New York State Partnership for Long-Term Care (NYSPLTC)


The New York State Partnership for Long-Term Care

According to the New York State Partnership for Long-Term Care (NYSPLTC), the New York Partnership was established to help New Yorkers prepare financially for the possibility of needing long-term care, without facing impoverishment. The program is also designed to help reduce New York's Medicaid tax expenditure. Perhaps most importantly, the Partnership offers New Yorkers, and the State of New York, a better alternative to fund long-term care costs.

The NYSPLTC is a unique and innovative program that works with private insurance companies to not only provide long-term care benefits, but also to protect a New York State resident's assets should the person need Medicaid. The NYSPLTC is a program that is monitored and administered by the State of New York; however the state does not sell Partnership insurance.

What Makes a New York State Partnership-Certified Policy?
Partnership-approved policies must be approved by the New York Department of Insurance and must include the NYSPLTC logo. Depending on the insurance carrier, different riders and benefits may be available, however all Partnership-approved policies must include the following core benefits:

  • · Nursing home care
  • · Home care
  • · Personal care
  • · Assisted living care
  • · Skilled nursing care
  • · Adult day care
  • · Respite care (14 nursing home equivalent days per year)
  • · Care management (2 days of long-term care planning services by a professional)
  • · Alternate level of care
  • · Nursing home bed reservation (20 days per year)
  • · Hospice care
  • · Inflation protection equal to 5% compounded annually
  • · Guaranteed renewable
  • These following benefits may be offered in addition to the core benefits and may increase the premium costs.
    • · Waiver of premium
    • · Combined home care benefit
    • · Independent provider benefit
    • · Non-licensed/non-certified provider benefit (not offered as part of the Dollar for Dollar 50 and Total Asset 50 policies)
  • Types of Partnership Plans Available
    The New York Partnership permits are now able to offer four different Partnership policies:


    Minimum Policy Duration

    Maximum Policy Duration

    Minimum Daily Benefit Allowances (2012)

    Home Care Benefit

    Maximu m Eliminati on Period

    Total Asset 50

    3 years Nursing Home Care or 6 years of Home Care *


    NH = $253 HC = $127

    Home care DBA is 50% of the Nursing Home Care DBA (Daily benefit allowance)

    100 days

    Total Asset 100

    4 years Nursing Home Care or 4 years Home Care


    NH = $253 HC = $253

    Home care DBA is equal to the Nursing Home DBA (Daily benefit allowance)

    100 days

    Dollar for Dollar 50

    1.5 years Nursing Home Care or 3 years Home Care *

    2.5 years Nursing Home or 5 years Home Care

    NH = $253 HC = $127

    Home care DBA is 50% of the Nursing Home Care DBA (Daily benefit allowance)

    60 days

    Dollar for Dollar 100

    2 years Nursing Home Care or 2 years Home Care

    2.5 years Nursing Home Care or 2.5 years Home Care

    NH = $253 HC = $253

    Home care DBA is equal to the Nursing Home DBA (Daily benefit allowance)

    60 days

    Source: http://www.nyspltc.org/expansion.htm

    *Home care days are counted on the basis of 2 home care days equaling 1 nursing home day.

    How Does the NYSPLTC Work with Medicaid?
    Medicaid is a state program that pays for health care that it not covered by Medicare, but only after the individual has spent down his or her assets to meet state and federal poverty guidelines.

    Medicaid coverage under the New York Partnership is called Medicaid Extended Coverage. Under the Partnership, insured individuals may qualify for Medicaid Extended Coverage when their medical and long-term care bills exceed the insured’s ability to pay for care, assuming they qualify under Medicaid’s asset and income guidelines. There are two kinds of plans from which to choose.

    Total Asset Protection – Insureds with Total Asset Protection plans may protect any amount of assets and are exempt from any penalty associated with the transfer of assets. The insured may sell, transfer, and/or spend his or her assets before, during, and after applying for Medicaid without affecting his or her eligibility as long as he or she exhausts the policy minimum duration period.

    Dollar for Dollar Asset Protection – Insureds with Dollar fo Dollar Protection may protect assets equal to the amount of insurance benefits paid out under the Partnership LTCI plan as long as the policy minimum duration period is satisfied. Any unprotected assets in excess of the allowableMedicaid level may affect eligibility for Medicaid Extended Coverage. Further, asset transfers are subject to scrutiny.

    Although Medicaid does not consider protected assets in determining eligibility for Medicaid Extended Coverage, an applicant's eligibility is determined based on his or her unprotected assets, income, and the cost of the care received. Therefore, if the insured’s income is too high and/or the unprotected assets exceed published Medicaid levels, the insured will not qualify for Medicaid Extended Coverage.



    “Not having a plan for extended care will have an impact on your family, health and your best thought out retirement plan.

    Living a long life could well be in your future.

    Planning for it is now a necessity

    Call Les Robinson to help develop a LTC plan 1-800-836-2040 ext 3014

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