LTC Bullet:  LTC Almanac Update

Friday, January 9, 2015

Seattle—

LTC Comment:  We’ve updated the “Almanac of Long-Term Care” in The Zone.  More on the LTC Almanac and today’s update after the ***news.***

*** 2015 MEDICARE NUMBERS updated in The Zone.  We also reported the new Medicare numbers in this LTC Clipping on Tuesday:

1/6/2015, “Key Elder Law Numbers for 2015: Our Annual Roundup,” ElderLawAnswers

Quote:  “Medicare Premiums, Deductibles and Copayments for 2015

  • Part B premium: $104.90/month (unchanged)
  • Part B deductible: $147 (unchanged)
  • Part A deductible: $1,260 (was $1,216)
  • Co-payment for hospital stay days 61-90: $315/day (was $304)
  • Co-payment for hospital stay days 91 and beyond: $630/day (was $608)
  • Skilled nursing facility co-payment, days 21-100: $157.50/day (was $152)

LTC Comment:  This is a handy compilation of all the new key Medicaid and Medicare numbers for 2015.  We’ve archived this information in The Zone for Center members here.  For a reminder of your user name and password, contact damon@centerltc.com.  We previously highlighted the new Medicaid numbers so we cite and archive only the new Medicare numbers today. ***

*** BUT DID YOU KNOW THIS?  Long-time Center supporter Carroll Harper shared this tip:  “If you know any one of the Medicare Part A deductibles and co-pays, you can figure out the rest. For example, the SNF co-pay is always the Part A deductible divided by 8, or $1260/8 = $157.50.  The co-pay for days 61 – 90 is always ¼, or $1260 divided by 4 = $315.  And the co-pay for days 91 – 150 (a beneficiary’s one-time 60-day lifetime reserve) is ½, or $1260 divided by ½ = $630. ***

*** ILTCI EXHIBITOR INFORMATION published for the 15th Annual Intercompany LTCi Conference - March 22-25, 2015 - The Broadmoor Hotel - Colorado Springs, CO.  If you didn’t receive all the details directly from the organizers, then contact Jim Glickman at jim.glickman@lifecareassurance.com or 818-867-2223.  He says:  “The ILTCI is the national conference for the Long Term Care Insurance industry (with about 1000 attendees).  In addition to all of the normal Exhibit Hall perks, we will be offering a ‘Theater’ where each exhibitor can sign up without charge, to make a presentation on their ‘solution.’  If you are a new Exhibitor, we are offering a new Exhibitor discount of $250.” ***

 

LTC BULLET:  LTC ALMANAC UPDATE

LTC Comment:  Center members know and appreciate our "Almanac of Long-Term Care" in The Zone, our password-protected website. 

*** SPECIAL:  We are making access to The Zone, including the "Almanac of Long-Term Care," free for one week—today through Friday, January 16, 2015.  To access this introductory peek into The Zone, go to http://www.centerltc.com/members/index.htm and use the following case-sensitive user name and password:  UN:  IntrotoZone / PW:  FreeTrial.  Like what you see?  Then join the Center for Long-Term Care Reform here.  Or contact Damon at 206-283-7036 or damon@centerltc.com.  ***

The LTC Almanac is divided into 11 sections:

Aging Demographics 
International 
Unfunded Liabilities--Social Security, Medicare, and Budgets 
Long-Term Care 
Caregiving 
Long-Term Care Financing 
Long-Term Care Insurance 
Reverse Mortgages 
Long-Term Care Providers 
Medicaid
Medicaid Planning   

Each section is divided into sub-sections and under each sub-section we provide a list by date of the most important reports and articles published on the topic, usually with a few highlights and sometimes with analysis.

The Almanac of Long-Term Care is a great way to find statistics you need quickly or to get current on topics you need to know the latest information about.

The Zone and the LTC Almanac are for Center for Long-Term Care Reform members only, except during the current free trial offer.  Join the Center here:  http://www.centerltc.com/support/index.htm.  Call or email Damon at 206-283-7036 or damon@centerltc.com.  He can give you a user name and password to open up The Zone even before your annual dues payment arrives.  Individual annual memberships are $150.  Premium memberships with access to our “Clipping Service” start at $250.  Premium Elite and “Regional Representative” membership (if you qualify professionally) are $500.  Corporate memberships with many extra benefits start at $1,000.  See our "Membership Levels and Benefits" schedule here.

Caveat:  With time, some hyperlinks go bad.  In a huge document like the "LTC Almanac," we can't keep all the links current all the time.  If you find a bad link, but want to get to the material, contact us.  We often have an electronic copy of the document and we can usually find a current live link.  We'll also fix the link in the LTC Almanac so it will be current again for others.

