Summary
Highlights
The underwriting process for Aetna Recovery Care is more in-depth than some other plans, asking about confinement, home health care, mobility, and various health conditions within the past 24-36 months. However, it's generally more lenient than Medigap underwriting for certain conditions like heart failure. The discussion includes a sales pitch strategy, emphasizing the value of comprehensive coverage and how Aetna's plan fills gaps left by other policies, making it a strong offering for individuals seeking robust supplemental care.
The session introduces Aetna's Senior Supplemental Recovery Care as a valuable addition for agents, explaining its potential role in needs assessment and frequent sales to customers. It clarifies that Medicare partially covers home health care but typically requires a three-day hospital stay and does not cover home health aid. Medicare covers skilled nursing facilities for the first 20 days fully, with a co-pay from day 21 to 100, and no coverage thereafter.
Aetna's Recovery Care covers skilled, intermediate, and custodial nursing facility care, including assisted living facilities, which Medicare does not cover. It also covers home health care/aid, which Medicare has significant gaps in. A key feature is that the facility or agency does not need to be Medicare-approved, a significant advantage over traditional Medicare coverage.
The Aetna Recovery Care is an indemnity product, meaning it pays a fixed rate for a specific service regardless of the actual cost or Medicare's approval. This allows benefits to be paid even if the service costs nothing to the beneficiary, as long as proof of service is provided. This structure bypasses Medicare's approval process and coordination of benefits.
The core plan offers daily benefits for nursing or assisted living facility confinement, ranging from $10 to $700 per day. Coverage periods can be 90, 180, 270, or 360 days, with elimination periods of 0, 20, or 100 days. A zero-day elimination period means coverage starts from day one. Shorter elimination periods result in higher premiums, a demonstration with various daily benefits showing price differences. The policy also includes coverage for prescription medications, bed reservation, and Medicare Part B excess charges. Benefits are paid directly to the beneficiary, are non-taxable, and the policy is guaranteed renewable.
Various riders can be added to the core plan. These include adult daycare, home modification (up to $2,500 lifetime maximum for accessibility upgrades), and inflation protection (3% or 5% annual increase on policy anniversary, simple or compound interest). Other riders cover mental health services, outpatient rehab, pet boarding, daily hospital confinement (less relevant with Medigap plans), ambulance transportation, and home care. The home care rider is notable as family and friends can receive 25% of the weekly benefit for providing care, even if unlicensed.
A sample quote for a medically underwritten plan with a $350 daily benefit for 90 days, zero-day elimination period, outpatient rehab ($50/day for 30 visits), and a 3% simple inflation rider comes to approximately $79 per month. The discussion highlights how to combine this plan with a Medigap Plan N, a hospital indemnity plan, and a dental, vision, and hearing plan for a comprehensive monthly package of around $316 covering health and final expenses.