsurance in your medical policy in addition to the plan deductible. 

 

 

CRITICAL IllNESS INSURANCE

The risk of getting a critical illness is very real. We all know someone who has/had Heart attack, Stroke, Organ Transplants, Cancer, Coronary Bypass, etc.  
 

Critical Illness Insurance provides a lump sum tax-free cash benefit if you ever get diagnosed with a critical illness. So, you can focus on getting better and not worry about finances.  
 

You can obtain coverage up to $250K*. Return on Premium (ROP)* rider available. With ROP, if you don’t get diagnosed with a critical illness before turning 80, you get all of your paid premiums back.  
 

Critical Illness Facts You Should Know

  • Some 1.7 million Americans were diagnosed with cancer cases (2015). American women have a 63% chance of living at least five years after a cancer diagnosis (for men it’s 66%). 
     

  • Every 40 seconds someone in the US has a stroke. 900,000 people will experience their first stroke (2015). 10% of stroke victims recover almost completely; 25% recover with minor impairments; 15 percent die shortly after the stroke.
     

  • Every 34 seconds, an American will suffer a heart attack. 985,000 will have a new coronary attack (2015). Where defibrillation is provided within 5 to 7 minutes, the survival rate from sudden cardiac arrest is as high as 45%. 
     

  • 7 million Americans will declare bankruptcy this year. 60% are due to medical bills (up 50% over 6 years). 78% had health insurance but were impacted by deductibles, co-payments, and uncovered expenses plus living expenses. 

Critical Illness Insurance FAQ

What is critical illness insurance? 
 

This insurance pays a benefit directly to you if you experience a serious illness — such as a heart attack or stroke. ​

 

What conditions are covered? 


The conditions covered vary depending on your policy.  Typical coverage includes,

  • Heart attack

  • Life-threatening cancer

  • Loss of hearing

  • Loss of speech

  • Loss of vision

  • Major organ transplant

  • Paralysis

  • Coma

  • Renal failure

  • Stroke

  • Carcinoma in situ

  • Coronary artery bypass graft


 

How much coverage can I get?


Depending on the policy, you can choose a benefit amount up to the maximum allowed. 

 

Am I guaranteed coverage? 
 

You may be asked some health questions. Your answers will be used to determine whether you are eligible for coverage.  

 

How much does it cost?  
 

Premiums for accidental injury coverage depend on your age, gender, the benefit amount, and deductible you choose and whether the policy is individual or family coverage. Plans start at $19.99/month.

 

What is the definition of a pre-existing condition?  
 

It means a disease or physical condition for which symptoms existed within the 12 months before the effective date of coverage or medical advice or treatment was recommended or received from a member of the medical profession within the 12 months before the effective date. A pre-existing condition can exist even though a diagnosis has not yet been made.  

 

How will I receive my payment?   
 

You will receive a single lump-sum payment based on the conditions covered under the plan.   

 

How does the family deductible work? 
 

With a family plan, once out-of-pocket expenses reach twice the chosen deductible, additional claims for the year are paid from the first dollar. For example, a family of four chooses a $300 deductible. If the husband has a claim for $250 and the wife has a claim for $200, neither has satisfied their $300 deductible. However, if a child then has a covered accident, the family only must pay $150 out of pocket before benefits are paid by the policy since the family’s costs for the year have now reached twice the individual deductible of $300. Since the family deductible has been met, claims made over the rest of the year will be eligible for payment, up to the maximum policy benefit.  

 

How can I use the money? 
 

Use it any way you choose.   

 

DISABILITY INCOME INSURANCE

Disability Income Insurance provides regular monthly cash benefits if you become disabled on a short or long-term basis. We, at HealthCare Affairs, shop all available disability income insurance finding you the right plan at the right price.  

Facts About Americans With Disability

Disability is a very real fact of life. There were nearly 40 million Americans with a disability in 2015, representing 12.6% of the civilian non-institutionalized population, according to the U.S. Census Bureau.  
 

Older Americans are significantly more likely than younger Americans to have a disability, according to the American Community Survey. About half of Americans ages 75 and older (49.8%) reported living with a disability in 2015, as did about a quarter (25.4%) of those 65 to 74. In contrast, just 6% of Americans ages 18 to 34 and 13% of those 35 to 64 said they had a disability. In absolute numbers, however, those ages 35 to 64 accounted for more disabled Americans – nearly 16 million in 2015 – than any other age group. 

 

While there is little difference between men and women in the likelihood of having a disability, there are differences by race and ethnicity. Asians were least likely to say they had a disability (6.9%), followed by Hispanics (8.8%). American Indians or Alaskan Natives, on the other hand, were most likely to report a disability (17.7%). Similar shares of whites (13.9%) and blacks (14.1%) reported living with a disability. 

 

The most common types of disability involve difficulties with walking or independent living. More than 20 million people ages 18 and older reported having serious difficulty walking or climbing stairs in 2015, representing 7.1% of the civilian non-institutionalized population. Another 14 million people ages 18 and older reported having a difficult time doing errands alone (for example, shopping or visiting a doctor) due to physical, mental, or emotional conditions. About 13 million people reported cognitive difficulties. Around 11 million people in the U.S. reported significant hearing difficulty, while roughly 7 million reported significant difficulty with vision, even when wearing glasses. 

 

Disabled Americans earn less than those without a disability. Those with a disability earned a median of $21,572 in 2015, less than 70% of the median earnings for those without a disability ($31,872), according to the Census Bureau. Both figures are for the civilian, non-institutionalized population ages 16 and older, measured in earnings over the past 12 months. 

 

Source: Pew Research 

 

SHORT-TERM DISABILITY VS. LONG-TERM DISABILITY INSURANCE

Short-term disability insurance and long-term disability insurance are both designed to provide replacement income to you and your family in the event you are unable to work due to accident or sickness. The definition of disability and the conditions under which you can collect benefits will differ depending on the policy and state.  
 

The most obvious difference between the policies is the amount of time they are designed to sustain your income. A short-term policy covers you for a select period up to a maximum of two years; a long-term policy will cover you for a select period of a minimum of two years and up to age 67.  
 

There are advantages to both policies:  

Short-Term Disability Insurance Advantages

Short-term disability insurance pays benefits after a pre-determined elimination period (The number of calendar days after a disabling injury or illness before your disability insurance policy would begin to pay benefits) has been met.
 

As implied by the name, short-term disability insurance lasts for a shorter, specified period. This type of insurance policy is useful for major, but relatively brief, disabilities such as those suffering from an accident or a non-terminal sickness.  
 

Often, short-term disability insurance is only a portion of how people protect their income in a situation where they cannot work. They will also use means such as emergency savings, workers' compensation, paid leave, and other forms of insurance in conjunction with short-term disability. But when these benefits are exhausted (or, if you never had them in the first place), short-term disability can provide critically important funds.

Long-Term Disability Insurance Advantages

In the case of a long-term absence from work, a combination of short-term disability insurance benefits and other savings may not be enough to sustain your family financially. This could leave you vulnerable to financial burdens, such as mortgage foreclosure or default on debt, for example.  
 

A long-term disability insurance policy can help protect you and your family from scenarios like this. These insurance policies provide comprehensive, long-term benefits that will cover you in the event of accident and sickness. There are also additional rider options available for a long-term policy, allowing you to tailor coverage to your unique needs.  
 

The benefit period on these policies ranges from two years or until age 67. Because your state may have different regulations governing the length and availability of long-term (and short-term) disability insurance, it is important to talk with a HealthCare Affairs licensed insurance agent to see what is not covered by a long-term disability insurance policy. 

Which Disability Insurance Option is Right for Me? 

If you rely on your income to pay bills or other necessary expenses, then both policies can help you. Long-term disability insurance is highly recommended for anyone that relies on their income, whether they have savings. People with robust savings and investments that they can draw from may be able to maintain their financial bearings without short-term disability, but it could be an unnecessary risk.  
 

Both long-term and short-term disability insurance policies protect you and your family from unpredictable accidents and illnesses.  

Disability Income Insurance FAQ

What is disability insurance? 
 

If you are sick or injured and unable to work, disability insurance helps replace your income. It can be used to pay monthly bills, like a mortgage, or for other expenses. Essentially, disability insurance serves as paycheck protection for times when you are unable to earn an income.  
 

Disability insurance functions like many other insurance policies. You pay a set amount at regular intervals, and in exchange, you receive benefits if you use your policy. The specific regulations regarding disability insurance vary by state. Talk to an agent¹ for detailed information regarding disability insurance regulations in your state.  

 

Why do I need disability insurance?  


Like most people, you may have a range of financial obligations you’re responsible for, such as rent or a mortgage, retirement savings, and everyday expenses. If you become disabled, you’ll still need to fulfill your commitments and provide for your loved ones. Even if you have group long term disability income insurance through your employer, it may not be enough. Individual disability income (DI) insurance may help protect more of your income if you become too sick or injured to work for an extended period. 

 

Income Protection: 


When you add up your income throughout your career, it will most likely be your single biggest asset. Without it, your ability to support yourself and your loved ones, as well as the future you envision, maybe in jeopardy. With so much at stake, it’s important to help protect a portion of your income with DI insurance. 

 

Retirement Protection: 
 

You've worked hard to save for retirement, so it's critical to protect the nest egg you've built. Since DI insurance can help you meet your current financial obligations if you become too sick or hurt to work, you may be able to avoid tapping into your retirement savings. You may also be able to purchase a DI policy designed to help you continue saving for retirement if you become too sick or hurt to work. And while they are not a retirement plan or a substitute for one, some DI policies may help replace an amount equal to the contributions you would have made to your retirement plan if you had not become disabled.  

 

If I have health problems, can I get disability insurance? 
 

Many people with health issues will still be able to purchase disability insurance. It is important to remember that premiums are, in part, based on age. Since health problems increase with age, typically, premiums increase as well. That's why it is important to consider purchasing a disability insurance policy sooner rather than later, to prevent higher premium payments.    

 

Where can I buy disability insurance?   
 

