Study Examines Long Term Home Health Care Utilization

December 1, 2009 - Some 7.5 million Americans currently receive long-term care at home because of an acute illness, long-term health condition, a permanent disability, or terminal illness according to a new report.

That compares to only 1.5 million in nursing homes and 1.1 million who reside in assisted-living communities according to the American Association for Long-Term Care Insurance which teamed up with Homewatch CareGivers to conduct a study examining trends in long-term health care and the utilization of associated support services.

"Most people incorrectly associate long-term health care with skilled nursing care in a facility when the vast majority of care takes place at home," explains Jesse Slome, Executive Director of the American Association for Long-Term Care Insurance. “It is clear that the people in today’s society prefer treatment for chronic conditions and issues related to aging in their own home rather than in a residential facility.”

One aspect of the study sought to compare individuals with long-term care insurance policies with those without insurance coverage. The findings indicated that individuals with long-term care insurance receive significantly more home care, and thus can stay in their homes longer. The study found that 70.6% of those covered by long-term care insurance received an average of between five and seven days of care each week, while only 35.1% of those without insurance received similar care as often.

"When possible, home is almost always the preferred setting for people who require care," says Leann Reynolds, president of Homewatch CareGivers. “This has been a clear and growing trend for more than a decade, as more and better home services have become available. The vast majority of people want to receive support care in their homes in order to maintain independence and quality of life for as long as possible.”

Possessing insurance to pay part or all of the cost of home care services enabled individuals to receive care at home for longer periods of time. The study found that 41.2% of those with insurance received care for longer than one year; compared to 29.7% of those without coverage.

"The study confirms what we've long suspected, that a basic long-term care insurance plan costing less than $1,000 a year may provide sufficient coverage for those who want care at home and still have the ability to transition to more costly skilled facilities should the need arise," adds Slome.

According to the Urban Institute, a nonprofit founded in 1968 that conducts research on social and economic issues to foster sound public policy, 21.3 percent of the frail older population receives paid home care services and it projects this will increase to 22.3 percent by 2030 and 25.5% by 2040.

"It is vitally important for individuals to recognize the increased likelihood of needing care at some point in their lives, and to plan for that inevitability," concludes Reynolds. “Having sufficient financial resources or the protection of long-term care insurance are the prime factors for all of us who want to stay in our homes and receive care for as long as possible.”

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Founded in 1980, Homewatch CareGivers http://www.homewatchcaregivers.com/ is the largest, most experienced international provider of full-service home care for people of all ages, including seniors, children, veterans, the chronically ill, and those recovering from medical procedures. In-home care services are personalized for each client and customized care plans are administered through an international network of 111 owners with 181 territories. Founded in 1998, the American Association for Long-Term Care Insurance http://www.aaltci.org is the national trade organization established to educate Americans about the importance of long-term care planning. For more information visit the organization's Consumer Information Center or to access a free guide to reducing the cost of long-term care insurance click on this link: www.aaltci.org/free-guide/ .

What Do Consumers Pay For Long-Term Care Insurance

The Partnership program provides enormous benefit for consumers. It also provides significant benefit to insurance professionals.

One of the most important benefits is the gathering of relevant information. The following is preliminary information gathered from the Partnership States. While the numbers may change, it sheds an important light on the subject of what people pay for long-term care insurance protection. It clearly shows that the majority of consumers are spending far less for long-term care insurance protection than what's reported in the consumer media.

The following data is based on over 70,000 individuals (under age 61) purchasing Partnership long-term care insurance policies between January 1, 2009 and June 30, 2009.

Premium Amount Percentage
Less than $500 18.1%
$500 - $999 33.2%
$1,000 - $1,499 11.1%
$1,500 - $1,999 10.2%
$2,000 - $2,499 7.6%
$2,500 - $2,999 6.0%
$3,000 - $3,499 4.7%
$3,500 - $3,999 3.3%
$4,000 and Over 5.3%

Why are these numbers so important?

Because, here is the number a highly respected organization reports to the media: "The average individual buyer in the first three months of 2009 is paying $2,129 during the first year of coverage." (June 8, 2009)

If consumers perceive $2,129 is the cost (that's $4,258 for a couple) they are going to believe that long-term care insurance is EXPENSIVE. And, they are not going to buy.

BUT 72.6% PAID LESS THAN $2,000. And more than half paid LESS THAN $1,000.

