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Long-Term Care Alternatives and Solutions: Questions & Answers

Chapter 17  Previous Top Next
The California Partnership for Long-Term Care

1. What is the California Partnership Plan?
A. The California Partnership Plan is an innovative partnership developed between the state and private insurance companies to provide middle-income wage earners with private to help them preserve their assets and to receive a wider range of care that Medi-Cal will allow.

2. Is the California Partnership Plan exclusive to California residents?
A. The plan is available to any citizen or legal resident of California. You must live in California at the time you purchase the policy. To claim the asset protection and to file for Medi-Cal you must reside in California.

3. Are there other states with similar plans?
A. The Deficit Reduction Act allows for the expansion of the public/private LTC partnership product beyond California and the other states (Connecticut, Indiana, New York). Those States planning to participate must file a “Medicaid plan amendment that authorizes the state to adopt “qualified state LTC partnerships.”

4. Are there non-government sponsored programs that assist with long-term care and medical expenses?
A. The Office of Personnel Management (OPM) for the long-term care insurance offering chose Metropolitan Life Insurance Company and John Hancock Life Insurance Company to form a jointly owned entity called LTC Partners, LLC, to operate this new program. Health Insurance Savings Account is an account that you can put money into to save for future medical expenses.

5. How does the federal tax code affect tax treatment of premiums and benefits for self-employed individuals and business owners?
A. Regarding premiums, self-employed individuals including sole proprietors, partners, and more than 2% shareholders of an S-corporation can generally deduct a percentage of eligible premiums paid for qualified LTC plans as a health insurance cost. The eligible premium is subject to the same age-based limits as apply to individuals generally and the eligible percentage has increased over time.
Benefits, for federal tax purposes, paid to self-employed individuals are treated the same as described for individual taxpayers.
C-Corporations can generally deduct as a reasonable business expense all qualified LTC premiums paid for employees and retirees, their spouses and dependents. In addition, an employer’s contributions toward the cost of premium are not included as imputed income for the individual. Benefits paid to employees of a C-Corporation are treated the same as described for individual taxpayers.
Contributory Plans, regarding premiums in the cases where the employer and the employees share the cost of premiums, the company may generally deduct all premiums it contributes for qualified LTC plans as a business expenses. Premiums paid for spouses and dependents of employees and retirees are treated similarly. For federal tax purposes, benefits paid to employees in a contributory arrangement are treated the same as described for individual taxpayers. Benefit payments received under a reimbursement contract have no tax-free cap but are required to coordinate with Medicare.
Limited Liability Companies/Partnerships/S-Corporations, Regarding premiums, premiums paid by a partnership (including a LLC taxed as a partnership) or S-Corporation for non-owners (including shareholders owning 2% or less of the stock) are treated the same as premiums paid by C-Corporations for their employees. The business may generally deduct as a business expense all premiums paid for qualified LTC plans covering employees, retirees, their spouses and their dependents. Benefits paid to all employees of a LLC, Partnership or S-Corporation and also partners, members and employees owning more than 2% of the S-Corporation stock are treated the same as described for individual taxpayers.

6. What are the constructs of the California Partnership for Long-Term Care?
A. The California Partnership for Long-Term Care is a plan designed by the state of California, private insurers and consumers.

7. What are the objectives of this partnership?
A. The California Partnership for Long-Term Care has the following goals:
• To educate consumers on the risks and costs of long-term care.
• To provide high-quality coverage.
• To protect the assets of Californians when they need to pay for long-term care.

8. Who is the primary provider of the insurance policies under The California Partnership for Long-Term Care.?
A. Policies sold for The California Partnership for Long-Term Care are sold by private insurance companies.

9. Are these policies available to a limited few?
A. The policies are available to any citizen or legal resident of California, although they are primarily designed for individuals whose net worth is less than $600,000.

10. What are the details of the “asset protection” feature of these policies?
A. The “asset protection” feature of these policies dictates that you must live in California at the time you purchase the policy. To claim the asset protection, and to file for Medi-Cal, you must reside in California. If you leave California, your policy protection will continue in force to the limits of your policy, no matter where you choose to live. The “asset protection” feature helps people to retain or protect more of their assets if they incur long-term care costs.

