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Old 04-30-2016, 10:24 AM   #21
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Lots of anecdotal stories from folks who purchased LTC through a group or employer long ago and got an apparently great deal. But the question is, would you buy LTC as an individual in today's market and at today's rates?
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Old 04-30-2016, 10:30 AM   #22
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He was at home. The help coming in allowed me to keep him at home. If we had to pay for it out of the estate eventually he would have had to go in to a home when the estate ran out.

OK, thanks for the info. To be sure I understand: the LTC paid for home care whereas Medicaid in your state would not have. Once on Medicaid he would have had to go into a NH for Medicaid to pay.

Interesting. I hadn't thought of that angle. I'll have to check on the policy in Illinois regarding Medicaid paying for home care for dementia.
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Old 04-30-2016, 11:22 AM   #23
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MIL does not have LTC and is in a memory unit. She's in spend-down mode right now - but once her house sells (should go on the market this week) she'll have enough cash to pay for several years... She turns 90 this year - so odds are she'll have enough... if not, medicaid will kick in 5 or so years from now.

We don't have it - despite being married/having kids. The quotes we received were pretty pricey. Our plan is to self insure... with the very big plan B of having the community spouse downsize and using the home equity to cover. It helps that we have a paid for overpriced California home... If the community spouse bought a condo for 1/2 the price... the other half of the equity would still pay for 5-10 years of very nice nursing home.
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Old 04-30-2016, 03:11 PM   #24
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MIL does not have LTC and is in a memory unit. She's in spend-down mode right now - but once her house sells (should go on the market this week) she'll have enough cash to pay for several years... She turns 90 this year - so odds are she'll have enough... if not, medicaid will kick in 5 or so years from now.

We don't have it - despite being married/having kids. The quotes we received were pretty pricey. Our plan is to self insure... with the very big plan B of having the community spouse downsize and using the home equity to cover. It helps that we have a paid for overpriced California home... If the community spouse bought a condo for 1/2 the price... the other half of the equity would still pay for 5-10 years of very nice nursing home.

Is your MIL in San Diego? I was wondering what's the average cost for NH in my area, southern Cal.


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Old 04-30-2016, 04:21 PM   #25
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What's a "community spouse"?
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Old 04-30-2016, 05:19 PM   #26
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Old 04-30-2016, 06:01 PM   #27
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From reading the responses here, sounds like the consensus is if you are single and no kids, then no need for LTC?

But how about say, if you get a stroke (or other illness/accident) and takes awhile for you to recover enough to resume your normal life? When you return, would be nice if you had some life savings left to return to instead of that being depleted. ... Or, what am I missing?
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Old 04-30-2016, 06:13 PM   #28
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Bought in 1995.. for DW and I have paid, so far, about 60K for $100/day coverage. Insurance changed hands 4 times and now managed by SHIP trust. No limit on time.
Now, at age 80,would pay $110K toward $$225 nursing home costs (in our area) for three years... then more if both of us were to be there/

Do it over no, but @ $2800/year payments for both of us, doesn't make sense to drop it now.
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Old 04-30-2016, 08:13 PM   #29
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Can someone explain why being single = no LTC recommended? Isn't the issue rather having the funds to self-insure? Several years of nursing care would wipe me out financially. Or if I become disabled and have to have in-home care for a while. What am I missing here? Just trying to justify continuing my own coverage (about 2600/year Genworth policy). Hate to stop it because I've now paid in a fair amount. Hate to continue it if it is going to be worthless. I wish I understood this whole thing better.
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Old 04-30-2016, 08:15 PM   #30
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From reading the responses here, sounds like the consensus is if you are single and no kids, then no need for LTC?

But how about say, if you get a stroke (or other illness/accident) and takes awhile for you to recover enough to resume your normal life? When you return, would be nice if you had some life savings left to return to instead of that being depleted. ... Or, what am I missing?
It's possible but rare to have a lengthy NH stay and then return to a normal life.
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Old 04-30-2016, 08:40 PM   #31
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From reading the responses here, sounds like the consensus is if you are single and no kids, then no need for LTC?

But how about say, if you get a stroke (or other illness/accident) and takes awhile for you to recover enough to resume your normal life? When you return, would be nice if you had some life savings left to return to instead of that being depleted. ... Or, what am I missing?
As long as you continue to recover and show progress, health insurance will cover the stay. Just like in a hospital.