It is very hard to overcome perceptions. Let's hope facts will help. Certainly the American Association for Long-Term Care Insurance and our members are doing all they can to properly educate consumers and other professionals.

Jesse Slome
Executive Director
American Association for Long-Term Care Insurance

Leaders From 18 Long Term Care Partnership States To Attend LTC Agent Summit

Executives from 18 states offering long term care Partnership plans will attend the National LTCi Producers Summit. The Summit takes place November 14-16, 2009 at the Westin Hotel in Kansas City and brings together hundreds of producers who market long-term care insurance products.

This year's Summit will combine two conferences - the producer sales and marketing conference organized by the American Association for Long-Term Care Insurance and the conference for state officials organized by the Center For Healthcare Strategies (CHCS).

Over 18 states will be represented each sending three or four executives from the State Medicaid office, the Department of Insurance, the Agency on Aging and State Dept. of Commerce. Summit attendees will have the opportunity to attend special Partnership workshops in addition to the extensive Summit program.

States Sending Executives Include
Arkansas
Colorado
Georgia
Idaho
Illinois
Maryland
Michigan
Minnesota
Missouri
New Jersey
Ohio
Oklahoma
Oregon
Pennsylvania
Wisconsin
South Dakota
Texas
Virginia

Summit registration is $275 ($324 for non-Association members) through September 30th.

Registration includes sessions, meals and receptions. Hotel discounts are currently available.
Complete information and registration forms are available online at http://www.aaltci.org/2009summit or by calling the American Association for Long-Term Care Insurance at (818) 597-3227.

Five Questions to Ask Before Hiring a Home Care Provider

When it comes to needing long-term care, the majority of Americans today receive care in their own home. "People mistakenly associate long-term care with nursing home care," explains Jesse Slome, Executive Director of the American Association for Long-Term Care Insurance.

"Today most long-term care takes place outside of a skilled care facility and the vast majority of long-term care insurance claims are not nursing home related."According to studies conducted by the industry trade group, some 42 percent of long-term care insurance benefits paid are for care at home (AALTCI's 2009 Long-Term Care Insurance Sourcebook). "Another 28 percent was for care in assisted living communities and only 30 percent was for care in skilled nursing facilities," Slome notes."

Home care services cover a wide range of needs, from memory care and companionship to meal preparation and medication reminders," says Jennifer Tucker, Vice President with Homewatch CareGivers, a national provider of homecare services. "They may also include help with the activities of daily living, including home care services like bathing, dressing, and grooming or care coordination services rendered by a registered nurse."

When selecting a home care agency, it is important to know what questions to ask. Here are five important questions that consumers should ask of a prospective service provider:

How long has the agency been providing private duty home care?

Is a written, customized care plan developed in consultation with the client and family members, and is the plan updated as changes occur?

How are emergencies handled after normal business hours?

Do they closely supervise the quality of care, including maintenance of a daily journal in the client’s home and non-scheduled supervisory visits?

Does the agency employ a nurse, social worker, or other qualified professional to make regular visits to the client’s home?

"A great way to find quality home care providers is to speak to a knowledgeable long-term care insurance professional," states Jesse Slome. "If they've been in the business for a few years, they likely have clients who are receiving care."

For additional information on home care for long-term care needs or to find local long-term care insurance professionals, visit the online Consumer Information Center from the American Association for Long-Term Care Insurance and request information from any of the organization's 3,500 members nationwide.

Federal Long-Term Care Insurance Plan Is Short-Term Thinking

The new long-term care insurance proposal that Democrats have included in a Senate health overhaul bill would produce about $58 billion in revenue for the government over the next 10 years, according to the Congressional Budget Office (CBO).

The $58 billion could be used to offset the cost of the national healthcare program. "Legislators must be salivating at a potential source of income with absolutely no potential for expenses for years to come," explains Jesse Slome, executive director, of the American Association for Long-Term Care Insurance, the industry professional trade organization.

Monthly premiums paid by individuals would account for the $58 billion. Premiums would vary by age but are expected to average about $65 per month ($780 a year). Under the proposed program, no one would be eligible for benefits until they have paid premiums for five years - a reason the CBO estimates the program would net revenue for the government for its first 10 years." The CBO generally does not estimate the cost of programs beyond 10 years, the period covered by procedural "pay-as-you-go" rules requiring legislation to be budget-neutral.