11. Can you offer an example of how asset protection protects my assets, while allowing legal application for Medi-Cal?
A. Each dollar your Partnership policy pays in benefits will protect one dollar of your assets. For example: if you have $50,000 in assets and purchased a long-term care Partnership policy covering that amount, the policy would pay for your long-term care needs up to the policy limits of $50,000. If you continue to require long-term care after your benefits are exhausted, you may apply for Medi-Cal and keep the entire $50,000 you have in assets, instead of the $2,000(for single persons) that would otherwise apply.

12. Are there other features of significance regarding the policies offered through this Partnership?
A. These policies have several other important features:
• Inflation protection (5% simple or compound for purchasers over 70). This will help benefits keep up with some of the rise in cost of care.
• The premium is waived from the first day you receive care in a nursing home or assisted-living facility.
• Care in a residential care facility is covered.
• Premium increases are limited.
• Each policy has standardized terms and a core set of benefits that make it easier to compare policies form different companies.

13. Is the Partnership policy available from any insurance company and/or all insurance companies?
A. No. Insurance companies participating in the California Partnership Plan must have their policies approved by both the Department of Insurance and the California Department of Health Services.

14. Are there specific California Partnership policies?
A. There are two kinds of California Partnership approved policies:
Facility only, which covers care in a nursing home or residential care facility.
Comprehensive, which covers a full range of benefits for home and community services, such as home health care, personal care, homemaker services, adult day care, hospice and respite care and care in a skilled nursing or residential facility is also provided.

15. Do Partnership policies contain insurance protection against inflation?
A. Both kinds of policies have built-in inflation protection, which means your asset protection increases each year you keep the policy at 5% compounded.

16. Are California Partnership Long-Term Care Plans available to groups or employers?
A. No. They are primarily designed for individuals whose net worth is less than $600,000.

17. Are there similar Long-Term Care Insurance Plans that are state sponsored and/or supported for employees?
A. Yes. There is the California Public Employer Retirement Systems (CalPERS).

18. Is every California employed person eligible for CalPERS long-term care program?
A. This program is available for purchase for all public employees and retirees, including all city, county and state employees; schoolteachers, legislators, judges and University of California employees. Employees may also enroll their spouses, parents and parents-in-law.

19. Do the insurance companies have their policies approved by both the Department of Insurance and the California Department of Health Services?
A. The CalPERS program is a self-funded program and not an insurance company program.

20. How is funding obtained for the program?
A. The funding for benefits comes from premiums members pay directly into the program. The premiums are invested at the direction of the CalPERS Board of Administration by an insurance administrator who manages the funds for CalPERS.

21. Is the program comparable to other programs?
A. Because CalPERS is self-funded and not-for-profit their plans tend to be less costly than comparable commercial policies.

22. What are the specific plans offered by CalPERS?
A. CalPERS offer three types of plans:
• Nursing home/assisted-living facility only.
• Comprehensive coverage for both facility care and home care.
• California Partnership Plan: Covers both residential and home care and offers a “spend-down” protection feature.

23. There are two benefit options offered within the Partnership Plan, what is/are the benefit/s and/or objective of each plan?
A. In 2001, CalPERS employees and their eligible family members could choose a total Partnership benefit amount of $47,450 or $94,900. The $47,450 plan was designed to help pay for at least one year of nursing home care at up to $130 per day, or two years of home or assisted-living facility care at $1,950 per month. The $94,900 plan will help cover at least two years of nursing home care, or four years of care at home or in an assisted-living facility. Purchasers can protect $300,000 of assets or more.

24. Does the Partnership Plan protect my assets and income from Medi-Cal?
A. No. The Partnership Plan only protects assets, not income. When you receive Medi-Cal services you must still apply a portion of your income to the cost of your care if you have more income than the Medi-Cal limits allow.

25. What are the eligibility for benefits requirements for Partnership policies?
A. With Partnership policies you may receive insurance benefits from your California Partnership policy if you are unable to perform two of the six activities of daily living (ADLs), which include: bathing, dressing, toileting, transferring, continence and eating; or if you have a cognitive impairment or a complex yet stable medical condition.

26. Does CalPERS provide an information and/or resource center for further information?
A. Yes. You can contact the CalPERS Customer Contact Center at 1-888-225-CalPERS (1-888-225-7377).

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