HealthCare Affairs is your trusted partner in purchasing Disability Income Insurance. We carry over 35 highly rated insurance carriers and will shop for the best and most affordable plan based on your needs and budget. You can pick between two types of coverage with most policies – accident only, or accident and sickness. Accident only coverage will provide benefits in the event you suffer an injury that keeps you out of work. The accident and sickness option will cover you if you have an injury or an illness that prevents you from working. Long-term disability insurance is only currently available for accident and sickness combination policies in most states.  

 

Can I live off disability insurance income?    
 

It is possible to maintain your lifestyle with disability insurance income. Depending on your income level and your policy, you may be able to nearly match your pre-disability income.  
 

With a well-planned combination of disability insurance, government assistance, and investments, it may be possible to meet your pre-disability income and keep your family living the lifestyle they are accustomed to.  

 

How high are disability insurance rates? 
 

Disability insurance rates vary depending on the size of your benefits and the type of riders you attach to your policy. In general, disability insurance can be an affordable investment that offers peace of mind and protection for your family.

 

Tips for Buying Long-Term Disability Insurance:
 

In the event of a severe injury or illness, you may be unable to work for years. Replacing your income is vital to keeping your family financially fit and emotionally comfortable during a period like this. Long-term disability insurance plans are designed for these situations.  
 

When you buy long-term disability insurance, you are making an investment that protects you and your family during tough times. But it's important to understand what you are purchasing. These tips for buying long-term disability insurance are designed to help you find a policy that fits your unique needs.  

 

Government Assistance:    
 

As with short-term disability, some people may rely on government assistance for their long-term needs. This can be a risky plan though. For example, in short-term situations, Social Security can be difficult to obtain and the income likely will not approach your current income. As a supplement, it can help you, but do not count on it to replace the income from your job.  

 

Employer Policies:    
 

Many employers do offer some type of long-term disability insurance. Check to see if this option is available to you and if the employer shares the premium payment with you. Also, check to see if they offer short-term disability and if so, when the benefit periods for both begin. For instance, if your short-term benefits end after 90 days but your long-term benefits do not begin until 180 days of disability, you will need to plan for the gap. Typically, the benefit periods will align. But this is not always the case.
 

Also, consider supplementing employer insurance with your insurance. Make sure that you know the specifics of your employer policy. Not all policies will cover the disabilities that you may want to ensure coverage for. In this case, contact HealthCare Affairs and have us help you find a more flexible policy.  
 

You may also want a private insurance policy if your employer policy does not cover enough of your income. Check the Needs Assessment calculator to determine how much coverage you would need in the event of a disability. Compare this to the employer-offered policy, and then determine if you need to supplement with a policy of your own.  

 

Optional Benefits (Additional premium applies):     
 

You can pick from several optional riders to help customize your policy to your needs. The additional options available with these plans help ensure that you can get the coverage and protection that your family needs. Some of the optional riders available (check with your agent¹ to make sure they are available in your state) are:  

  • Future Insurability Options 

  • Cost-of-Living Adjustment Rider 

  • Critical Illness Benefits Rider 

  • Hospital Confinement Indemnity Benefits Rider  

     

Short-Term Disability: Government Assistance:
 

As with short-term disability, some people may rely on government assistance for their long-term needs. This can be a risky plan though. For example, in short-term situations, Social Security can be difficult to obtain and the income likely will not approach your current income. As a supplement, it can help you, but do not count on it to replace the income from your job.  

 

Tips on Buying Short-Term Disability Insurance:    
 

You might wonder if you need short-term disability insurance. After all, few people plan to be seriously injured and miss work for an extended period. And, many have emergency funds, work-issued insurance or compensation plans set up to protect themselves in the event of an illness or injury. However, have you considered how much of your income is necessary to sustain you and your family if you are unable to work? Our Needs Assessment calculator can help you see just how much money it will take to pay your bills and maintain the lifestyle you are accustomed to if this happens.  
 

If you've noticed that your current savings and plans may not be large enough to fund your family during an extended work absence, short-term disability insurance can help. These insurance plans can help you pay bills and other expenses if you are unable to work.  
 

The following are some tips to keep in mind when looking for short-term disability insurance plans.


 

Don't Depend on Government Assistance:     
 

There are government programs that can help you in the event of a disability. Social Security, for example, has a disability component. However, you likely will have to wait several months before you are eligible to claim any benefits. And once you begin to draw benefits, the amount you receive will likely be substantially less than the income you are used to. These plans are a nice supplement to your income during a tough time, but they alone will likely not be enough to maintain your lifestyle.  

 

Personal Insurance vs. Employer-Provided Insurance:      
 

Some businesses offer forms of short-term disability insurance to their employees. These plans can help supplement or even replacing your income (depending on the benefits) during a time of disability. But before committing to an employer-provided plan over a personally funded plan, make sure you understand the terms and conditions. It may be difficult to collect on benefits from the employer plan, or the benefit period may be much shorter. A personally funded plan is also portable, and not tied to your current job. 

 

Accident Only or Accident/Sickness Policy:       
 

Short-term disability insurance plans typically come in two types - accident only or sickness and accident protection. The type of policy you pick determines what type of benefits you can receive and under which circumstances. If you have an accident-only policy, you will not receive benefits if you fall ill and are unable to work.  

Since accident-only policies are less comprehensive than combination policies, they will typically have lower premiums and a lower cost to you. An accident-only policy, from the Mutual of Omaha Disability Income Choice Portfolio, can be customized in three diverse ways:  
 

  • Selecting an elimination period  

  • Selecting the benefit period  

  • Selecting an optional rider  

 

Your elimination period can vary from zero to 90 days in these policies; benefits can vary from three months to two years, and we have an optional rider that can customize your policy (accident hospital confinement indemnity benefits).  

Accident and sickness short-term disability insurance, as the name implies, covers you in both circumstances. Our policies in this category can be customized in the same manner as accident-only insurance plans. The major difference (other than the obvious inclusion of sickness in coverage) is that the optional rider selection is expanded. You can add a Hospital Confinement Rider, a Return of Premium Benefit Rider, or a Critical Illness Benefits Rider to this policy. (Additional premium applies)  

Choosing a short-term disability insurance option that best protects you and your family can be an arduous process.  

Long Term Care Insurance

Short and Long-Term Care Insurance pays for your expenses while you receive care.  

10 Misconceptions About Long Term Care Insurance

According to AARP, here are 10 misconceptions about LTC insurance to consider when deciding whether to make this investment: 

1. Medicare will pay for care

Medicare only covers LTC for short periods, such as rehabilitation after an injury or illness. It does not cover assistance with ADLs that many older adults need to maintain their independence.

 

Medicaid will cover nursing home care only if your income / asset is below a certain level and after you've depleted almost all your savings. 

2. Insurance only covers nursing home care

Most policies are joint policies, meaning they cover both in-home assistance and nursing home care.  

3. My family will take care of me for free: 

Yes, they likely will. But think about whether you want them to. If you need help using the bathroom, bathing, or changing soiled undergarments (incontinence does happen), would you want your children doing that or would you prefer the help of a skilled medical professional? LTC insurance covers in-home assistance from licensed home health agencies. 

4. I'm too young to worry about it: 

The younger you are, the more likely you are to qualify for coverage. "The median age when people purchase is 57, but the sweet spot is between 52 and 64 because once you qualify for Medicare your health history tends to get more complicated as you suddenly get all these free medical screenings and tests," says Jesse Slome, executive director of the American Association for Long-Term Care Insurance. 

5. When I need it, I'll get it:

Once you have a diagnosis of an illness, you can't get coverage. Think of it this way: We can't insure a house once it's on fire. When you apply for coverage, the insurance company will look at your most recent medical history to evaluate your health. Only 17 percent of people in their 50s are denied coverage, but that number jumps to 45 percent for people in their 70s. Once you have coverage and pay your premiums, you have it regardless of what medical issues arise. 

6. I'll fail the medical screening:

Don't assume that just because you have high cholesterol or are a few pounds overweight that you won't qualify. For most applicants, especially the young ones in their 50s and 60s, underwriting only looks at your most recent medical records from your doctor to see what illnesses you've been diagnosed with and what medications you are on. You'll also undergo a cognitive exam via phone. There's no in-home visit by a medical professional. 

7. I was denied and so am uninsurable: 

Yes, denial is a strike against you, but it doesn't mean you should stop shopping around. There are many companies out there, and an independent long-term care insurance agent can help you find one that might not consider you as much of a risk. Different insurance companies has different underwriting guidelines. 

8. I can't afford it:

Coverage might be less costly than you think, especially if you purchase in your 50s. For a husband and wife, both age 55 and in good health, the average annual premium is $2,350, (The range is $2,085 to $3,970 depending on your health history and the individual insurer.)
 

Premiums can rise over that time, but increases are never based on your personal medical history and require state regulatory approval. 

9. Insurance will cover all my needs: 

Long-term insurance is not limitless. In the above scenario, the 55-year-old couple qualifies for $338,000 in coverage as soon as they pay their first premium. That amount increases over time to $821,500 by age 85. Many plans also have deductibles, meaning you will have to pay out a certain amount for care before coverage kicks in. And if your medical needs exceed those amounts, you will have to pay the balance. 

10. It's too complicated:

If your eyes glaze over at talk of contingent, non-forfeiture, share care … you're not alone. Many different companies offer many different plans. But the LTC insurance industry is working to make it less confusing. "I think as agents, we've made it complicated, but it doesn't have to be that way," says Boals. "We talk in insurance terms. But what I ask my clients is, 'If something happened, what would you want it to look like? Where would you want to be? What are the things that you worry about?' And then we craft a policy from there." 
 

Source: AARP

Must-Know Statistics About Long-Term Care:

Demographics: 

 

  • 40.2 million: Number of Americans age 65 or older in 2010.  

  • 88.5 million: Projected number of Americans age 65 or older in 2050.  

  • 67%: Percentage of Americans age 65 or older who will need some form of long-term care in their lifetimes.  

  • 6.3 million: Projected number of Americans age 85 or older in 2015.  

  • 17.9 million: Projected number of Americans age 85 or older in 2050. 

     

Usage:  
 

  • 15 million: Number of people in the U.S. using nursing facilities, alternative residential care, or home-care services for long-term care needs, 2000.  