Suggestion:  Read through the following update to stay current on new resource materials.  Then browse the full LTC Almanac at your leisure.  When you need a quick fact or the latest research on a particular topic, you'll know right where to go.  Enjoy.

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Chapter 3:  Unfunded Liabilities--Social Security, Medicare, Pensions and Budgets

National Health Expenditures

Health Affairs on 2013 NHE 1214 URL:  http://content.healthaffairs.org/lookup/doi/10.1377/hlthaff.2014.1107

“Spending Remains at 17.4 Percent of Gross Domestic Product, Unchanged since 2009 

Bethesda, MD--A new analysis from the Office of the Actuary at the Centers for Medicare and Medicaid Services (CMS) estimates that in 2013 health care spending in the United States grew at a rate of 3.6 percent in 2013 to $2.9 trillion, or $9,255 per person. The increase was slower than the 4.1 percent growth in 2012 and continued a pattern of low growth that has held relatively steady at between 3.6 percent and 4.1 percent annual growth for five consecutive years.” 

 

Health Affairs on Estimated Health Costs through 2023 URL:  http://content.healthaffairs.org/content/early/2014/08/27/hlthaff.2014.0560.full

“National Health Expenditure Projections, 2013-23: Faster Growth Expected With Expanded Coverage And Improving Economy”

“ABSTRACT:   In 2013 health spending growth is expected to have remained slow, at 3.6 percent, as a result of the sluggish economic recovery, the effects of sequestration, and continued increases in private health insurance cost-sharing requirements. The combined effects of the Affordable Care Act’s coverage expansions, faster economic growth, and population aging are expected to fuel health spending growth this year and thereafter (5.6 percent in 2014 and 6.0 percent per year for 2015–23). However, the average rate of increase through 2023 is projected to be slower than the 7.2 percent average growth experienced during 1990– 2008. Because health spending is projected to grow 1.1 percentage points faster than the average economic growth during 2013–23, the health share of the gross domestic product is expected to rise from 17.2 percent in 2012 to 19.3 percent in 2023.”  (p. 1)

For analysis, see:  LTC Bullet:  CMS Health Expenditure Data Mask LTC Cost Growth, September 5, 2014

 

Unfunded Liability Estimates

Medicare Trustees Report 2014 URL

2014 Annual Report Of The Boards Of Trustees Of The Federal Hospital Insurance And Federal Supplementary Medical Insurance Trust Funds

For analysis, see LTC Bullet:  Entitlement Double Talk, 8/1/14

 

Chapter 5:  Caregiving

General

DHHS on Informal Caregiving URL 0414:  http://aspe.hhs.gov/daltcp/reports/2014/NHATS-IC.cfm

“Informal Caregiving for Older Americans: An Analysis of the 2011 National Health and Aging Trends Study,” April 2014; Brenda C. Spillman, Ph.D., Urban Institute; Jennifer Wolff, Ph.D., Johns Hopkins Bloomberg School of Public Health; Vicki A. Freedman, Ph.D., University of Michigan; Judith D. Kasper, Ph.D., Johns Hopkins Bloomberg School of Public Health

AbstractThis report examines the role and experiences of informal caregivers for the older population, using a new resource, the National Survey of Caregiving (NSOC). The NSOC is unique in interviewing all informal caregivers for a nationally representative sample of persons age 65 or older receiving assistance with daily activities. NSOC respondents report on types of assistance they provide beyond traditional household (IADL) and self-care or mobility (ADL) tasks. These tasks range from assisting with transportation to help with health or medical care, including such things as injections or ostomy care. Thus, estimates capture the full range of supports informal caregivers provide and contributions they make in areas other than explicit long-term care. Information collected about positive and negative aspects of caregiving, health, and indicators of subjective well-being allows examination of how gains and burdens differ by caregiver and care recipient characteristics and by the intensity of care provided.

 

Chapter 6:  Long-Term Care Financing

General

Center for American Progress on Long-Term-Care 103114 URL

For press release

LTC Clipping 10/31/2014:  “RELEASE: CAP Issue Brief Calls for Tax Credits for Long-Term Care Insurance; Expanding Service-Corps Programs to Aid in Providing Long-Term Care,” by Center for American Progress

Quote:  “In a new issue brief, the Center for American Progress recommends two reforms to help make long-term care more affordable and allow more individuals to live independently in their homes for longer periods of time.

LTC Comment:  This unusual call for LTCI tax credits from a progressive think tank is welcome, but the report fails to recommend restrictions on easy and elastic Medicaid LTC eligibility rules without which positive incentives for LTC planning will have little effect.

