Long Term Care Insurance 60% premium hike--yikes!

[Texas Proud]

I have not worried about LTC.... but Nunthewiser's post brought up something that I think is important...

One of my sisters was laid up in nursing home with an illness... she did get better, but there were 'test' along the way to determine if the insurance would pay for the facility and rehab...

One of the test was dressing... so, my sister was telling me that if they put her panties on the floor and she was able to step into the leg holes but not do anything else such as pull them up, that was considered that she could help get dressed.... but as my other sister pointed out, you are still standing there naked....

The rules and fine print can trip you up....

 

[MichaelB]

I've read through those terms in the contracts, but I've always wondered just how difficult it is to prove you are deficient in these areas. How can the insurance company challenge you if you say you can't eat by yourself or get yourself dressed? Who is going to validate these claims? Is a doctor going to ask you to undress and dress up while they watch? Is stating you are deficient good enough, or do the insurance companies make it difficult to prove?

And if a doctor's note is required, how hard would it be to find a doctor who would acknowledge that a 95 year old can't dress or feed themselves?

You may find this thread helpful. Nords shared his experience with his father's LTC policy.

 

[akck]

I've read through those terms in the contracts, but I've always wondered just how difficult it is to prove you are deficient in these areas. How can the insurance company challenge you if you say you can't eat by yourself or get yourself dressed? Who is going to validate these claims? Is a doctor going to ask you to undress and dress up while they watch? Is stating you are deficient good enough, or do the insurance companies make it difficult to prove?



And if a doctor's note is required, how hard would it be to find a doctor who would acknowledge that a 95 year old can't dress or feed themselves?

My understanding is that the insurance company has the right to examine you at their expense and have access to your medical records. Initially, her doctor would validate the claim. Hopefully her doctor would've seen the deterioration over time and realize she isn't able to perform the tasks consistently.


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[Nunthewiser]

I've read through those terms in the contracts, but I've always wondered just how difficult it is to prove you are deficient in these areas. How can the insurance company challenge you if you say you can't eat by yourself or get yourself dressed? Who is going to validate these claims? Is a doctor going to ask you to undress and dress up while they watch? Is stating you are deficient good enough, or do the insurance companies make it difficult to prove?

In the case of Mom's Genworth policy, a doctor's recommendation is what starts the claim process. Genworth then gets the right to examine the records of the nursing home/ALF. They (Genworth) then provide a nurse to examine/interview the claimant with regard to observations of physical limitations on everyday life as stipulated in the contract. In our case the exam/interview took about an hour. We witnessed it. The nurse was very young and seemed sympathetic, but YMMV, as always.

So, thats the drill.


edit: I flipped through the ordeal poster Nords went through a few years back and chuckled:

You may find this thread helpful. Nords shared his experience with his father's LTC policy.

I had nowhere near the "pleasure" that he had collecting on his Dad's claim, but at least, in the end, his LTC was quite lucrative.

Even 4 years later Genworth is still not accepting emails and pdfs. Everything is done with snail mail and faxes just to add to the effect. Amazing.

 

[Mulligan]

I inquired about such a catastrophic policy (similar to a regular policy but with a long exclusion period) from a broker and never got a good response. I would think it would be affordable because the risk of claims is low.

I wonder that maybe there is a specific monetary reason companies would not provide this type of plan intentionally. Such as healthier people not taking the traditional plan thus exposing the companies to the "healthy ones" (strong body, demented mind) who live 10-15 years in a nursing home? They would be expected to provide lower premiums for the 3 year deferral, but still be "on the hook" for the long term inhabitants of a home?
If they mitigated the unlimited expense by capping, would many people be interested in a plan that didn't pay for three years, but then paid only for the next 3?


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[akck]

I had nowhere near the "pleasure" that he had collecting on his Dad's claim, but at least, in the end, his LTC was quite lucrative.

Even 4 years later Genworth is still not accepting emails and pdfs. Everything is done with snail mail and faxes just to add to the effect. Amazing.

That may be changing. I received an email from my optometrist that they were installing a HIPPA approved email system so all communications and documents can be emailed to/from them. I assume other medical facilities will adopt an approved system. If they don't, at least they can't use HIPPA as the excuse.


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[Independent]

I wonder that maybe there is a specific monetary reason companies would not provide this type of plan intentionally.

Uncertainty.
Insurers figure they have a better shot at estimating future costs during the first 3 years than they have at estimating future costs during the remaining years.

 

[Ready]

Uncertainty.
Insurers figure they have a better shot at estimating future costs during the first 3 years than they have at estimating future costs during the remaining years.

Agreed. Plus I wonder how much of a market there is for insuring stays beyond 3 years. It's got to be a very small number, and it would only be attractive to people who can fully self insure for the first three years. And chances are, if they can insure for three years, they probably could go further if necessary and wouldn't be interested in the insurance anyway.

 

[pb4uski]

I guess that I'm an outlier then. We could self insure a few years, but if it was 5 or more years then it would be a big dent and I would be interested in insuring against a big dent.

 

[mathjak107]

typically at 5 years most folks with assets have shifted them and going forward is not on their dime.

if the states really didn't want that they could just increase or do away with the look back and just disqualify any transfers .

depending on state partnership plans why would someone who's state requires you p/u only the first 3 years want to even consider paying for 5 or more ?

i doubt there would be much of a market for those plans .