  • 27 million: Projected number of people in the U.S. using nursing facilities, alternative residential care, or home-care services for long-term care needs by the year 2050.  

  • 29.5%: Percentage of nursing home residents who were under age 75 in 2011.  

  • 27.5%: Percentage of nursing home residents who were between the ages of 75 and 84 in 2011.  

  • 35.3%: Percentage of nursing home residents who were between the ages of 85 and 95 in 2011.  

  • 7.6%: Percentage of nursing home residents who were over age 95 in 2011. 67%: Percentage of nursing home care residents who were female, 2011-2012.  

  • 72%: Percentage of residential care community residents who were female, 2011-2012.  

  • 14%: Percentage of people age 71 or older who suffered from Alzheimer's disease or other types of dementia, 2007.  

  • 49%: Percentage of nursing home residents who suffered from Alzheimer's or other types of dementia, 2011-2012.  

  • 4.5 years: Average length of time someone lives after being diagnosed with dementia. 12%: Percentage of adults age 65 or older who suffered from depression, 2008.  

  • 49%: Percentage of nursing home residents who suffered from depression, 2011-2012.  

  • 2.8 years: Average length of the nursing homestay.  

  • 5 months: Average length of nursing home stay for patients who eventually died in the nursing home. 

     

Cost of Care:
 

  • $87,600: Median annual cost for nursing home care, private room, nationally, 2014.  

  • 4.35%: Increase in cost of a private room in a nursing home between 2013 and 2014, nationally.  

  • $58,765: Median annual cost for nursing home care, private room, Louisiana, 2014. 

  • $164,250: Median annual cost for nursing home care, private room, Manhattan, 2014.  

  • $42,000: Median annual cost for an assisted-living facility, nationally, 2014.  

  • $19: Average hourly rate for home health aides, nationally, 2014.  

  • 1.59%: Increase in the hourly rate for home health aides between 2013 and 2014.  

  • 34%: Percentage of seniors who had incomes that were less than 200% of the poverty threshold in 2013 ($20,916 for individuals and $26,388 for couples). 

     

Unpaid Care Giver:  
 

  • 80%: Percentage of long-term care provided by unpaid caregivers at home.  

  • 67%: Approximate percentage of unpaid caregivers who are female.  

  • 14%: Percentage of unpaid caregivers who are age 65 or older.  

  • 20%: Percentage of unpaid caregivers who provide more than 40 hours of care per week.  

  • 10%: Percentage of unpaid caregivers who go from full-time to part-time work because of their caregiving responsibilities.  

  • 67%: Percentage of people who plan to have a loved one provide care but haven't asked. 

     

State and Federal Funding:   
 

  • $143 billion: Amount of long-term care services and supports financed by Medicaid, 2011.  

  • 40%: Percentage of all long-term care costs financed by Medicaid.  

  • $117,240: Maximum amount of assets that a healthy spouse can retain for the other spouse to be eligible for long-term care benefits provided by Medicaid. (Actual amounts vary by state.)  

  • 100 days: Amount of care in a skilled nursing facility covered in full or in part by Medicare following a qualifying hospital stay. 

     

Insurance:  
 

  • 24.7%: Percentage of people who apply for long-term care insurance between the ages of 45 and 54.  

  • 54%: Percentage of people who apply for long-term care insurance between the ages of 55 and 64.  

  • 57: Average age of long-term care insurance applicants.  

  • 92.3%: Percentage of long-term care policies with an elimination period of 90-100 days.  

  • 63.7%: Percentage of new long-term care claims that were opened by people over age 80, 2012.  

  • $2,466: Average annual cost for long-term care insurance for a 55-year-old couple, 2012; the daily benefit of $150 with a 3% inflation option and three-year benefit period.  

  • $3,381: Average annual cost for long-term care insurance for a 60-year-old couple, 2012; the daily benefit of $150 with a 3% inflation option and three-year benefit period.  

  • $6.6 billion: Amount of long-term care claims paid in 2011.  

  • 45.9%: Average premium increase requested for approval by John Hancock for 8,600 long-term care policies in force in Connecticut, 2014.  

  • 1%: Estimated lapse rates for long-term care insurance policies.  

  • 102: Number of companies selling long-term care insurance policies in 2002.  

  • 12: Estimated number of companies selling long-term care insurance policies at the end of 2009. 

Data Source: http://news.morningstar.com/articlenet/article.aspx?id=564139 


 

Using Life Insurance to Pay for Long-term Care:     
 

You can use your life insurance policy to help pay for long-term care services through the following options: 
 

  • Combination (Life/Long-Term Care) Products 

  • Accelerated Death Benefits (ADBs) 

  • Life settlements 

  • Viatical settlements 

  • Combination Products 
     

Many consumers are reluctant to buy long-term care insurance because they fear that their investment will be wasted if they do not use it.  Some insurance companies have attempted to solve this problem by combining life insurance with long-term care insurance.  The idea is that policy benefits will always be paid, in one form or another.  These products are relatively new and the features are changing as the product evolves.  The amount of long-term care benefit if often expressed in terms of a percentage of the life insurance benefit. 

 

Accelerated Death Benefits (ADBs) 
 

A feature included in some life insurance policies that allows you to receive a tax-free advance on your life insurance death benefit while you are still alive. Sometimes you must pay an extra premium to add this feature to your life insurance policy. Sometimes the insurance company includes it in the policy for little or no cost. 

There are several types of ADBs each of which serves a different purpose. Depending on the type of policy you have, you may be able to receive a cash advance on your life insurance policy’s death benefit if: 

  • You are terminally ill 

  • You have a life-threatening diagnosis, such as AIDS 

  • You need long-term care services for an extended amount of time 

 

You are permanently confined to a nursing home and incapable of performing Activities of Daily Living (ADL), such as bathing or dressing.


 

Good To Know Information:

The amount of money you receive from these types of policies varies, but typically the accelerated benefit payment amount is capped at 50 percent of the death benefit. Some policies, however, allow you to use the full amount of the death benefit. 
 

For ADB policies that cover long-term care services, the monthly benefit you can use for nursing home care is typically equal to two percent of the life insurance policy’s face value. The amount available for home care (if it is included in the policy) is typically half that amount. 
 

For example, if your life insurance policy’s face value is $200,000, then the monthly payout available to you for care in a nursing home would be $4,000, but only $2,000 for home care. Some policies may pay the same monthly amount for care, regardless of where you receive the care. 

 

When you receive payments from an ADB policy while you are alive, the amount you receive is subtracted from the amount that will be paid to your beneficiaries when you die. 
 

Key things to consider before taking advantage of an ADB policy include: 

If your life insurance policy includes an ADB feature, you may be able to use your life insurance policy to help cover long-term care services. Depending on the policy amount, there may be little or no health screenings required. So, if you have a health condition that might exclude you from long-term care insurance eligibility, you can still obtain a long-term care insurance policy through the ADB feature on a life insurance policy. 
 

ADB policy payouts for long-term care services are often more limited than the benefits you could receive from a typical long-term care insurance policy. 
 

The face value of your life insurance policy may not be enough to allow ADB payments that are enough to cover your long-term care services needs. The benefit payments may be too low and the duration may be too short to cover your long-term care services expenses. 
 

ADB riders on life insurance policies may not offer inflation protection. If the policy does not include inflation protection, the ADB payment may not be sufficient to cover your future long-term care service costs. 
 

If you want to leave an inheritance, you should consider whether using your life insurance death benefit to pay for long-term care services is the right option. If you use the ADB feature for long-term care services, there may be little or no death benefit remaining for your survivors. 
 

Using the ADB option may affect your eligibility for Medicaid. Check with your state Medicaid agency for more information. 

 

Life Settlements:     
 

These plans allow you to sell your life insurance policy for its present value to raise cash for any reason. This option is usually only available to women age 74 and older and men age 70 and older. You may choose to use the proceeds to pay for long-term care services. 
 

Key things to consider before moving forward with a life settlement: 

  • If you sell your life insurance policy, there may be little or no death benefit left for your heirs when you die 

  • The process does not require any health screens; you may be in good or poor health 

  • The proceeds of the sale may be taxed 

  • Viatical Settlements 
     

These plans allow you to sell your life insurance policy to a third party and use the money you receive to pay for long-term care. A viatical settlement is like a life settlement, but it is only possible if you are terminally ill. During the settlement process, a viatical company pays you a percentage of the death benefit on your life insurance policy, which is based on your life expectancy. The viatical company then owns the policy and is its beneficiary. The viatical company also takes overpayment of premiums on the policy. As a result, you get money to pay for care, and the viatical company receives the full death benefit after you die. 
 

Unlike the life settlement, the money you receive from a viatical settlement is tax-free, if you have a life expectancy of two years or less or are chronically ill and the viatical company is licensed in the states in which it does business. 

 

Key things to consider before using a viatical settlement:    
 

You can only use the viatical settlement if you are terminally ill and have a life expectancy of two years or less. 
 

If you use the viatical settlement option, you do not have to satisfy the health requirements for long-term care insurance. 
 

If you use the viatical settlement option, your life insurance policy will not pay a death benefit to your heirs. 
 

Viatical companies approve less than 50 percent of applicants. The amount that you receive in cash from a viatical settlement is a percent of the death benefit on your life insurance policy. The chart below lists guidelines from the National Association of Insurance Commissioners (NAIC), for how that percent varies based on your life expectancy. 

Long-term Care Insurance FAQ

Long-Term Care (LTC) insurance only pays for long-term care. Long-term care is primarily supervision or assistance with everyday tasks like bathing and dressing and does not require a licensed health care professional to provide those services. This kind of care is often needed because of an illness, an injury, or as a result of aging and the inability to take care of one’s self. This product used to be sold almost exclusively to seniors, but today LTC insurance is sold to people as young as 30-years-old. The federal government allows taxpayers to deduct some, or all, of the premium for a tax-qualified (TQ) policy as a medical expense based on the age of the purchaser and the amount of premium paid. California allows a similar deduction on state income tax returns. TQ policies meet certain minimum federal requirements in addition to those required by state law. This fact sheet answers some frequent questions about LTC insurance.  