 

Who Will Pay for LTC? (includes "Not the VA")

ACLI on LTC URL

http://insurancenewsnet.com

LTC Clipping:  12/9/2014, “For Long-Term Care's Future, 2 Dates Loom,” by Cyril Tuohy, InsuranceNewsNet

Quote:  “American Council of Life Insurers vice president and chief economist Andrew Melnyk wants people to keep two years — 2030 and 2050 — in mind.  The year 2030 is when the youngest baby boomers turn 65 and the oldest baby boomers turn 85, and the year 2050 is when the youngest baby boomers turn 85.  Like a submarine in slow descent with water pressure building slowly on its hull, so too are the 76 million baby boomers exerting a ‘slow intensification’ on long-term care needs as they retire, Melnyk said.  …  Melnyk and associate Harsh Sharma have issued a white paper titled ‘Who Will Pay For Our Long-Term Care?’

LTC Comment:  You can find a .pdf of the full report here

 

State Budgets and Reports

NCPA on LTC in Wisconsin URL:  http://www.ncpa.org/pub/st361

11/19/2014, “Improving Long-Term Care in Wisconsin,” by  Pamela Villarreal, National Center for Policy Analysis

Quote:  “At the federal level, allow states to establish their own home equity limits, or none at all, for Medicaid eligibility.  …  Allow Medicaid to require and support reverse mortgages as an alternative to asset recovery. …  Phase out the public/private partnership, and replace it with a state income tax credit for the purchase of long-term care insurance.  …  Use home care in place of institutional care when possible.”

LTC Comment:  We agree with three of this report’s recommendations:  letting state Medicaid programs set their own home equity limits, requiring reverse mortgages as a condition of eligibility, and providing more home care assuming the first two recommendations are actually implemented so that home care doesn’t drive up Medicaid’s cost and make Medicaid dependency more attractive than ever.  Cancelling the LTC Partnership program, however, would be a mistake.  Read the full study here.

 

Chapter 7:  Long-term Care Insurance

General and Data

Benefits of LTCI by Lifeplans 1114 URL:  http://www.ahip.org/Epub/The-Benefits-of-LTC/

LTC Clipping:  11/13/2014, “New Report: Long-Term Care Insurance Offers Critical Financial Stability, Security for Consumers,” InsuranceNewsNet.com

Quote:  “With more Americans planning for retirement and future medical expenses, a new report (http://www.ahip.org/Epub/The-Benefits-of-LTC/) released by America's Health Insurance Plans (AHIP) finds that long-term care insurance offers critical protection and needed flexibility for millions of families managing the significant costs associated with long-term care. The latest analysis prepared by LifePlans finds that long-term care insurance provides a more cost-effective way to pay for health care expenses later in life, such as nursing homes, assisted living, or in-home care, rather than relying on personal savings or depleting assets in order to qualify for Medicaid.

LTC Comment:  Hard evidence of the real and substantial benefits of private long-term care insurance.  Use it to counteract adverse opinions in the media that poison public opinion.

 

SOA on LTCI Pricing 0714 URL:  https://www.soa.org/research/research-projects/ltc/research-2014-understanding-volatility.aspx

Understanding the Volatility of Experience and Pricing Assumptions in Long-Term Care Insurance

“The Society of Actuaries is pleased to make available two reports aimed at advancing knowledge in Long-Term Care pricing. The first report, authored by Actuarial Resources Corporation of Kansas, illustrates how the risks of Long-Term Care Insurance can be understood through modeling the liabilities using a Monte Carlo simulation approach.  The second report, authored by PricewaterhouseCoopers, is forthcoming. The reports can be accessed by clicking the links to the right [at the link above].”

 

Chapter 9:  Long-Term Care Providers

Medicaid Reimbursement

GAO on Provider Taxes 0714 URL:  http://www.gao.gov/products/GAO-14-627

See LTC Clipping:  July 30, 2014:  U.S. GAO - Medicaid Financing: States' Increased Reliance on Funds from Health Care Providers and Local Governments Warrants Improved CMS Data Collection:  http://www.gao.gov/products/GAO-14-627

Quote:  “GAO found, based on a questionnaire sent to state Medicaid agencies, that states financed 26 percent, or over $46 billion, of the nonfederal share of Medicaid expenditures with funds from health care providers and local governments in state fiscal year 2012. State funds were most of the remaining nonfederal share. . . .  For example, in Illinois, a $220 million payment increase for nursing facilities funded by a tax on nursing facilities resulted in an estimated $110 million increase in federal matching funds and no increase in state general funds, and a net payment increase to the facilities, after paying the taxes, of $105 million.”

LTC Comment:  Instead of taxing their citizens to raise funds for Medicaid, states tax providers like nursing homes, leverage up federal Medicaid matching funds, and kick back some of the “profits” to the providers.  It’s “Medicaid planning” on a grander scale and results in much higher costs for federal taxpayers.  It also tips the balance away from private LTC financing toward more Medicaid dependency.

