The New Medicare Advantage – Coming 2019 to an Insurance Broker Near You

The New Medicare Advantage – Coming 2019 to an Insurance Broker Near You




In a world of well intended plans, there is one plan that stands out. It’s called Medicare Advantage, with one company pushing the limits even further.

Imagine getting paid to walk. Well, there’s an insurance company paying out millions of dollars a year to people who meet walking goals.

Where skill used to be everything, or should I say skilled care, but now CMS raises the stakes.

The folks at Medicare got together and they’re scratching their heads and they’re like, “This doesn’t seem right. If our coverage is for primarily health-related care, we should be covering more nutritious food, transportation to health-related services, independent living, assisted living, adult daycare…Other health care settings are now considered for Medicare reimbursement.

A place where wellness programs fail. A new data rich Medicare Advantage is getting stronger by the day, enforcing individual healthy habits.

Get ready for more insurer-promoted healthy choices, like free gym membership for people that clearly do not need it.

Of course the most annoying are those people in exceptionally good shape at the gym. I’m always like, “What are you doing here? You’re done. What are you, rubbing it in? Luckily there’s always one or two people at the gym you look at and you’re like, “Don’t bother. You’re wasting your time. And then you realize it’s just your reflection in the mirror.”

The new Medicare Advantage coming in 2019 to an insurance broker near you.

What is CHOW?

What is CHOW?




Hey everyone, you remember Harold.

What’s up?

What’s up, Harold? I’m so happy to have you back here. Everybody’s been asking to have Harold back, so we got you back.

We’re not going to talk rapping today, we’re going to talk business. You want to talk some business?

Absolutely. What do you want to talk about?

I want to talk about CHOWS.


Yeah. Could we talk about that?


Do you know what CHOW means?

Um…a fine Chinese restaurant?

OK, in the healthcare realm, CHOW, does that mean anything to you?


Let me tell you, CHOW stands for change of ownership.

Stop right there. I’m sure it does.

No, you see how change, CHOW, change of ownership.

Shouldn’t that be COO? Or is that your title?

Oh, please.

Was that already taken?

Don’t start getting personal. Yeah, I guess COO would make sense.

Do they have a suggestion box? I could throw that in.

If they did, you should drop that in. I think that’s a good idea. But that’s what the industry calls it. When there’s a transaction going on and there’s a change of ownership, they’re going through a CHOW.

And what does that process entail?

It’s a very difficult process. It’s a lot of different pieces, mainly financial, that need to be done in order to make sure that every part of the transaction is set up for them to go live.

Interesting. How do most operators/owners maneuver through that process?

They usually would either choose to work with an attorney or they would actually try…


Yeah, why?

And they pay the attorney legal fees through the financial paperwork?

Yeah, it doesn’t really make sense because they actually don’t handle a lot of the financial stuff anyway. I don’t know why. Some of them would try to wing it on their own and see if they can make those deadlines….

Always trying to outsmart the system.

Yeah, I don’t know why people don’t realize there’s a solution out there.

Well, what do you suggest?

Well, you know at LTC we handle everything for a CHOW from A to Z.


Everything, yeah.


Yeah, licensure. Of course we handle that.

A to Z…Medicare/Medicaid Enrollment?


Managed Care Contracting?

You know that’s a big focus of ours, of course we do that.

Software setup?

Software setup.

Bank account structuring?

Bank account structuring. Come on, yeah. A to Z. I’m serious.

A to Z? What about the old AR that I inherit with my acquisition?

Do you know we have a team of specialists that focus on collecting outstanding AR and write offs when there was a change of ownership? Of course, this is something we’re very big about.

OK, time out. Is there anything you don’t handle? Is there a catch?

What don’t we handle? We don’t change carpets when they’re getting replaced.

I knew it! There’s a catch.

Long-Term Care Statistics You Need to Know in 2018

Long-Term Care Statistics You Need to Know in 2018

If you operate a nursing home or other long-term care facility in the United States, your primary concern is to care for your senior residents and their families. However, finances are the lifeline of your facility, so you need adequate revenue to pay the bills and still make a profit at the end of the day. Consider these long-term care statistics that relate to your business.

  • 52 percent of people—47 percent of men and 58 percent of women—who reach age 65 will need long-term care in their lifetime.
  • 10 percent of Americans over age 65 have Alzheimer’s disease. This increases to 33 percent among people ages 85 and older. Two-thirds of Americans with Alzheimer’s are women.
  • The average length of time spent in long-term care is two years (2.5 years for women and 1.5 years for men). Only 14 percent of people need long-term care for five years or more.
  • As the US population ages, the number of people needing long-term care is on the rise. As a result, long-term care expenditures skyrocketed from $30 billion in 2000 to $225 billion in 2015.
  • The median yearly cost for weekday adult day care is $18,200.
  • The median yearly cost for assisted living care is $45,000.
  • The median yearly cost for nursing home care is nearly $86,000 for a semi-private room and over $97,000 for a private room. These figures vary significantly by location. For instance, the average yearly cost for a private room in a nursing home in Monroe, LA is under $52,000, while in Manhattan, NY, it’s over $215,000.
  • The median household wealth for adults over age 65 with no disabilities is just over $263,000. As for those with physical or mental limitations, the median household wealth is $94,200.
  • Unpaid family members and friends provide 83 percent of all long-term care in America, and two-thirds of older adults rely exclusively on free care. The estimated economic value of this unpaid care is $470 billion per year.
  • 65 percent of unpaid long-term caregivers are female, and 25 percent of them are in the “sandwich generation,” meaning they provide care for their aging parents, as well as their children. Another 34 percent are over age 65 themselves.
  • Medicaid provides care for 62 percent of nursing home residents, which covers 51 percent of all long-term care costs. 20 percent of Medicaid’s total funding goes toward paying long-term care, which is expected to increase by 50 percent between 2016 and 2026.
  • In 2000, 125 insurers offered standalone long-term care insurance policies. As of 2014, fewer than 15 do. Also, only 20 percent of businesses with 10 employees or more offer long-term care policies to their workers. Still, the number of people with long-term care insurance has increased from 4.5 million in 2000 to 7.25 million in 2014.
  • 14 percent of long-term care applicants ages 50 to 59 are denied coverage due to health issues. 45 percent of applicants ages 70 to 79 are denied.

With mounting costs, an aging population, and an increasing need for quality, affordable long-term care, you may struggle to manage it all. LTC Consulting can help you cut costs and navigate Medicaid and Medicare reimbursements to boost company profits. With us in your corner, you can focus on providing the best possible care for your senior residents while we oversee every financial aspect with great care and accuracy.

To learn more about LTC Consulting’s health care management services, please contact us today.