Who sells LTC insurance?

Individuals can purchase LTC insurance from many companies through insurance agents or a variety of groups or employers. Some private employers sponsor this type of insurance, and public employers like the California Public Employees Retirement System (CALPERS) or the Federal Employees Long Term Care Program (FLTCP), sponsor their long-term care programs. Some associations, like the American Association of Retired Persons (AARP), and fraternal and faith-based organizations also sponsor LTC insurance programs. Employers and other groups rarely pay any part of the premium. They simply make the insurance available to their employees or members, and sometimes to other family members as well. Health screening or medical underwriting is still required, although active employees may be exempt from this requirement or be subject to only minimal screening for employer-sponsored coverage.  

 

Should I buy LTC insurance?   

This answer depends on your individual needs and circumstances. Buying LTC insurance is part of a planning process for life and retirement. You need to have enough income to pay the premiums for the rest of your life, regardless of premium increases or life changes, such as the death of your spouse. You need to consider how long the benefits should last about the premium you will pay. Most people with modest resources may be better able to pay for a policy with one, two, or four years of coverage rather than one with benefits that last if they need care. Also, if you have few, if any assets, it may not make sense for you to buy this type of insurance. Other options for paying for long-term care include investments, savings, home equity conversion or a reverse mortgage, and Medicaid.  

 

What is the best LTC insurance policy?   


What is best for one person may not be good for another. The benefits and amount of coverage an individual or couple needs depend on their unique circumstances. A single or widowed woman may need very different benefits than a married man, particularly if their economic circumstances are different. Women are more likely to live longer than men and more likely to live alone at the end of their life. Without family members willing to provide some home care and support services, women are more likely to get their long-term care in a nursing home or an assisted living facility.  


 

What is the best company to buy from? 

 

Many companies sell LTC insurance, although recently some companies have stopped selling this type of insurance. Some companies that remain in the market have decades of experience, while others are relatively new to this product. Some are large companies with many other products and subsidiaries; others are smaller and specialize in LTC insurance. Rating services like AM Best or Standard and Poor’s provide information to help you evaluate the financial strength of these companies. Speak with your agent for the best pricing.    

 

What is a “Tax Qualified” (TQ) policy?    
 

These policies meet minimum standards set by the federal government OR are ones that were approved for sale in your state as an LTC insurance policy before the 1996 change in federal law. Some, or all, of the premiums, may be tax-deductible as a medical expense, depending on the amount of premium you pay and your current age. The premiums for a non-tax-qualified policy (NTQ) are not tax-deductible. The benefits paid by a TQ policy are NOT taxable as income. No public decision has yet been made by the Internal Revenue Service (IRS) about the tax treatment of NTQ policies. In general, a TQ policy is more restrictive than an NTQ policy. The soonest a TQ policy can pay benefits is when someone is unable to perform two Activities of Daily Living (ADLs) out of a list of six ADLs, or when a person is cognitively impaired. The six ADLs are bathing, dressing, eating, transferring (e.g. from bed to chair), toileting, and continence. NTQ policies can pay benefits using a more generous threshold for paying benefits or include additional ways to trigger benefits. NTQ policies have a seventh ADL—walking—to make it easier to qualify for benefits. Until recently, when the law expired in California, companies were required to offer you an NTQ policy along with a TQ policy. Some companies still sell these, but if you want one, you may have to ask for it.  

 

If I buy a policy before my next birthday, will I pay a lower premium?  
 

Not necessarily. Companies do base their premiums on age, and the older you are the more you will pay. However, the difference in premium for one year of age may not be significant. If the only reason you are buying a policy is to lock in a lower premium, you may not know enough about the policy to justify that decision. Also, a well-trained, professional agent won’t pressure you to decide before you fully understand the product you are buying just to save a few dollars. They understand that this is a product you will be keeping for the rest of your life and it’s important that you understand how it works and is comfortable with the decision you are making. It is always a clever idea to have a friend, relative, or another advisor with you when having an agent visit for selling you a long-term care insurance policy.    

 

I am planning to buy a policy from a company and agent, but the cost of inflation protection adds hundreds of dollars to the premium. Do I need it?  
 

In general, yes. Inflation protection should be included in every LTC insurance policy because these policies pay a fixed dollar amount for each day of care. Most people are buying these policies years before they will need care. A fixed daily benefit loses buying power each year. In fourteen years, it will only pay for half the care that it pays for today while the cost of care continues to inflate each year. The difference between the LTC insurance benefit and the cost of care will have to come out of your pocket. Inflation protection will help your benefits keep up with inflation. As greater numbers of people begin to need care, the competition for caregivers and places of care will fuel increases in the cost of care. Also, inflation protection is important even at age 80 because some people live longer, maybe another 20 years or more.  

 

Will I be able to stay out of a nursing home if I buy an LTC insurance policy?
 

Not necessarily. Having an LTC insurance policy may not keep you out of a nursing home if that is the only place that can provide appropriate care. Around the clock care at home is generally more expensive than nursing home care and may require more than one caregiver for each 8-hour shift. Since the reason, you may need care, and the amount of care you may need is so unpredictable, an LTC insurance policy should provide you with protection in any of the settings where you are likely to need care, including care at home, in assisted living facilities and nursing homes. While most people want to be cared for at home, and many can be for at least short periods, others may have no choice if their condition becomes so severe that getting care at home is not feasible.    

 

If I buy a two-year LTC insurance policy, will the company only let me keep it for two years?   
 

No. It means that when you begin collecting benefits, your benefits may only last for two years if you use them up at the maximum amount each day. Newer policies provide a pool of money that can last for the stated number of days or much longer if your daily expenses are less than the maximum daily benefit in your policy. Remember that you will have to pay premiums for as long as you want the protection you bought unless your policy has a paid-up provision.  

 

My insurance agent says his policy is different and has a pool of money I can use to pay for long-term care. What does that mean?      
 

Some state law requires all LTC insurance policies to define the maximum benefit the policy will pay by a single dollar amount, not years. This is commonly called a pool of money or a total dollar amount that is available to pay for your care in all the places covered by the policy. For example: If you bought a policy that pays a maximum daily benefit of $100 a day in a nursing home for two years, but pays only $50 a day for home care, your maximum policy benefits may last longer than two years. You would have $73,000 in total benefits ($100 x 730 days) available to you. After you used home care benefits every day for one year ($50 x 365), you would still have $54,750 in benefits left; equal to one and a half years of nursing home care, or three years of home care, or any combination that equals $54,750. If you bought inflation protection, the amount of your maximum daily benefit and maximum policy benefit would be greater than $100 or $50 a day, depending on how many years you had the policy before you began using it.  

 

What is the right age to buy LTC insurance?    
 

This is a very individualized decision, based on many factors. Most people think about this type of insurance when they are close to retirement. Others buy it through an employer much earlier. Premiums are much lower for people in their 40’s or 50’s than at 65 years of age. Also, as people age, they are more likely to develop a health condition that would make them uninsurable. After 60 years of age, premiums for this type of insurance begin to rise steeply and you may be unable to afford the same amounts of coverage you could when you were younger. However, long-term care services and places where people get care are changing and may not be the same services or places described in an LTC insurance policy purchased forty years earlier.


 

Several people in my husband’s family have Alzheimer’s disease and I think my husband may be showing signs of it. How can I get a policy for him?

 

All LTC insurance policies require some health screening, called medical underwriting. Insurance companies won’t insure people who are likely to need long-term care. Some companies review the medical records of each applicant, others will do so only when someone is over a certain age at the time they apply, and some will do a phone interview or face-to-face interview for everyone over 70 years old to assess their functional and cognitive abilities. Still, others will rely on your answers to health questions on the application when you apply for coverage. Some companies use strict medical underwriting; others are less strict and will sell a policy to people who have certain acceptable health conditions but may charge a higher premium. However, it is unlikely a company would issue an LTC insurance policy to someone who already shows signs of cognitive deterioration. An application must be completed accurately and truthfully. Otherwise, it could result in the company canceling the coverage later.


 

I have an LTC insurance policy that I bought in 1986 for $600 a year. It only pays $50 a day for nursing home care after a 100-day waiting period. It doesn’t have inflation protection and I want home care benefits. What should I do?

 

You have several choices if you are still insurable and can afford to pay an additional premium. You could keep the policy you already have and add the benefits missing from your existing policy by buying a second policy from the same or different company. (The policy you have is probably already a TQ policy if it was sold under state law before December 31, 1996. Federal law granted those previously sold policies the same tax status as the new TQ policies.) Or, your current company might issue you one of their newer policies and give you a premium credit for your old policy towards a premium for a new policy if you can pass their health screening. Your agent can help you add benefits to your existing policy, or replace it. If you decide to replace the policy your agent must give you a written comparison of the difference between the two policies and identify how the replacement will benefit you. If you are NOT still insurable, your policy will still pay the benefits you bought, but it will not provide the newer benefits you want. You will need to weigh the continuing cost of your older policy against the benefits it provides to determine if it is in your best interest to keep the policy. Generally, older policies are less expensive than newer policies and it may be worthwhile to keep it for the benefits you originally bought. If you decide not to keep it, the company will retain the premiums you have paid without incurring any future risk of a claim.  

 

Should I cancel my LTC insurance policy if I can’t afford to pay the premium?    
 

Consider another option first. Any consumer can request a reduction in their policy’s benefits so they can continue to afford their premiums. You don’t have to wait for a premium increase to exercise this right. You can reduce the daily benefit amount, the number of years the policy will pay, or make other changes that will reduce the premium to an amount you can afford. When you have paid for this type of insurance for years, you probably will not want to cancel your policy and waste those premium payments. Instead, you can reduce your benefits and keep some of the coverage for which you have been paying.  


 

Why did my premium go up by 40 percent and my neighbor’s policy only went up 15 percent?    
 

Premium increases are based in part on the benefits that were purchased. Someone who has a comprehensive policy that will pay benefits for five years will usually have a greater premium increase than someone with a policy that pays benefits for just one year.  

 

Premiums for LTC insurance cannot be increased, right?      
 