"When has a government entitlement program accurately estimated income and projected expenses," Slome queries. "The CBO already estimates that premiums will be insufficient and will likely need to be increased to maintain the program's solvency. The government already runs a disability insurance program through the Social Security Administration, but it is very difficult to qualify for that program and there is a backlog of people who have appealed Social Security's initial decline of their benefits."

According to the Association some 8.25 million Americans have already purchased long-term care insurance on an individual basis or through their employer. "Some 400,000 new policies are now sold each year," as more people understand the need to plan for the risk of needing care. Millions of others will be able to use the built-up value of their homes through a reverse mortgage.

"Another underfunded entitlement program where the real cost won't be known for 10 or more years simply shifts the financial obligation to the next generation," Slome says. "That's long-term care planning of the worst kind."

Long-Term Care Insurance Association Study Looks At Buyers of Life Insurance Plus LTC Benefits

Los Angeles, CA - June 23, 2009 -- Nearly half of individuals purchasing asset-based long-term care protection in 2008 were under age 65 according to the first national study of buyers. Two thirds (66%) of purchasers were women and the average single premium paid was just under $71,000 ($70,975). Research conducted by the American Association for Long-Term Care Insurance (AALTCI), the national trade organization, examined 2008 sales data for over 5,000 new policies.

"Asset-based long-term care insurance protection is becoming an increasingly popular way for individuals to protect against the risk," explains Jesse Slome, AALTCI's Executive Director. Asset-based long-term care policies offer the dual benefit of access to long-term care benefits as well as life insurance protection. "Many individuals find this coverage attractive because if they don't use their long-term care protection, their beneficiaries still benefit from the life insurance coverage," Slome explains.

The average single premium paid for an asset-based LTC policy in 2008 was $70,975, according to the Association study. This represented a four percent increase compared to 2007 when the average premium was $68,300. Just under half of policies (49.7%) had a base face amount of between $100,000 and $200,000. Some 30 percent had a face amount of life insurance protection of between $50,000 and $100,000. "Policies offer a long-term care insurance protection in multiples of the life insurance benefit," Slome explains.

Purchasers of asset-based LTC policies were almost equally divided between pre-65 (49%) and 65-or-older (51%). Just over 10 percent (11.2%) of purchasers were between ages 45 and 54. Exactly two-thirds of purchasers were women (66%). "Buyers are older than individuals purchasing traditional long-term care insurance protection," Slome notes. According to the Association's study, some 84 percent of buyers of traditional LTCi protection in 2008 were younger than age-65.

Asset-based long-term care protection and traditional LTC insurance policies share the requirement that applicants health qualify for coverage. The percentage of accepted applicants declined with age according to the study's findings. Some 70.2 percent of submitted policy applications by individuals between 45 and 54 were accepted. The percentage declined to 60.5 percent for applicants between ages 65 and 74.

"We anticipate the market for asset-based long-term care protection will increase in the years ahead," predicts Slome. "Leading insurers such as Genworth Financial and Lincoln Financial Distributors are focused on the growth of this market and policy sales."

The American Association for Long-Term Care Insurance is the national organization serving insurance and financial professionals who provide long-term care financing solutions. Consumers can obtain information from the organization's Consumer Information Center, the nation's leading resource for LTC insurance information. Insurance agents and financial professionals can visit the organization’s online Producer's Resource Center at www.aaltci.org.

Women And Long-Term Care Insurance

Some quick facts about women and long-term care.

All statistics show that women live longer than men. Women who reach age 65 have a life expectency of (another) 20 years versus 17 years for men.

Women over age 75 are far less likely to be married (than men) and are twice as likely to be living alone.

Women over age 65 include 980,000 nursing home residents; versus 337,000 men.

Women are also typically the caregivers. Women provide between 60% and 75% of family or informal care.

These facts come from the Association's 2009 Long-Term Care Insurance Sourcebook and they will be an important part of the upcoming guide the Association will publish specifically for women.

But, facts support the issue and I am hoping readers of this blog will share their insights with me as I prepare the booklet. What have you found resonates with women - both those who are living alone ... as well as those who are married? My intent is to address both of these audiences with messages they will relate to.

What should be included in this brochure?

Please share your thoughts by sending me an E-mail to Jesse Slome.

Thanks. I can't think of a more important topic.