It's when there is no longer improvement you get to a nursing home status.
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Old 04-30-2016, 09:00 PM   #32
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My dad was in a home for nearly 7-8 years, after a stroke. I think maybe he was in assisted living for 2 years and after that mostly bedridden for 5 years.


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Old 05-01-2016, 09:54 AM   #33
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Do I need long term care insurance

You should check out the book by Janet Quinn Bryant, How to make your money last, retirement guide. She recommends that single not to have LTC because if you run out of money, Medicaid will take over.


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Old 05-01-2016, 11:43 AM   #34
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You should check out the book by Janet Quinn Bryant, How to make your money last, retirement guide. She recommends that single not to have LTC because if you run out of money, Medicaid will take over.


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Here older book "Making The Most of Your Money" is one of my favorite financial books. I like how she doesn't berate the reader like Suze Orman.

Staying on topic, if you need care and you have LTC, don't you have have a better choice of what facilities to go to versus Medicaid only approved locations?
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Old 05-01-2016, 12:43 PM   #35
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Staying on topic, if you need care and you have LTC, don't you have have a better choice of what facilities to go to versus Medicaid only approved locations?
Complicated question and the answer varies from state to state. We've been through this with MIL fairly recently. It seems that here in Illinois, LTC insurance would only give you more choices if you're otherwise destitute when you enter the NH.

If you clearly have the insurance and/or personal money to fund your NH stay well beyond your likely lifespan, you do have more choices. You can go anyplace you can afford.

If you think you'll run out of insurance and/or personal money while in the NH (say you have 3 yrs of insurance and another year or personal money and a medical conditional where you could live a long, long time), you need to go to a home that accepts Medicaid. Otherwise, out you go when you run out of insurance and/or personal money. This still leaves you with a lot of choices.

If you are going to be Medicaid from the get-go, your choices are slim, at least here in Illinois. Most NH's save their Medicaid beds for incumbent clients who run out of insurance and/or personal money and don't take any Medicaid patients who don't start out as insurance/private pay. Generally, here at least, it can be tough, really tough, finding a "nice" NH for someone who will be entering on Medicaid or who only has money to private pay for a short time.

My MIL is in a "nice" NH with great staff, nice amenities and high ratings. It has the minimum number of Medicaid beds allowed to still qualify to take Medicare rehab cases. The vast majority of clients are private pay/insurance. MIL started as private (for about two years), ran out of money and was switched to Medicaid. To get her in, we had to show she had the assets to private pay for some time. We were told if she had LTC insurance, that could have substituted for all or part of the private pay.

So, yes, if you have LTC insurance you're likely to have more choices than if you're totally destitute and must be on Medicaid from day one. If you have assets to cover you for a while or SS + pension that would pay a significant chunk of the annual bill, that would substitute for the LTC insurance.
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Old 05-01-2016, 02:26 PM   #36
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If you are going to be Medicaid from the get-go, your choices are slim, at least here in Illinois. Most NH's save their Medicaid beds for incumbent clients who run out of insurance and/or personal money and don't take any Medicaid patients who don't start out as insurance/private pay. Generally, here at least, it can be tough, really tough, finding a "nice" NH for someone who will be entering on Medicaid or who only has money to private pay for a short time.

My MIL is in a "nice" NH with great staff, nice amenities and high ratings. It has the minimum number of Medicaid beds allowed to still qualify to take Medicare rehab cases. The vast majority of clients are private pay/insurance. MIL started as private (for about two years), ran out of money and was switched to Medicaid. To get her in, we had to show she had the assets to private pay for some time. We were told if she had LTC insurance, that could have substituted for all or part of the private pay.
That parallels our experience with FIL before he passed a few years ago, this in Maryland. He got into a nice nursing home but had to show he had assets to private pay for two years, which he did, or sustain independent living level for an indefinite period. We worked with an elder law attorney to preserve half of those assets. FIL was about two months from going on Medicaid when he passed.