Indeed, companies cannot single you out for a rate increase based on your age or your health. However, every company reserves the right to increase premiums, usually for a group of people in the same state who all bought similar policies issued during a particular period, often referred to as a “class.” That right is stated on the first page of your policy. In some cases, companies underestimated what these policies would cost over time because they thought more people would drop their policies before using the benefits. Some companies underestimated the cost of the claims that would be made against these policies. Insurance companies also invest in the stock market and their investment income may have been less than they estimated when they designed the premiums for a certain group of policies. A change in any one of these factors can affect the premium a company needs to charge to have enough money in the reserve to pay claims over the life of the policies they sold. Some companies were better than others at predicting these factors and haven’t needed to increase premiums. Others had worse experiences and needed significant increases.  
 


Can a company sell my policy to another company?       
 

Yes, companies can sell all their long-term care business or only selected groups of policies. It is also not unusual for an entire insurance company to be bought by another company. However, your policy and the benefits it provides will not change, although your premium might if the new company uses different assumptions for pricing than your previous company did.
 

SHORT TERM CARE / RECOVERY CARE  INSURANCE

Short-Term Care insurance (STC) policy provides coverage for 1 year or less. For many people, this is a very appropriate and affordable amount of coverage. Some long-term care claims indeed last for many years, however, almost half (49%) of long-term care insurance claims LAST ONE YEAR OR LESS. 
 

The majority of policies have a 0-day deductible (Elimination Period) and a full year of benefits. Simply, that means the policy pays on the very first day one qualifies for benefits. Most traditional long-term care insurance policies (about 94%) are sold with a 90-Day Deductible that must be met before benefits are paid. 
 

It is important to know that these policies can pay in addition to Medicare -- something a traditional Long-Term Care Insurance policy is prohibited from doing. 
 

Most Short-Term Care applications have 7-to-10 health questions. If you can answer "NO" to all the questions, you are 95% through the health underwriting process. However, some policies have ONLY 2 "YES" "NO" QUESTIONS and can be ideal for people with existing health problems. 

How Much Does Short-Term Care Insurance Cost? 

Typical premium at age 65 -- $105 monthly. 

Typical premium at age 70 -- $141 monthly option. 
 

Can an STC policy pay for Assisted Living? YES! 

Can an STC policy pay for Nursing Home Care? YES! 

 

Source: The American Association for Long-Term Care Insurance

Short Term / Recovery Care Insurance FAQ
 

How does this plan work? 
 

The Short-Term Recovery Plan pays you or anyone you choose cash benefits once you're admitted to the hospital as an inpatient. 
 

This plan also pays a cash benefit for each day a covered home health expense is incurred when you’re recovering at home after a hospital stay. You'll receive benefits for physical, speech, and occupational therapy. Benefits would be payable for nursing services by a Registered Nurse (RN) and Licensed Practical Nurse (LPN). 
 

In some cases, you may need personal care after your hospital stay as well. The Short-Term Recovery Plan can be used for a Home Health Aide to assist you with items such as bathing and getting dressed. It could even help with homemaker services if you need someone to help with your laundry, shopping, cleaning, and cooking. 


How soon can my protection start? 


Your protection starts as soon as the first day of the month after we receive your Confirmation Form and first premium payment. 
 

 

What benefits would I collect?    
 

This plan would pay cash benefits for your hospitalization for a covered sickness or injury and your recovery afterward:  

Hospital Benefit: You'll collect $750 when you're admitted to the Hospital as an Inpatient for at least one day, regardless of whether you need home recovery care later. If your hospital stay exceeds 14 days, you'll get an additional $500. After 30 days in the hospital, you'll collect another $200. 

 

Home Recovery Care Benefits: You'll collect $200 a day for each day you incur a covered home health care expense. Benefits are paid to you or anyone you choose for benefit periods up to 40 days per Accrual Year. * (Maximum of 20 days per occurrence.) 
 

That's up to a total of $8,000 per year. You won't have to pay out of pocket for the home recovery care you need. Plus, your Hospital Benefit is unlimited in the number of times you can collect it. For example, if you're hospitalized three times in one year, you'll collect at least $750 each time. 
 

Conditions for which you've received medical care or treatment in the 6 months before your effective date will be covered after you've been in the plan for 6 months; or when you've gone 6 months without treatment for the condition, whichever is sooner. 
 

* At age 80, Home Recovery Care Benefits reduce to $200 a day for you up to 20 days per Accrual Year (one benefit period and an annual maximum of $4,000). 

 

What if I have second thoughts after I enroll?  
 

You will have 30 days from the date of receipt to review the insurance certificate. If you are not satisfied with the terms of the certificate, simply return it to the Insurance Administrator and any premiums paid will be refunded in full, minus any claims paid.

 

When does my protection end?    
 

You can keep the Short-Term Recovery Plan if you want. Your coverage won't end due to age. At age 80, home health benefits reduce from a $4,000.00 per year maximum to a $2,000 per year maximum. If the Group Master Policy remains in force, you only need to pay your premiums when due and remain an association member to keep your protection. A member's spouse's coverage ends when the member does and when premiums are not paid. Your spouse can not be legally separated or divorced from you. 

 

Who can sign up? 
 

All members, over age 65 and their spouse, are guaranteed acceptance into this plan. This plan is yours for the asking. You must satisfy the waiting period for pre-existing conditions. 

 

Will acceptance into this plan always be guaranteed? 
 

We're hopeful it will be. However, it's unclear at this point whether underwriting will be necessary for the future for you to qualify. This means now is the perfect time to get in on the plan, when you can't be turned down (subject to Pre-existing Conditions Limitations). 
 

 

International & Travel Insurance

International Health insurance provides healthcare insurance while you are traveling or residing in a foreign country. This type of coverage is available to individuals, families, and employees of organizations. Such plans are fully customizable based on your needs. Coverage available in your country of visit/stay as well as in the US. At HealthCare Affairs, we shop over 15 A-rated carriers finding you the best options at the right price.  

International Health / Travel Insurance FAQ


 

Can I go anywhere in the world for treatment? 
 

Typically, international health insurance offers two areas of cover - Worldwide including the USA and Worldwide excluding the USA. If you choose Worldwide including the USA, you can receive treatment anywhere in the world. If you choose Worldwide excluding the USA, you can receive treatment anywhere except in the USA. 
 

If prior approval is obtained, but the beneficiary decides to receive treatment at a hospital, medical practitioner or clinic that is out of network, the plan will reduce any amount which we insurance pays by 20%. I list of in-network providers are available on your insurance company’s website or speak with an agent for details.  

 

How do I get treatment? 


When you need treatment, call your insurance Customer Care Team. They can help you arrange your treatment plan, and point you in the right direction, saving you the time and hassle of looking for a hospital, clinic, or medical practitioner yourself. We appreciate that there will be times when it will not be practical or possible for a beneficiary to contact us for prior approval (for example, emergencies, or when a family member is suddenly sick and the priority is to get treatment for them as soon as possible). In circumstances like these, we ask that you or the affected beneficiary get in touch with us 48 hours after treatment has been sought, so that we can confirm whether treatment is covered and arrange a settlement with your provider. 
 

 

How do I find my nearest hospital, clinic, or doctor?     
 

Log in to the online Customer Area and you can search our directory of hospitals, clinics, and doctors. Simply type in your zip code, specify the distance you are willing to travel and it will list the medical experts within your area. Alternatively, call our Customer Care Team. Please remember to take your ID card with you when you go for treatment and ask your hospital, medical practitioner, or clinic about direct billing if this has not already been confirmed. Where possible, we will arrange to pay the hospital, clinic, or doctor you wish to see directly.

 

Do I need to pay for treatment upfront?   
 

Where possible insurance carrier will arrange to pay your hospital, clinic, or doctor directly. However, if you have chosen a deductible, you must pay this amount yourself. 
 

 

How do I submit a claim?    
 

Your insurance company’s customer service listed on your ID card.  

 

What currency will my claim be reimbursed in, and how long will it take? 
 

Typically, the insurance company reimburses you within five working days of receiving your fully completed paperwork and can pay you in the currency of your choice (you can choose to be reimbursed in more than 135 currencies). 

 

How do deductibles work? 
 

When you create your tailored plan, you have the option of adding deductibles. If, for example, you choose a deductible of $250, you'll need to pay the first $250 of a covered claim or covered claims in any period of cover directly to your hospital, clinic, or doctor at the time of treatment. So, if your treatment costs are $500, you'll need to pay $250, and we'll pay the remaining $250 for covered costs. If a deductible is chosen, you would only have to pay this once during any period of cover irrespective of the number of claims. 

 

What is cost-share and out of pocket maximum?  
 

Cost-share is the percentage of every claim you will pay. Out of pocket maximum is the maximum amount you would have to pay in cost-share per policy year.  For example: 
 

You have a claim value of $20,000. You have a $500 deductible on your policy. You have a 20% cost share with a $2,000 out of pocket maximum. We would pay $17,500
 

How this is calculated: 

After you paid your deductible of $500, your cost share is 20% of $19,500 ($3,900). This is more than your out of pocket maximum, so you would only pay $2,000 out of pocket maximum for the cost-share (and the $500 deductible you paid at the outset) and we cover the remaining $17,500. 

 

Will pre-existing conditions be covered by my plan?  
 

If you've sought advice or experienced symptoms before the start date of your plan - whether you have been diagnosed or not - we may decide to add special exclusions to your plan. So, you must complete the medical questionnaire as accurately as possible when applying. 

 

Am I covered for dental treatment?  
 

International Medical Insurance provides cover for core benefits, such as emergency dental cover in the event of an accident that requires you to have treatment in a hospital. If you want more cover, choose our International Vision and Dental option and enjoy access to a wide variety of preventative, routine, major, and orthodontic treatments. 

 

Am I covered for inpatient treatment? 
 

Yes, you are. Inpatient treatment is included as standard within our core International Medical Insurance. It covers you for treatment received as an inpatient when staying overnight in the hospital, or when receiving treatment at the hospital as a day case. 

 

Am I covered for outpatient treatment? 
 