Jesse Slome
mailto:jslome@aaltci.org

Long-Term Care Insurance Producers Summit Planned

The American Association for Long-Term Care Insurance, the national professional organization, announced plans for the eighth National Long-Term Care Insurance Producers Summit.

The national conference which will focus on the marketing and selling of long-term care insurance as well as life insurance and annuity products that now offer long-term care benefits will be held November 15 and 16, 2009 at the Westin Crowne Center Hotel in Kansas City, MO.

The Summit is the premier long-term care insurance industry meeting for insurance and financial professionals who market long-term care solutions to individuals and the employer marketplace.

The Association is extending a special Pre-Early Registration offer--a $130 discount off the general registration fee of $325. In addition, for those who register before February 18th, the Association will provide two $25 credits toward room charges at the Westin in Kansas City. For details on this limited-time offer, contact Jesse Slome, Executive Director of the organization. Click here of call (818) 597-3227.

Long-Term Care Insurance: What Happens After They Buy

One of the most interesting aspects of my job is compiling the data for the annual Long-Term Care Insurance Sourcebook. This is a compilation of all the most relevant data we can compile ... acquire ... and share with members of the Association.

One of the questions I've been asked is "what happends after someone purchases long-term care insurance? How many people keep their policies? How many drop them? How many die?"

It is important information for several reasons. First, most people who purchase long-term care insurance understand the value of what they have purchased. Compared to other forms of insurance, fewer drop this protection that say life insurance or diability products. Thus, one can assure people who buy, they will likely have and keep this coverage should the need for benefits arise.

The 2009 Sourcebook will provide detailed (cumulative) data on what happens after people buy long-term care insurance protection. Here's what it will note based on data reported by the Indiana Partnership for Long-Term Care. Of some 43,475 policies purchased, some 8,086 have been dropped (35,412 are still in force).

The Indiana Partnership was implemented in 1993. Thus, in the 15 years since sales began, 82% of policies sold remain in-force.

Primary reasons for dropping the policies are:
Voluntary (2,016 or 25%)
Died (990 or 12.3%)
Unknown (2,543 or 31.5%)
Not Taken Up (2,381 or 29.5%)
Converted (78 or 1%)

A little tid bit worthy of including should you ever be asked the same question by a prospect or client.

For more information, visit the Association's Producer Resource Center where we will continually add new audios and information.

If you have suggestions for data you want included, send me an E-mail: Click Here.

Long Term Care Insurance Cost: What People Really Pay

How much did Americans pay for long-term care insurance in 2008? What the average age of buyers? At what ages did long-term care insurance policyholders begin their claims?

Each year the American Association for Long-Term Care Insurance publishes an annual industry Sourcebook that is packed with the best facts and figures we can obtain. Some comes from independent research conducted by the Association, others from studies. Here are some findings that will be included.

Let me begin with a stated opinion. I dislike industry averages. Reporters like them and they use them regularly. But, without context, averages are meaningless. If I told you you couldn't control the temperature of the water in your shower, but that the average would be a balmy 80 degrees ... how would you feel if one minute it was 100 and the next it was 60. You get the picture.

The very same is true when it comes to long-term care insurance. For years, articles and experts talk about the average amount people pay for long-term care insurance. But, half of those who buy pay less than the average (they didn't get inferior protection) ... and half paid more (they didn't get ripped off). Okay, for those addicted to statistics, the average paid for individual long-term care insurance in 2008 will likely be about $1,900. Hope you are happy.

But for those who really want a more relevant perspective, new data that is reported in the Association's 2009 LTC Insurance Sourcebook, sheds more meaningful light. The data breaks down the range of premiums paid into age bands, showing the high and the low amount paid, as well as the mean.

Here are the findings for select age bands (2008 annual premiums paid by buyers in New York State):
Between ages 45-49 the low was $1,008 and the high was $6,445
Between ages 50-54 the low was $989 and the high was $6,407
Between ages 55-59 the low was $844 and the high was $6,939
between ages 60-64 the low was $1,125 and the high was $7,413
Between ages 65-69 the low was $1,883 and the high was $9,496

All information published in the Sourcebook or on this blog may be utilized with credit to the American Association for Long-Term Care Insurance.

Court Approves Order to Protect Penn Treaty Policyholders

January 6, 2009: Pennsylvania Insurance Commissioner Joel Ario announced today that the Commonwealth Court approved his petition for an Order of Rehabilitation for Penn Treaty Network America Insurance Co. and its subsidiary, American Network Insurance Co.