BTW, the monthly bill ran from $9k to $14k a month.
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Old 05-02-2016, 06:26 AM   #37
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No way!! The way policies used to be written, it would be a close call, but with the limitations and lifetime caps, I wouldn't spend a penny on a LTC policy.
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Old 05-04-2016, 10:11 AM   #38
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No way!! The way policies used to be written, it would be a close call, but with the limitations and lifetime caps, I wouldn't spend a penny on a LTC policy.
You really need to read the policy carefully and understand what you are buying. The policies differ in some important respects. I was initially inclined not to buy LTC insurance, but I was offered an unusually good group policy (no longer available), so I did it. I could have opted for lifetime coverage but I opted instead for 6 years, because the premium was significantly lower and statistics show that only a very small percent of people are on-benefit for more than 6 years. The two best things about my policy are:

(1) it provides coverage on an indemnity basis. In other words, once I show that I need substantial assistance with two or more ADLs or have the requisite memory impairment (the standard requirement for all tax-qualified LTC policies), I get the benefits paid. I do not have to be in a licensed facility (or any facility). And I do not have to be paying for care. So if my wife or kid or whomever takes care of me at home, or if I hire someone who is not licensed, we still get paid the monthly benefit; and

(2) the benefit amount inflates by 5% per year, which adds up.

I ran some scenarios with projected premium increases and policy value, and concluded that it makes sense.

My mother is on-benefit now, under her LTC policy. It has enabled her to live in a very nice facility which looks more like a high-quality hotel than a nursing home. Whenever she needs an aide, she has one. They treat the residents with respect. And she does not have the stress or unhappiness of spending down her assets, which she would not personally be happy about doing. It is true that she could have spent down her assets and gone into some crappy Medicaid facility, but that was not the approach she wanted.

As with many decisions, there is no single "right answer." But for my mom, it worked out pretty well, and I think the policy that I have is a good one, even though I could, if I wanted to do so, self-insure.
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Old 05-13-2016, 11:37 AM   #39
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That parallels our experience with FIL before he passed a few years ago, this in Maryland. He got into a nice nursing home but had to show he had assets to private pay for two years, which he did, or sustain independent living level for an indefinite period. We worked with an elder law attorney to preserve half of those assets. FIL was about two months from going on Medicaid when he passed.

BTW, the monthly bill ran from $9k to $14k a month.
Were you working before the 5-year look back window started? Was it the goal to preserve the assets from the heirs or was there a chance that your FIL could leave NH to go to his regular home and have home help? I'm curious of angles people work on with the attorneys and if it's worth their services.

Also, does it depend on the state that a person can go to a NH, show s/he can afford to pay for it for 2 years with private money or LTC insurance and then stay in the same NH and Medicaid would kick-in? I'm not sure I understood correctly. If I understood it then, after 2 years of paying for the NH, it must be proven that there's no more private money before Medicaid helps, correct? That's how strategies of preserving assets come into the play, I'm guessing? From what I've read, it's quite tricky to do that. Sure, when it's single, then those strategies are not needed, but if there's a surviving spouse it might be worth it to know how preserve some of those assets.
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Old 05-13-2016, 05:07 PM   #40
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Were you working before the 5-year look back window started? Was it the goal to preserve the assets from the heirs or was there a chance that your FIL could leave NH to go to his regular home and have home help? I'm curious of angles people work on with the attorneys and if it's worth their services.
We started with the elderlaw attorney long after the 5-year lookback window closed. The goal was to preserve assets for the heirs, an objective that we hadn't even thought of before going to the attorney because we didn't know it was possible. It turned out to be an academic exercise because he passed about two months before qualifying for Medicaid. In spite of that we still consider the attorney's fees worthwhile because he knew lots of other things that smoothed the path immensely. Understand though, that Medicaid is a state-administered program and the laws vary widely. FIL lived in MD. In PA this would not be a good idea because they have successfully gone after the adult children.

There was no chance that FIL was ever going back to even assisted living, let alone by himself.

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Also, does it depend on the state that a person can go to a NH, show s/he can afford to pay for it for 2 years with private money or LTC insurance and then stay in the same NH and Medicaid would kick-in? I'm not sure I understood correctly. If I understood it then, after 2 years of paying for the NH, it must be proven that there's no more private money before Medicaid helps, correct?
No, not correct. The "have assets for two years private pay" rule is a policy that many nursing homes have, but AFAIK there is no basis in law for it. They're working with the actuarial statistics there - they figure that enough people who enter the NH with enough to pay for two years will pass away before needing Medicaid that they can absorb the cost of keeping on those who run out of money. The NH that FIL stayed in said they lost ~$127 a day on a Medicaid patient. It was a nonprofit church-affiliated NH so profit for shareholders was not a motive but they do have to stay fiscally solvent.

Understand too that not all NH will absorb the cost of a Medicaid patient. Some will evict the patient when private pay money runs out so you have to read the contracts carefully. This is an excellent time to have an elderlaw attorney with you, that is not a time you want to have surprises later!
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