International Medical Insurance covers you for selected outpatient costs such as treatment room fees, surgeon and anesthetic costs, advanced imaging, cancer, and mental health care. However, the International Outpatient module covers you more comprehensively for outpatient care and medical emergencies that may arise where a hospital admission as a day patient or inpatient is not required. As well as this, consultations with specialists and medical practitioners, prescribed outpatient drugs and dressings, pre-natal and post-natal outpatient care, physiotherapy, osteopathy, chiropractic, and much more. 

 

Does my insurance ID card provide a guarantee of cover? 
 

No, it doesn't. Your insurance ID card is purely a means of identifying you and has no payment capabilities. When you need treatment, call out the Customer Care Team. We will arrange to pay for your hospital, clinic, or doctor directly wherever possible.  
 

 

Tele-Health & Rx


 

Tele-Health & Rx FAQ


 

How much does it cost?


The cost of a Telehealth visit varies, depending on your plan design.  

 

Do I talk to “real doctors”? 

Yes. Telehealth members only talk to actual doctors who are U.S. board-certified internists, state-licensed family practitioners, and pediatricians licensed to practice medicine in the U.S. and living in the U.S. When you request a visit, Telehealth & RX will connect you with a doctor licensed in your state. 

 

What are some of the common conditions Telehealth & RX treats?     


Common conditions include sinus problems, respiratory infection, allergies, urinary tract infection, cold and flu symptoms, and many other non-emergency illnesses. 

 

Can Telehealth & RX handle my emergencies?     

Telehealth & RX is designed to handle non-emergent medical problems. You should NOT use it if you are experiencing a medical emergency. Call 911 if you are experiencing a Medical Emergency.  

 

Can I request a particular doctor?    

You cannot request a particular doctor. Telehealth & RX is designed to support your relationship with your existing doctor. It is not a means of establishing an exclusive relationship with one of our doctors. All Telehealth & RX doctors are board-certified, state-licensed, and go through rigorous training and credentialing. 

 

Can I use it for my family?  

This varies depending on your specific plan. Most plan designs allow you to use the Telehealth & RX service for you, your spouse, and your dependents. 

 

Can I get a prescription? 


Telehealth & RX does not guarantee prescriptions. It is up to the doctor to recommend the best treatment. Telehealth & RX doctors do not issue prescriptions for substances controlled by the DEA, non-therapeutic, and/or certain other drugs which may be harmful because of their potential for abuse. Also, non-therapeutic drugs such as Viagra and Cialis are not prescribed by Telehealth & RX doctors. 


View the current list of DEA controlled substances » 

 

How are prescriptions sent to the pharmacy?

 

Telehealth & RX does not dispense prescription drugs. If the doctor prescribes medication, it is submitted electronically, phone, or by fax to the pharmacy of your choice. 

 

Can I be turned down for a pre-existing condition? 


Telehealth & RX visits are unavailable outside of the United States. 

 

How do I access the service?  

Dermatology visits are available online. You can contact the Telehealth & RX call center for assistance logging into your account. 

 

Can I ask to follow up questions?

  
Follow-up questions can be directed to the provider within 7 days of the initial visit. All treatment plans will be communicated through your Message Center. 


 

Do I have to upload an image? 


So that your Telehealth & RX physician can properly review and diagnosis your condition, Telehealth & RX does require a minimum of three (3) images to be uploaded before scheduling your visit. 

 

What types of images are allowed? 


Acceptable image file types: JPEG, GIF, PNG, 15MB max per image 
 

 

Are there a maximum number of images I can upload? 

 

Telehealth & RX allows up to five images to be stored per visit. 


How long will it take for the physician to respond to my visit request? 

 

Physicians have up to two (2) business days to diagnose or ask for more information if needed. 

 

If I am given a prescription as a result of my visit, how will I be notified?  

All diagnoses and prescription information will be managed through your Message Center. 

 

Will I be speaking with a licensed dermatology provider?  


All Telehealth & RX dermatologists are board-certified. 

 

If my condition requires immediate attention, how will I be notified?

 
Telehealth & RX will send you information through your Message Center but to ensure patient safety, Telehealth & RX will also have a licensed clinician contact you by phone. 


 

Can I address more than one condition when I request a visit with a dermatologist?  


Telehealth & RX does ask that you limit the request for a visit to one medical condition. 

 

Are there dermatology conditions not treated by Telehealth & RX? 

  
The Telehealth & RX dermatologist will determine treatment options based on the visit.  


 

What can be shared with PCPs? 


The Telehealth & RX do not share a member’s medical record unless specifically asked for by the member. Image uploads are not available on the Telehealth & RX portable continuity of care record but are always available in the member’s Telehealth & RX medical health record. 

 

Why do I have to fill out additional intake questions? 


 To make sure our providers have the best information possible to assist members, we do require a short intake with specific questions about their dermatology issue. 

 

Is Dermatology available in all states? 


Telehealth & RX offers visits in states where tele dermatology is allowed and within states where Telehealth & RX provides telemedicine services.  

 

Can a dermatology visit be scheduled for someone under the age of 18? 
 

Dermatology visits are available to all Telehealth & RX members. 

 

If the dermatologist has additional questions, how will I be notified?  
 

The physician will send you a message through your Message Center asking for further clarification. You can choose how you are alerted that a new message is in your Message Center (i.e. text or email). 

 

Do I have to have online access to have a Dermatology visit? 
 

Yes. Because of the nature of the Dermatology visit (required images and additional health information), you must have online access. 

 

Do I have to have online access to have a Dermatology visit? 
 

Yes. Because of the nature of the Dermatology visit (required images and additional health information), you must have online access. 

Behavioral Tele-Health FAQ
 

Do I have to schedule an appointment or can I just call and get the next available time? 
 

All Behavioral Health visits are scheduled. Telehealth & RX does not support an on-demand option at this time.   

 

How long is the typical Behavioral Health visit? 


Our first-time Behavioral Health visits an average of 45 minutes. Psychiatry visits vary in length based on patient needs.  

 

Can a Behavioral Health visit be scheduled for someone under the age of 18?     
 

Telehealth & RX will provide Behavioral Health services to anyone over the age of 18. 

 

Can I use the Behavioral Health service for an emergency?    
 

This program is not intended to be used for emergencies. Visit requests require an advance scheduling notification. 
 

 

Are there Behavioral Health issues not treated by Telehealth & RX?    
 

There are some prescriptions not provided by our service, but the licensed specialist will determine if you are best seen for an in-person visit for further evaluation. 

 

Can I use it for my family? 
 

This varies depending on your specific plan. Most plan designs allow you to use the Telehealth & RX service for you, your spouse, and your dependents. 

 

What should I expect during my call? 
 

After completing a quick intake assessment you will have a conversation with the Behavioral Health professional just as if you were in person. 

 

Can I talk to the same specialist each time I request a visit? 
 

Yes. A member can choose to see the same specialist or a different one. It’s your choice. 

 

How secure is the communication line and who retains my medical records?  
 

Confidentiality is very important to Telehealth & RX and we follow the same strict security protocols as we do for our core services. All medical records are kept in a secure environment and Telehealth & RX does not share the information with anyone outside of the patient’s specific request or as required by law. 

 

How do I access this service? 
 

Members can access the Behavioral Health service by logging into their account or by calling customer service. 

 

What type of equipment do I need for a Behavioral Health visit? 
 

You will need a telephone for telephonic visits. For video visits, you will need to have internet connectivity and webcam. Video visits are strongly encouraged by our specialists. 

 

What if I need medication? 
 

Psychiatrists can prescribe from a limited formulary. If the Behavioral Health specialist determines a different/higher level medication is appropriate, they may refer you for an in-person visit. 

 

Can I select my doctor based on preferences such as specialty, gender, language? 
 

Our specialist profiles display information about each Telehealth & RX professional, including gender, language, and specialty. This information will display when making your specialist selection online. 

 

Will I be able to schedule recurring appointments? If so, how far in advance can I schedule? 
 

At the end of the visit, the provider will schedule a follow up if the individual specialist deems necessary. At this time, only the next visit can be scheduled. 
 

 

Is there bilingual assistance provided when I contact Telehealth & RX for the visit? 
 

Telehealth & RX does display a provider’s languages on the profile screen when making your selection. If a bilingual Telehealth & RX specialist is not available, an interpreter will be provided. 

 

Is there a time limit on how long I can speak with a specialist? 
 

Our therapy visit is expected to be 45 minutes on average. Psychiatry visits vary based on patient needs. 

 

What type of Behavioral Health specialist does Telehealth & RX have? 

Psychiatrist, Psychologist, Counselor, Clinical Social Workers, Therapist (Marriage and Family) 

 

What types of specialists can prescribe medications?  
 

Only psychiatrists can prescribe medications.  

 

What do I do if I feel I am in immediate danger of self-harm?   
 

This is considered an emergency and the member should immediately dial 911 for assistance. 

 

Are there limits to how many visits can be scheduled within a month?    
 

Not at this time. However, Telehealth & RX is committed to evaluating this program to ensure compliance with patient safety standards. 
 

 

Is there a maximum number of days a prescription can be issued?   
 

At the discretion of the appropriately licensed specialist, prescriptions can be issued between 30-90 days. 



SexualHealth™, a Trusted Partner of Telehealth & RX

 

What is APG Services? 
 

APG Services is short for Analyte Physician Group Services. To help protect your privacy, sexual health uses “APG” in email and billing communications.

 

How does the process work?  
 

After you place your test order online or by phone, we’ll fax a doctor-authorized test requisition to the local lab of your choosing. At the lab walk-in visit, you’ll have a quick specimen draw. For most people, the lab visit takes about 15 minutes. In 3 business days or less, you’ll receive a discreet email directing you to log in to your secure account on the sexual health system to view your test results. For patients whose test results are positive or require further explanation, you can request a visit with one of our doctors. If appropriate, the doctor will prescribe treatment or provide linkage to further care. 
 

 

How quickly can I get my test results? 
 

Test results are typically ready in 3 business days or less. 
 

 

How quickly can I speak with a physician? 
 

If you have a medical emergency, please go to the emergency room or call 911. If your question is non-urgent, please call a Care Advisor toll free at 888-631-0116  so they can direct your call to a doctor or nurse. For patients who receive positive STD test results, or whose results require further explanation, a visit may be requested with a doctor at a time that is convenient for you. Once you request a visit, a doctor will call you back within 3 hours. 
 


