Aetna Long Term Care Insurance

In order to decide which Aetna long term care insurance plan to choose, you need to understand the options available from the three core plans. Having studied the plans, you will be able to decide which one works best for you. The three plans are the disability plan fixed dollar model, service plan reimbursement model option 1 and service plan reimbursement model option 2. The plans work on the basis of a benefit trigger. These benefits are triggered by Activities of Daily Living or ADLs aids that are eating, toileting, bathing, dressing, continence, transferring and severe cognitive impairment.

Disability plan fixed dollar model
For this plan, the benefit trigger will be accessed if you need assistance for a minimum of three of the ADLs, as well as severe cognitive impairment, such as Alzheimer’s disease. Then you decide on the amount of Daily Benefit Amount (DBA) you need. You will be able to work this out by deciding how much you would want to receive and for how long. This will tell you how much you would need to have in your DBA fund. So, for example, if you planned to have a DBA of $100 for 5 years, your benefits pool should be worth $182,500. With the disability plan, the DBA can be between $50 and $250 per day.

Assisted care facilities
The disability plan fixed dollar plan provides nursing home and hospice facility care payments too. In the case of this plan, 100% of the DBA will be covered. For assisted living facility care, 50% of the DBA will be paid in cash. If you need access to community facilities and services, the disability plan can assist too. For example, there are services such as home health care, adult day center care, homemaker services as well as home health care. In the case of this plan, 50% of the DBA will be paid in cash. There is no spousal premium discount available for this plan.

Costs and discounts
Sample monthly payments are available based on your age at the time you start contributing into the benefits pool. For example, if you contribute into the $100 DBA and you start at the age of 30, your premium will be approximately $5.50 per month; starting at age 40, the monthly premium would be $14.10; at age 50, the monthly premium would be $33.30; and at age 60, the monthly premium would be $71.20. There are certain provider’s discounts available across all three plans. These discounts can vary between 10% to 30% for some nursing facilities and home health care services.

Service plan reimbursement model option 1 and 2
This plan has a benefit trigger of three out of six ADLs, or a severe cognitive impairment such as Alzheimer’s disease. The DBA can be between $50 and $350 and can last for 5 years. Expenses for nursing care and hospice facilities are fully covered. These include submitted expenses, and benefits will be received up to the correct benefit level of the DBA. Assisted living facility care will be covered up to 100% on the submission of expense claims, and benefits will be paid. For community based services, up to 50% of the DBAs will be reimbursed. In addition, a 10% spousal premium discount is available for employees and spouses. Monthly premiums range from $5.70 for someone aged 30, to $50.90 for those aged 60.

The service plan model option 2 is very similar to service plan option 1 except that 100% of DBA will be paid for community based services and the monthly premiums range from $8.40 for those aged 30, to $69.90 for those aged 60 years.

General rules apply to all plans
Restoration of benefits is possible should you recover from a qualifying loss. Therefore, you are able to resume making your monthly payments. Once you return to repaying your monthly contribution, total lifetime maximum benefits will be re-applied. Furthermore, your coverage goes along with you. This means that there is no problem if you change jobs or move across the country. As long as you continue to pay the same monthly contribution, your policy will not be altered. Choosing the right plan is quite straightforward; first of all, you choose the plan that suits you from the three available, then you decide which level of community based service benefit you require (50% to 100%), and lastly you choose the daily benefit amount you want to receive.

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