 

Chapter 10:  Medicaid

Medicaid Financing

KFF on Medicaid LTC 080114 URL:  http://kff.org/medicaid/report/medicaid-and-long-term-services-and-supports-a-primer/

LTC Clipping August 1, 2014:  Medicaid and Long-Term Services and Supports: A Primer, The Henry J. Kaiser Family Foundation

http://kff.org/medicaid/report/medicaid-and-long-term-services-and-supports-a-primer/

Quote:  “With limited coverage under Medicare and few affordable options in the private insurance market, Medicaid will continue to be the primary payer for a range of institutional and community-based LTSS for persons needing assistance with daily self-care tasks.”

LTC Comment:  As usual, this report from Kaiser pooh-poohs the potential of private long-term care insurance.  But have a look at its Figure 3, a pie chart showing the sources of LTC financing.  Medicaid is 40% and other public sources are 38% leaving only 22% for private financing of which 7% is LTC insurance.  In other words, only 15% of LTC spending in the USA is “out-of-pocket.”  Can anyone really believe the share covered by private LTCI would be only 7% if it weren’t for the vast mostly un-means-tested (Medicare) or ineffectually means-tested (Medicaid) federal expenditures that have crowded out the market for LTCI?  If we were to target publicly financed LTC to the genuinely needy, most Americans would either purchase LTCI or they’d fund their LTC with savings or home equity, an outcome which would cause the next generation to plan more responsibly for LTC risk and cost.

 

Medicaid Actuarial Report 2013 URL:  http://www.cms.gov/Research-Statistics-Data-and-Systems/Research/ActuarialStudies/MedicaidReport.html

Christopher J. Truffer, et al., “Report to Congress:  2013 Actuarial Report on the Financial Outlook for Medicaid,” Office of the Actuary, Centers for Medicare & Medicaid Services, United States Department of Health & Human Services, Kathleen Sebelius, Secretary of Health and Human Services, 2013; http://www.cms.gov/Research-Statistics-Data-and-Systems/Research/ActuarialStudies/MedicaidReport.html.

“This is the fifth annual Medicaid report from the Office of the Actuary (OACT) at CMS. The purpose of this report is to describe the past and projected trends for Medicaid expenditures and enrollment, including estimates for Federal fiscal years (FYs) 2012 and 2013 and projections over the next 10 years.”  (p. 1)

For analysis, see LTC Bullet:  Does Medicaid Solvency Matter?, October 31, 2014

 

Medicaid Crowd-Out

Boston College on spend down URL:  http://crr.bc.edu/wp-content/uploads/2014/11/IB_14-18.pdf

“Long-Term Care: How Big A Risk?, By Leora Friedberg, Wenliang Hou, Wei Sun, and Anthony Webb, November 2014, Number 14-18, Center for Retirement Research, Boston College

For analysis, see LTC Bullet:  How Careless Economists Boosted LTC Risk, December 12, 2014

LTC Clipping:  11/14/2014, “'Spending down' for Medicaid is the most practical LTC financing plan for most Americans, researchers assert,” by Tim Mullaney, McKnight's LTC News

Quote:  “The upshot is that the 100-day Medicare benefit would cover many of these stays. Therefore, most ‘rational, far-sighted, well-informed’ single people would be smart to avoid paying LTC insurance premiums; if faced with a worst-case scenario, they could spend down their assets until they qualify for Medicaid, the study authors stated.”

LTC Comment:  We referenced and debunked this same Boston College report in an earlier clipping.  Ignoring Medicaid’s quality, access, financing and institutional bias problems is the height of scholarly irresponsibility.  With new political winds blowing we’ll have the chance again in coming years to combat this nonsense with hard facts and logic before state and federal legislative bodies as we have done successfully in the past.

 

Dual Eligibles

GAO on Dual Eligibles Cost-Effectiveness URL:  http://www.gao.gov/products/GAO-14-523

“Disabled Dual-Eligible Beneficiaries:  Integration of Medicare and Medicaid Benefits May Not Lead to Expected Medicare Savings,” GAO-14-523:  Published: Aug 29, 2014. Publicly Released: Sep 29, 2014.

“What GAO Found:  Overall spending for high-expenditure disabled dual-eligible beneficiaries—those in the top 20 percent of spending in their respective states—was driven largely by Medicaid spending, and the service use and health status often differed widely between those with high Medicare expenditures and high Medicaid expenditures. For these beneficiaries, Medicaid expenditures accounted for nearly two-thirds of overall spending. Also, states with high Medicaid spending often had lower Medicare spending but nearly always had greater overall spending for these beneficiaries. Furthermore, service use and health status often differed widely between high-Medicare-expenditure and high-Medicaid-expenditure disabled dual-eligible beneficiaries. Those with high Medicare expenditures were considerably more likely than those with high Medicaid expenditures to have multiple health conditions and use inpatient services but far less likely to use long-term services and supports.”