The order places the company under the statutory control of the Pennsylvania Insurance Department. It also grants the commissioner direct authority to preserve the company's assets and oversee its current financial situation and operations, while continuing to pay policyholder claims.

"It is the Insurance Department's responsibility to take action when a company is in financially hazardous condition," Ario said. "Placing Penn Treaty into rehabilitation will make certain that long-term care policyholder claims are paid, helping to ensure continuity of care for a community in need. "We gave Penn Treaty time to find a buyer and infuse new capital. To date, the company has been unable to raise enough capital, so we must protect the company's assets and put policyholder protections into place. I want to assure policyholders that their policies remain in effect during this rehabilitation and that their premiums should continue to be paid in order for coverage to remain in place."

This rehabilitation is the first receivership action the department has taken in more than four years. Penn Treaty, headquartered in Allentown, provides long-term care insurance to more than 126,000 policyholders. Together, Penn Treaty Network America Insurance Co. and its subsidiary, American Network Insurance Co., write long-term care insurance in all 50 states and the District of Columbia.

The Insurance Department will perform an independent, comprehensive evaluation of the company's finances. Based upon this review and analysis, the department then will determine the viability of a rehabilitation plan. Any plan will give payment priority to policyholder claims.
Policyholders and other interested parties will receive further information about the rehabilitation in the future. In the interim, policyholders with questions on claims or non-claim matters may use the following toll-free number: 800-362-0700, ext. 3190.

Media interested in discussing consumer protections for those purchasing long-term care insurance, can contact Jesse Slome, Executive Director of the American Association for Long-Term Care Insurance. Call 818-597-3227 or E-mail: Jesse Slome

Comment on Congressional Budget Office Long-Term Care Proposals

Received several notes from people regarding the information posted from the Congressional Budget Office's report on Long-Term Care proposals.

I thought I would share comments (below) from one leading expert whom I respect as one of the more knowledgable LTCi industry pros. On a personal note, I completely concur that the proposals will cost taxpayers and will do nothing to keep Medicaid solvent to meet the future needs of consumers. The American Association for Long-Term Care Insurance is not chartered as a lobbying entity but we'll do our best to keep everyone apprised and if the time comes to raise our voices ... we will. My goal for this blog is to be information (not an ongoing rant) ... but I'm personally glad to see some folks have signed-up. You can post comments to the blog.

Let's keep building ... we have some wonderfully bright and passionate minds (on our side!)

Jesse Slome


One Expert Comments to the CBO Proposals for Long-Term Care

"I won't go into the problems the Medicaid suggestions raise: How does a minimally trained case worker in a county get info about expenditures made 7 years ago from anyone much less from a cognitively impaired 85 year old! But the LTC insurance piece does concern me. I'm surprised you were not more critical of the CBO report proposal.

As I look at it, it would severely impact LTCi sales opportunities and harm the public.
1. Even where a person made $100K over 40 years, a savings account of 1.2% of income would only accumulate about $53K. Scarcely adequate to buy LTCi for a 65 year old 40 yrs from now. If the client had used the 1.2% right along to pay premiums rather than put money into the Treasury account it would work, but not the way this concept is set up.

2. Second, I couldn't find anything in the report about treasury bills. Nothing in the report that says any interest would be paid which makes affordability of decent LTCi at 65 even more unlikely.

3. Why buy LTCi at all until 65 when the windfall occurs. We've fought the "Medicare covers LTC" myth for years. This would be a million times worse especially since the feds will be touting the plan. Windfall is also an appropriate word. The concept implies a single premium. There is no other way to explain the report's provision that allows funds remaining after the "best" policy is purchased to go back to the accountholder (after taxes). If the CBO authors had envisioned annual premiums, this would never come up because remaining funds would be premised on death or LTC eligibility .

4. The report says insurers would have huge opportunities to sell new products. I agree, but not the products we do today nor products that actually help our clients. CBO optimism is premised on the idea that the cost of LTCi is driven primarily by negative selection. Not so. If everyone had to buy coverage, the cost of policies would go down (maybe 15%), but not enough to make even modestly adequate coverage affordable under this plan. So, at age 65, people would find that unless they were willing to kick in a lot, their promised coverage would be next to nothing. As to insurers, our sales outside the 65 mandated group would be even less than they are today.

