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The Affordable Care Act (Obamacare): If You Have Health Insurance

Home Care Insurance (CLASS)

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The Act establishes a national, voluntary insurance program for purchasing coverage for home care. The act refers to this as "community living assistance services and supports" to be referred to as the CLASS program. CLASS is effective January 1, 2011. The Act is intended to eliminate the situation where people may be required to spend down all their assets in order to obtain this care through Medicaid.

The Act includes a five-year vesting period. Then the CLASS program will provide individuals with functional limitations a cash benefit. The cash benefit will be not less than an average of $50 per day to purchase non-medical services and supports necessary to stay at home.

Any individual who is at least 18 years old  and actively working will be automatically enrolled (unless they op out), and pay their premiums through payroll deduction or another alternative method. Any non-working spouse may enroll in the program and pay their premiums through an alternative payment procedure. 

The Act does not affect Long Term Care Insurance.

To Qualify For Benefits

To qualify for benefits, individuals must:

  • Be at least 18 years old AND
  • Have voluntarily contributed to the program on a monthly basis for at least five years.

Benefits are limited to people who:

  • Are unable to perform two or more activities of daily living (ADL) (such as eating, dressing, transferring) OR
  • Have an equivalent cognitive disability that requires supervision or hands on assistance to perform activities of daily living. For example, people with traumatic brain injury, Alzheimer's disease, multiple sclerosis or mental retardation AND
  • The physical or mental limitation is expected to last for a continuous period of 90 days or more. 

Eligibility for benefits will be determined by state disability determination centers.


There will be two cash benefit tiers:

  • Tier 1 benefits will be payable to eligible individuals who are unable to perform 2 or more ADLS or have the equivalent cognitive impairment. Initially, the benefit will be $50 per day
  • Tier 2 benefits  will be payable to individuals who are unable to perform 4 or more ADL's or have the equivalent cognitive impairment. Initial benefit wilbe $100 per day.   
The monthly case benefit will be posted monthly to a debit account or a "Choice Account."  Individuals who do not use the full monthly amount may roll it over from month to month, but not roll it over from year to year.

If an individual becomes ineligible for CLASS benefits (by improvement in functional status or death), CLASS Act benefits will stop. Any left-over balance of available money remaining in the individual’s account will not be payable. If an eligible individual does choose to move into an institutional facility, CLASS Act benefits will be used to pay those associated expenses.  

Relationship of CLASS Act Insurance Program to Social Security Disability Insurance 

Eligibility for CLASS Act benefits will be independent of whether or not an individual is eligible for Social Security Disability Insurance (SSDI), so participation in the CLASS Act insurance program will not impair an individual’s ability to remain qualified for SSDI.

Relationship of CLASS Act Insurance Program to Social Security Retirement Benefits

Similarly, eligibility for CLASS Act benefits will be independent of retirement benefits eligibility. 

Relationship to Medicaid

An individual who is eligible for CLASS Act benefits is also eligible for the long term care benefit under Medicaid, CLASS Act benefits can be used to offset the costs to Medicaid.

Relationship to Health Insurance 

The “Class” program benefit does not replace the need for basic health insurance --- it provides a mechanism to pay for those non-medical expenses that allow a disabled person to remain independent.

Relationship to Private Long Term Care Insurance

The “Class” program benefit can be an addition to long term care insurance.  It provides a consistent, basic cash benefit to glove with the insurance products that provide more intense medical services over a shorter period of time.

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