How can I learn more about SexualHealth?   
 

The physician will send you a message through your Message Center asking for further clarification. You can choose how you are alerted that a new message is in your Message Center (i.e. text or email). 

 

Will my lab test be reflected in my medical record with Telehealth & RX?  
 

No. Please contact SexualHealth to request your lab test-specific medical record. 

 

Can I get assistance if I have additional questions?  
 

The SexualHealth Care Advisors are available to guide you through the testing and test results process from start to finish. Simply log in to your Telehealth & RX account and click on the Request Lab Testing link or call 888-631-0116  6 am-10 pm CDT. 

 

Can my lab results be sent to my primary care provider?   
 

Yes. You can request a copy of your lab test through the SexualHealth website. 

 

If I need to speak with a physician, will I be speaking with a Telehealth & RX provider?  
 

Yes. Telehealth & RX members will be speaking with Telehealth & RX providers. 

 

What types of tests are available through SexualHealth?   
 

We provide STD testing for 8 of the most common sexually transmitted infections that can be detected through blood or urine: chlamydia, gonorrhea, hepatitis B, hepatitis C, herpes 1 + 2, HIV, syphilis, and trichomonas. 

 

Which laboratories do sexual health work with?   
 

Your tests will be processed by the lab you select at the time you place your order. The laboratory options are among the largest CLIA-certified laboratories in the United States. 

 

If the provider prescribes medications for my issue, can I pick it up the same day?   
 

Yes. Prescriptions are typically sent electronically and can be picked up the same day. Please check with your pharmacy first to ensure they have the prescription ready for pick up. 

 

If the provider prescribes medications for my issue, can I pick it up the same day?   
 

Contact SexualHealth directly. 

Life Insurance

Having the correct life insurance can save you and your family from financial disaster. At HealthCare Affairs, we shop all available life insurance plans based on your needs and budget. Most life insurance brokers will sell you a policy where they make the most commission.

 

We at HealthCare Affairs DO NOT work that way. We will find you the right plan regardless we get paid or not. Because it is the right thing to do. Insurance rates are fixed by law, meaning you WILL NOT find a better price elsewhere.  
 

There are many reasons to get life insurance. Some major reason customers obtain life insurance to financially protect the following life events:  

  • Getting Married 

  • Having A Baby 

  • Buying A Home 

  • Dealing with Debt 

  • Changing Jobs  

  • Supporting Aging Parents 

  • Changes in Your Business  

  • Changes in Marital Status 

  • Planning for College 

  • Planning for Retirement 

  • Other 

 

One of the most common questions people have about life insurance is “term or permanent?” Well, it depends on several factors, including how long you need the coverage, how much you can afford, how much risk you can tolerate, and how much flexibility you need. 
 

To help you gain a better understanding of which type of insurance might be right for you, speak with one of our licensed agents at (720) 744-0065. 

 

Click here to download the official “Life Insurance Buyers Guide” by the National Association of Insurance Commissioners.  

 

Optional Life Insurance Riders

Return on Premium (ROP) Rider: Life insurance policy with an ROP rider provides you with peace of mind. Under ROP rider, if you never die during the term of the policy you get all your paid premiums back.  
 

Living Benefits Rider: Life insurance with a Living Benefits rider policy pays out if you become permanently disable or get diagnosed with a terminal illness.  
 

Long-Term Care (LTC) Rider: Life insurance policy with LTC rider provides lumpsum or monthly cash benefit if you need LTC. 

No Exam Life Insurance

 

Many people purchase life insurance to help secure the financial stability of their loved ones after their death. In most cases, you must submit to a medical exam to purchase a life insurance policy, because the insurance company wants to assess the risks involved with insuring you. But some insurance companies offer life insurance policies without a medical exam. 
 

Medical Exam: An applicant to undergo a medical examination as a part of the underwriting process. Typically, when applying for most types of life insurance, an applicant will be required to meet with a paramedical professional (or “paramed”).  During this meeting, the paramed will usually ask some in-depth health questions. They will also usually take blood and a urine sample from the applicant for life insurance. These samples are then tested for various health conditions that could be deemed as risky for the insurance carrier. Because of this, those who have health issues such as diabetes and other serious conditions may not qualify for what is referred to as “medically underwritten” life insurance coverage. But, without having to take a medical exam, qualification for coverage can be much easier. 
 

Also, because there is no medical underwriting to contend with, a no medical exam life insurance policy can often be approved much more quickly than a medically underwritten policy. Therefore, someone who applies for no medical exam coverage may have his or her policy approved in as little as 48 hours – or possibly even sooner. 

When to Buy No Medical Exam Life Insurance? 

No medical exam life insurance is often marketed as affordable, convenient, and fast. While this is somewhat true, it is still not the right solution for everyone. Only certain people will truly benefit from purchasing no exam life insurance. 
 

If you have a chronic health condition like diabetes that is not under control, purchasing life insurance can be expensive or impossible. You may be able to purchase guaranteed issue life insurance in these cases. 
 

If you cannot wait to purchase a fully underwritten policy, no exam life insurance may be a good option. These policies can sometimes be issued in as little as a few days. 

If you have a risky occupation or participate in a risky hobby, you might have a tough time getting life insurance that utilizes a complete underwriting process, even if you are healthy. 
 

If you are older or have a serious health condition and want to help your loved ones pay for funeral or final expenses, a no medical exam life insurance policy may help give you peace of mind. 
 

If you have health problems and your employer does not offer group life insurance, no exam life insurance may be a good option for you. Employer-provided life insurance is usually obtainable even for those with health problems, and it is usually very affordable for lesser amounts of coverage. But if you lose your job or your employer stops offering the coverage, you may be a suitable candidate for no medical exam life insurance if you have no other options. 
 

If these circumstances do not apply to you, and you want to provide for more than just final expenses, no medical exam life insurance is probably not for you. Young, healthy individuals with families typically need enough life insurance coverage to pay off a home mortgage and other outstanding debt and provide some income replacement for their spouse and children. 
 

You may also want life insurance to fund your children’s education and other future. Under most circumstances, submitting to the medical tests and underwriting process will be the best option for obtaining appropriate life insurance that achieves your goals and gives you peace of mind. 
 

Life Insurance FAQ


 

What is life insurance?

Life insurance is a contract between an insurance policyholder (you) and an insurer where the insurer will pay a designated beneficiary a sum of money upon the death of the insured person. There are diverse types of life insurance depending on your specific needs, including term life insurance, permanent life insurance, accidental death insurance, and more.    


 

Why do I need life insurance? 


A death in the family is not only emotionally tragic; it can also take a tremendous toll on the future financial security of a family. Suddenly, paying the mortgage or providing for a child's college education may become much more difficult.  Those who decide to buy life insurance do so to help ensure their loved ones are taken care of financially. 
 

 

What if I already have insurance coverage?     
 

If you already have a life insurance policy, it's a clever idea to review it every few years to make sure it still meets your needs. Check to make sure all beneficiaries and other information are current. It might be time to speak a licensed agent if you: 

  • Were recently married or divorced.  

  • Have a child or grandchild who was recently born or adopted.  

  • Provide care or financial help to a child or parent. 

  • Need to help or long-term care for a loved one.  

  • Purchased a new home recently.  

  • Have children or grandchildren who are about to enter college.  

  • Refinanced your home mortgage in the past six months.  

  • Received an inheritance.  

  • Retired or your spouse has retired.  

  • Started a business. 

     

What are some basic life insurance terms I should know? 
 

 

Term Life Insurance:
 

Term Insurance is the simplest form of life insurance. It pays only if death occurs during the term of the policy, which is usually from one to 30 years. Most term policies have no other benefit provisions. There are two basic types of term life insurance policies: level term and decreasing term. 

  • Level term means that the death benefit stays the same throughout the policy. 

  • Decreasing term means that the death benefit drops, usually in one-year increments, over the policy’s term. 

     

Whole Life/Permanent Life Insurance
 

Whole life or permanent insurance pays a death benefit whenever you die—even if you live to 100! There are three major types of whole life or permanent life insurance—traditional whole life, universal life, and variable universal life, and there are variations within each type. 
 

In the case of traditional whole life, both the death benefit and the premium are designed to stay the same (level) throughout the life of the policy. The cost per $1,000 of benefit increases as the insured person ages, and it gets very high when the insured lives to 80 and beyond. The insurance company could charge a premium that increases each year, but that would make it very hard for most people to afford life insurance at advanced ages. So the company keeps the premium level by charging a premium that, in the early years, is higher than what’s needed to pay claims, investing that money, and then using it to supplement the level premium to help pay the cost of life insurance for older people. 
 

By law, when these “overpayments” reach a certain amount, they must be available to the policyholder as a cash value if he or she decides not to continue with the original plan. The cash value is an alternative, not an additional, benefit under the policy. 


 

What are the benefits of term life insurance? 

Term life insurance is life insurance coverage designed to be purchased for a specific time, typically between 10 and 30 years. Term life insurance is an affordable way to get maximum coverage throughout that time frame, and so is great for helping to cover specific financial responsibilities, such as paying for a mortgage or saving for college expenses.


 

How much life insurance do I need? 

Consider what your spouse and dependents would need to cover day-to-day bills and larger expenses, to live comfortably and to have financial stability. Don't forget to include savings for college and retirement. Also, consider the effect of inflation over time; the amount needed for college, say, twenty years from now is likely to be significantly higher than today. Speak with one of our licensed agents for a complete evaluation of your needs. 

To keep your premiums as low as possible and save money in the long run, buy it now. Premiums for the same coverage generally increase the older you become. And the longer you wait, the more you risk developing a health condition that could increase your premium further or make you uninsurable. 

If you want permanent life but you're on a budget, consider some term for now. You can save money initially by buying some term life in combination with permanent life. Then later, if your budget increases, consider converting the term policy to permanent life. 

Consider group life insurance offered through your employer. It may be available at a relatively low cost. But keep in mind that your group coverage may end or become more expensive when you leave your job or as you get older.  


 

How many years should I choose for my policy? 