On the bright side, we'd have the opportunity to sell new products that matched the limited account funds. On the downside, those products are likely to be standardized (whatever that means to the CBO) products (like Medigap) but dominated by NTQ minimal indemnity coverage akin the old hospital indemnity policies."

Congressional Budget Office Recommends New Savings Program To Fund Purchase Of Long-Term Care Insurance

Congressional Budget Office Recommends Savings Program To Enable Americans To Purchase Long-Term Care Insurance

To aid the incoming 111th Congress and the Obama Administration, the Congressional Budget Office (CBO) has just released a 235-page report outlining 115 budget options for health care reform. The report expands on one the CBO's regular reports to the House and Senate Committees on the Budget. The authors claim the report presents ideas for reducing "and in some cases, increasing" federal spending on health care, altering federal health care programs and making (in again their words) "substantive changes to the nation's health insurance system.

When it comes to the long-term care section according to Jesse Slome, Executive Director of the American Association for Long-Term Care Insurance, most of the changes will increase spending adding costs to an already strained federal program.

One proposal would require workers to contribute a percentage of their pretax wages to an individual account reserved specifically to pay for long-term care insurance. In the Congressional Budget Office’s estimation, a contribution of 1.2 percent of income subject to the Social Security payroll tax would meet the option’s funding requirements. Non-wage earners, such as stay-at-home spouses, would not be covered under this option.

Under the proposed plan, the accounts themselves would be administered by a federal entity, which would invest them in Treasury securities. The money in the account would be the property of the individual and would be part of the individual’s estate if he or she died before turning 65. At age 65, the balance of the account would be required to be used to purchase the most generous long-term care insurance policy available given that balance.

Here is a summary of the other proposals and some preliminary estimated costs:

1. Increase States' Flexibility to Offer Home- and Community-Based Services Through Medicaid State Plan Amendments. This option would increase Medicaid’s spending by an estimated $2.7 billion over the 2010–2014 period and by $8.1 billion over the 2010–2019 period.

2. Make Home and Community-Based Services a Mandatory Benefit Under Medicaid. This option would increase Medicaid spending by approximately $20 billion over the 2010–2014 period and by about $90 billion over the 2010–2019 period. That estimate incorporates a reduction in nursing home spending as a result of a modest decline—compared with current law—in the number of Medicaid beneficiaries who receive care in nursing homes and a subsequent increase in the number of individuals receiving home or community-based services.

3. Increase the Federal Matching Rate for Home and Community-Based Services and Decrease the Federal Matching Rate for Nursing Home Services. This option would increase Medicaid spending by about $8 billion over the 2010–2014 period and by about $13 billion over the 2010–2019 period.

4. Clarify Medicaid's Definition of Permissible Asset Transfers. This option would explicitly define which types of transfers are permissible. Because the rules are ambiguous, states tend to interpret them narrowly. This option would clarify that the following types of transfers are permissible:
Providing financial assistance to a family member for educational expenses;
Assisting a family member with medical expenses;
Assisting a family member facing a financial crisis, including a failing business or family farm;
Assisting an individual who is a caregiver for a family member or person with whom he or she lives; or
Donating funds to a church, religious organization, or charity.
Implementing this change would increase mandatory federal spending by about $2.6 billion over the 2010–2014 period and by $6 billion over the 2010–2019 period.

5. Increase the "Look-Back" Period for Transfers of Assets in Medicaid. This option would further extend that period from 60 months to 84 months for transfers made on or after October 1, 2009. Transfers made prior to that date would be subject to the 60-month look-back period. The look-back period would increase to 84 months over time, with the option generating its first budgetary effects in year six of the 10-year period from 2010 to 2019—that is, after 60 months had passed. Therefore, this change would have no effect on federal spending until 2015; over the period from 2015 through 2019, it would reduce spending by approximately $220 million.

6. Implement Policies That Encourage the Use of Advance Directives. Provided that appropriated funds were available, implementing those activities would increase federal discretionary spending by about $60 million over the 2010–2014 period and by $110 million over the 2010–2019 period. There would be a savings to Medicare of about $30 million over the 2010–2014 period and $100 million over the 2010–2019 period resulting from the portability of advance directives.

Here is the link to access the full report click on this link or paste the following address into your Web browser. The long-term care provisions are contained in Chapter 10 that actually begins on page 193. http://www.cbo.gov/ftpdocs/99xx/doc9925/12-18-HealthOptions.pdf