 

[Turn_the_Page]

DW and I have LTC policies from MetLife, just before they exited the market. Premium combined for both of us is $1500 per year. This for $120 per day for a maximum of 4 years with inflation protection. Yes - $120 per day is chump change, but it will help.

Some of us will spend a long time in expensive care. Most won't. It's the people in the middle - net worth-wise who benefit most from the coverage. Those with mucho assets can self insure. Those without much - like my mom - will exhaust their assets and go on Medicaid.

 

[Nords]

You may find this thread helpful. Nords shared his experience with his father's LTC policy.

Boy, was that a stroll down memory lane. I'll write an update over there to cap it off.

My father's been in that care facility for 4.5 years now and will turn 82 years old in a few months. He's still alert and mobile, but he's slowing down. Every week his energy levels and his cognition decline by a fraction of a percentage. He's still deep into mid-stage Alzheimer's and he spends most of his time doing jigsaw puzzles. Well, technically that's jigsaw puzzle-- every morning the same puzzle is brand-new for the first time all over again.

My experiences with John Hancock have hardened my opinion about long-term care insurance:
Why I Won't Buy Long-Term Care Insurance - Military Guide

Good question--I'm not sure. Interestingly my financial advisor told me that the policy I currently have would now cost me between $12,000 and $14,000 a year were I just signing on--which obviously makes $5,000 seem like a real bargain--frankly even $8,000. My concern is though that with new policies priced at these exorbitant rates, what is the future of LTC insurance? I don't see many new signees coming on board at those rates--not that everyone will sign up for maximum benefits. But it gives one pause--with insurers dropping out of the LTC market, I really wonder if it's going to survive.

I think you made the right choice to abandon the policy.

Genworth is probably heaving a huge sigh of relief, too.

 

[samclem]

depending on state partnership plans why would someone who's state requires you p/u only the first 3 years want to even consider paying for 5 or more ?

One possible reason--to be in a better facility, after 3 years, than can be bought at the Medicaid rate.
Another reason: The Partnership Plans only allow you to exclude the value of the insurance from your remaining assets in order to qualify for Medicaid. You still have to be basically broke (excluding the things that don't count in the Medicaid formula). So, if you've got assets that exceed your policy value that you'd like to pass on, it would be handy to have 5 years (at least) to accomplish the transfer outside of the Medicaid lookback window.

Just a note: From the LTCi policies I looked at, the duration specified for the payout really doesn't mean much--you could have a "3 year" policy that is still paying after 10 years, provided you haven't used up the total value of the policy ($ per day x number of days). But you can't "accelerate" the daily/weekly payouts. So, it's more flexible (but more costly) to buy a 3 year, $250/day policy than a 5 year, $150/day policy, even though they have the same total payout "pot".

 

[mathjak107]

Our state offers either dollar for a dollar which is what you described or total asset protection after 3 years insurance in a home or 6 years assisted living or in home care.

We have to shift no assets and go directly on medicaid after the insurance runs out.

All assets you have are exempt from any look back and are exempt from medicaid formulas.

We also have total income protection for the stay at home spouse and are not limited to medicaid limits.

We have a special version of medicaid called extended medicaid which is made to go with the plans and have their own special set of rules.

Not all partnership plans in all states offer total asset protection plans.

From what someone said here only ny and indianna offer it as of now.

 

[mathjak107]

Boy, was that a stroll down memory lane. I'll write an update over there to cap it off.

My father's been in that care facility for 4.5 years now and will turn 82 years old in a few months. He's still alert and mobile, but he's slowing down. Every week his energy levels and his cognition decline by a fraction of a percentage. He's still deep into mid-stage Alzheimer's and he spends most of his time doing jigsaw puzzles. Well, technically that's jigsaw puzzle-- every morning the same puzzle is brand-new for the first time all over again.

My experiences with John Hancock have hardened my opinion about long-term care insurance:
Why I Won't Buy Long-Term Care Insurance - Military Guide


I think you made the right choice to abandon the policy.

Genworth is probably heaving a huge sigh of relief, too.

I think the experience you had could be true of any type of insurance.

You can pull out the words long term care and replace it with home insurance.

Many new yorkers are still fighting it out from their claims for sandy and with similiar issues of being short changed.

 

[bingybear]

Our state offers either dollar for a dollar which is what you described or total asset protection after 3 years insurance in a home or 6 years assisted living or in home care.

We have to shift no assets and go directly on medicaid after the insurance runs out.

All assets you have are exempt from any look back and are exempt from medicaid formulas.

We also have total income protection for the stay at home spouse and are not limited to medicaid limits.

We have a special version of medicaid called extended medicaid which is made to go with the plans and have their own special set of rules.

Not all partnership plans in all states offer total asset protection plans.

From what someone said here only ny and indianna offer it as of now.

I had stated the New York and Illinois (IL) have total asset protection. NY have total asset protection and dollar for dollar plans. The pages I've seen online do not describe it well. They note dollar for dollar are dependent on the benefits paid. If like many other states the assets that you could maintain would be those allowed by typical medicare plus the benefits paid by your insurance (this is dollar for dollar plan). You would have to spend down to this level before MEC would step in. My understanding of total asset protection is that enhanced medicaid will start paying after LTCi is exhausted. Please correct me if I'm wrong in my understanding.

 

[mathjak107]

yep , that is it . the extended medicaid pays the bills once the insurance runs out and all assets are not counted .