It depends. The period you'll need coverage for should be the main factor. For example, if you have young children, you may want to consider 20 or 30 years of term life coverage to help your children for college or other future financial endeavors. On the other hand, if your children are out of college and supporting themselves, a shorter coverage period might suit your needs better. 


 

Can my health affect the price of my life insurance policy? 

 

It depends on the type of life insurance policy. Some plans offer Guaranteed Acceptance Whole Life Insurance, which is guaranteed acceptance-no medical questions or health exams. Depending on your health status, we will offer you a fair price for the risk that they take on when providing you with coverage (assuming you qualify for coverage). For example, there will be a difference in policies for someone who is a heavy smoker compared to the same person who has never smoked. 


 

Who can I contact to learn more about life insurance? 

Speak with one of our agents at (720) 744-0065. As an independent broker, it is our job to explore your needs and budget and find you the best available Life Insurance policy.

If you need help with selecting the right plan at the right price.

Source: Insurance Information Institute, Online at https://www.iii.org/ 



 

Other Life Insurance Terms


Policy owner :
 
The policy owner is the person who owns the life insurance policy. In many cases, the policy owner is also the person who is insured by the policy. However, the policy owner may also be a relative of the insured, a trust, partnership, or a corporation. 


 

Beneficiary : 

A beneficiary is a person(s) selected by the policy owner to receive the life insurance payments upon the death of the insured. 


 

Premium :
 
Premiums are the payments made to the insurance company to purchase and keep a policy active.  


 

Death benefit : 

A death benefit is an amount paid to the beneficiary at the time of the death of the insured.  


 

Face amount :
 
The face amount of the policy is the amount of the death benefit as stated in the policy. This does not include additional amounts that the policy may provide. 


 

Insured/insured life :
 
Insurability refers to how likely an applicant is to be offered coverage based on current health, medical background, family history, and other factors. 

 

 

Final Expense Insurance

Final Expense Insurance FAQ


 

What is Final Expense / Burial / Funeral Insurance?

Life insurance is a contract between an insurance policyholder (you) and an insurer where the insurer will pay a designated beneficiary a sum of money upon the death of the insured person. There are diverse types of life insurance depending on your specific needs, including term life insurance, permanent life insurance, accidental death insurance, and more.  

  
 

Who Needs Final Expense Insurance?
 

It depends on person to person. Both individuals with or without life insurance can benefit from Final Expense Insurance. If you are 40+ years old and don’t have any kind of life insurance, you probably consider final expense insurance.  Even if you have life insurance, you still run the risk of outliving your life insurance policy; in which case you should consider final expense insurance.  If your family has plenty of assets (money) to work with, you can self-insurance and don’t need final expense insurance.   

 

Can I Pre-pay for My Funeral?       
 

You certainly can, and some people do. This approach does have its advantages and disadvantages. When you pre-pay for your funeral, you get to personalize it. Plus, pre-paying will more likely prompt you to talk to your loved ones about your choices. This may give both parties more peace of mind.
 

States have varying guidelines on funeral pre-payment. These guidelines work to prevent you from paying unscrupulous folks who can take your money and run. It helps protect you or your family from overpaying on top of what you pre-pay. Before you pre-pay, check your state guidelines for how the money will be held until your death. 
 

Make sure you know what you’re paying for. Also, check whether you get to lock in the rate for your funeral. That way your family won’t be surprised by an up-charge later. When pre-planning or making any pre-payments, be sure to keep documentation. That way you and your loved ones will have records of what you want and what you did. 
 

The disadvantage of pre-payment is that it’s less flexible than burial insurance. If your funeral plans change or you move, you and your family may not get that money back. Even worse, the funeral parlor could go out of business and you may lose that money entirely. Final expense insurance provides your surviving relatives with a payout they can spend anywhere. You have less control, but your family has more flexibility. 

 

As an independent broker, it is our job to explore your needs and budget and find you the best available Final Expense plan. If you need help with selecting the right plan at the right price for you or your family, give us a call at (720) 744-0065.  

 

Mortgage Protection Insurance (MPI)

Buying a home is a major financial commitment. Depending on the loan you choose, you might commit yourself to 30 years of payments. But what will happen to your home if you suddenly die or become too disabled to work? Mortgage protection insurance (MPI) protects homeowners from health issues, disability, job loss, and death.

 

Health Savings Account (HSA)

A Health Savings Account (HSA) is a savings and investment account that can be used to reimburse eligible medical expenses, like doctor’s office visits, prescriptions, vision, and dental expenses. Unlike a simple savings account, the money is deposited tax-free or is tax-deductible if contributed after tax.
Those funds remain tax-free when used to pay or reimburse for eligible healthcare expenses.

 

Help for Low Income and Needy Individuals, Seniors, and Families

Federal Help

 

https://www.benefits.gov 

Benefit Finder Tool: https://www.benefits.gov/benefit-finder



Medical Help


Medicaid & CHIP online at https://www.medicaid.gov/ 
Medicare: https://www.medicare.gov/
Free / Low-Cost Medical Clinics. Online directory: https://www.freeclinics.com/ 
Local Senior Help Resources



Prescription Drug Help

Medicaid
Medicare
Medicine Assistance Tool
Rx Hope



Dental Help


Local Health Departments: The Bureau of Primary Health Care (1-888-Ask-
HRSA) supports federally funded community health centers across the country
that provide free or reduced-cost health services, including dental care. Find
your nearest location http://findahealthcenter.hrsa.gov/

 

Dental Schools: (American Dental Association) can be a reliable source of
quality, reduced-cost dental treatment. Most of these teaching facilities have
clinics that allow dental students to gain experience treating patients while
providing care at a reduced cost. Experienced, licensed dentists
closely supervise the students. Post-graduate and faculty clinics are also
available at most schools. Search for local dental programs here.  
 
American Dental Hygienists’ Association: may also offer supervised, low-cost
preventive dental care as part of the training experience for dental
hygienists.  

American Dental Hygienists’ Association 

444 North Michigan Avenue, Suite 3400 
Chicago, IL 60611 
General Phone: (312) 440-8900 
http://www.adha.org/ 

Clinical Trials: The National Institutes of Dental and Craniofacial Research
(NIDCR) sometimes seeks volunteers with specific dental, oral, and
craniofacial conditions to participate in research studies, also known as
“clinical trials”. Researchers may provide study participants with limited free
or low-cost dental treatment for the condition they are studying. 
Online at http://www.clinicaltrials.gov/ 
Clinical Center’s Patient Recruitment and Public Liaison Office at 1-800-411-
1222. 

United Way: The United Way may be able to direct you to free or reduced-cost
dental services in your community. Local United Way chapters can be located
on the United Way website. 
Online at http://www.unitedway.org/find-your-united-way/


 

Vision Care Help

Eye Exams & Surgeries:  
 

EyeCare America, a public service foundation of the American Academy of Ophthalmology (AAO). Provides comprehensive eye exams and care for up to one year, often at no out-of-pocket expense to eligible candidates age 65 or older. Its Glaucoma EyeCare Program provides a glaucoma eye exam. The EyeCare America Children’s EyeCare Program educates parents and primary care providers about the importance of early childhood (newborn through 36 months of age) eye care. Telephone: 1-877-887 6327. 

Website: https://www.aao.org/eyecare-america  

VISION USA, coordinated by the American Optometric Association (AOA), provides free eye-care to eligible uninsured, low-income workers and their families. 

Telephone: 1-800-766-4466. Website: https://www.aoa.org/ 

Lions Clubs International is a service organization whose local club member are all volunteers. A local Lions club in or near your community may sponsor a program that may help you buy corrective eyewear or obtain eye health care. https://www.lionsclubs.org/en/start-our-global-causes/vision 

Mission Cataract USA, is a program providing free cataract surgery to people of all ages who have no other means to pay. Surgeries are scheduled annually on one day. Website: http://missioncataractusa.org./ 

InfantSEE® is a public health program designed to ensure early detection of eye conditions in babies. Member optometrists provide a comprehensive eye and vision assessment for infants within the first year of life regardless of a family’s income or access to insurance coverage. Telephone: 1-888-396-3937. Website: https://infantsee.org/ 

Free Eye Glasses 

Sight for Students is a Vision Service Plan (VSP) program that provides free eye exams and glasses to low income and uninsured children 18 years and younger that qualified for the program. 
 

Telephone: 1-888-290-4964. Website: https://vspglobal.com/cms/vspglobal-outreach/giftcertificates-nationalpartner.html 

New Eyes for the Needy provides vouchers for the purchase of new prescription eyeglasses.  Website: https://new-eyes.org/  

Child Care:

The Child Care and Development Fund, online at https://www.benefits.gov/benefit/615 

Food Assistance:

The Supplemental Nutrition Assistance Program (SNAP). Online at :

https://www.benefits.gov/benefit/361 

https://www.fns.usda.gov/ 

Food Bank: 

Feeding America, online at https://www.feedingamerica.org/ 

Rental / Housing Assistance: 

Online at https://www.hud.gov/topics/rental_assistance 

Low Income Housing Directory, Online at https://www.lowincomehousing.us/ 

Help with Bills: 

https://www.usa.gov/help-with-bills 

Welfare / TANF: 

https://www.acf.hhs.gov/ofa 

211.Org 

Provides a comprehensive source of locally curated social services information.  

  • Health insurance & medical expenses 

  • Home Internet access 

  • Unemployment benefits 

  • Federal Family and Medical Leave Act (FMLA) 

  • Mortgage, rent, and utility payment assistance 

  • Supplemental Nutrition Assistance Program (SNAP)/Food Stamps 

  • Food Assistance 

  • Relief for "gig economy" workers and contractors 

  • Mental health and crisis 
     

Online at https://www.211.org/ 

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This website is operated by HealthCare Affairs and is NOT the Health Insurance Marketplace website. In offering this website, HealthCare Affairs is required to comply with all applicable federal laws, including the standards established under 45 CFR 155.220(c) and (d) and standards established under 45 CFR 155.260 to protect the privacy and security of personally identifiable information. HealthCareAffairs.Com is privately owned and operated by Trust Financial Corp. We are not a government website.