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Old 09-07-2009, 11:50 AM   #41
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Insurance is insurance so what can you do. I paid for disability ins for 25 years and never got to use it. Also pay 7K a year for my whole life policy and have done so for over 20 years. I pay health ins and auto ins and home owners ins. So should I hope that I got to use the life ins, had a car accident, hope my house burns down or was disabled?
I understand your point, but the analogy is not quite adequate for LTC insurance, IMHO. Statistically you are insuring an event that is probably 20 to 30 years away. Life insurance does the same, but it is a sure thing in that you will die, while LTC may happen or may not. Policy and health care reimbursement are likely to change substantially over a 20 to 30 year period and may render LTC insurance less important (or maybe more so?). Premiums are likely to rise a lot, creating a different decision equation, yet your prior premiums (hopefully which bought you a better actuarial premium for the life of the policy) are hard to walk away from, so you may feel trapped into continuing the higher-premium coverage.

The current LTC policies are widely described as being underpriced, and as the boomers boom, the premiums may rise sharply -- we don't know how the carriers will fare in these new, untested waters.

Then there's the opportunity cost of all those premiums: $3,000 a year at 6.00% for 25 years $165K, which pays for 2+ years in a NH (which is under 50% likely to occur); You can factor in inflation, but most policies cap coverage on a nominal per diem basis, so even with LTCI you have some out-of-pocket expenses, making this an even closer call.

I am not saying I have a good answer and you have to look at your individual circumstances, but I find that just assuming "insurance is insurance" doesn't paint the whole picture for me for this tough issue. DW and I have decided to hold off for now, but will try to reassess this every so often.
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Old 09-07-2009, 12:34 PM   #42
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My DH and I recently received the letters and are also looking at the 25% increase. I am not sure what we will do.

I think that there were only 2 people in my office that enrolled for LTC insurance when it was offered. I don't know of anyone in my family that has been in a nursing home, other than 1 recently that was in for a very short stay. My side of the family has in the past died fairly early and fairly quickly. However, my DH's father had a stroke and numerous other medical problems and so has his mother. She is currently in a NH paid for by Medicaid. (DH's father is deceased.) I do not want to have to have either of my 2 kids take care of me, if something happens. I also don't want to be left high and dry if spouse has a stroke and I can't take care of him and he has to go in a NH. As far as I know, I am the only person in my family to ever have LTC ins. I keep wondering if I am just wasting my money. I also see seminars advertised in the paper for how to be able to keep your money if you have to go into a NH. I know that at least one of the retirees, that did not obtain LTC ins, went to one of them and said briefly that they made some changes. I did not ask her about it, but I might. Both her and her DH are federal retirees.

Sorry, that I can't help, but I am unsure what to do. If anyone figures out a good solution, I hope that they will update this thread. Thanks in advance.
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Old 09-07-2009, 01:02 PM   #43
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And yet if you drop the insurance, essentially you have put $11,400 into LTC insurance over the past 10 years and got nothing for it, so that is an incentive to accept whatever increase is imposed. With LTC premiums going up so much, even for the fed LTC insurance, I think you and many others have good reason to be worried.
Do you look at your auto insurance premium at renewal time and regret that you haven't had any claims? Purchasing insurance is a risk mitigation strategy not an investment.

re: "...an incentive to accept whatever increase is imposed"
Prior sunk costs do not justify future expenditures --
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Old 09-07-2009, 01:24 PM   #44
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I also see seminars advertised in the paper for how to be able to keep your money if you have to go into a NH.
I've seen those too. My understanding is you have to be pretty much broke before Medicade kicks in. You are allowed to have a house and a car, but most of your other assets must be depleted. I believe many of the seminars focus on transferring assets out of your name. There are very specific rules on this - it must be done well in advance of applying for Medicade for LTC.
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Old 09-07-2009, 01:43 PM   #45
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I've seen those too. My understanding is you have to be pretty much broke before Medicade kicks in. You are allowed to have a house and a car, but most of your other assets must be depleted. I believe many of the seminars focus on transferring assets out of your name. There are very specific rules on this - it must be done well in advance of applying for Medicade for LTC.
There is some variation by state, but they consistent theme is "...you have to be pretty much broke before Medicade [sic] kicks in." My mother-in-laws pension and SS exceed the maximum monthly amount and wife has to periodically (annual?) renew her mother's Medicaid application. The first time she had to renew she filled out the web based application and then received a phone call from a moron in FL social services telling her to fill out the hard copy form because "...we don't read the applications submitted electronically." He literally snickered when he told my wife she was up against a deadline and her mother's Medicaid payments could cease.

My mother-in-law had to burn close to $400k in skilled nursing facility costs before qualifying for Medicaid. I wish all states would adopt the LTC insurance partnership model used in NY, CA, CT and IN. I think this would increase the size of the LTC insurance pool.
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Old 09-07-2009, 01:49 PM   #46
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When I look at my family and it is fairly large no one has ever spent time in a nursing home and the women in my family have incredible longevity . That is why I waiver on LTC insurance .
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Old 09-07-2009, 01:54 PM   #47
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When I look at my family and it is fairly large no one has ever spent time in a nursing home and the women in my family have incredible longevity . That is why I waiver on LTC insurance .
Barring some sort of genetic disease I'm not sure family history can give us much of a clue what the future holds for us. My mom spent 2+ years in a NH, my dad about 9 months. My two oldest siblings both died without spending a day in one...
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Old 09-07-2009, 02:21 PM   #48
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When I look at my family and it is fairly large no one has ever spent time in a nursing home and the women in my family have incredible longevity . That is why I waiver on LTC insurance .
Then there's my family. MIL 15 years so far (she's now 90 and comes from a very long-lived family), aunt 7 years, grandmother 5 years.
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Old 09-07-2009, 03:32 PM   #49
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Barring some sort of genetic disease I'm not sure family history can give us much of a clue what the future holds for us. My mom spent 2+ years in a NH, my dad about 9 months. My two oldest siblings both died without spending a day in one...

Absolutely , my late husband had an incredible family history of longevity . In his family 65 was middle aged . His Dad died at 96 and he died at 60 .
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Old 09-07-2009, 03:56 PM   #50
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Investment losses from John Hancock, who recently won the contract or MetLife, who currently has the contract? I'm confused.
Don't know if this was already answered, but the original Fed LTC contract was awarded to both JH and MetLife, as some sort of joint venture. The revised current contract only has JH as the insurer.
I believe the correct term here is contract modification, not re-award.
I also got my "warning letter" about premium increases, but have not seen the actual increase in premium data yet.
I got in at age 42, and took the ACIO feature and the minimum wait period, also thinking my premiums ($152/mo) were fixed for the life of the policy. I read every single line of the brochures and the website.
I am not happy about what OPM has allowed to occur (premium increases), but without having the original contract in hand, it's impossible to figure out how the loophole was allowed.
In any case, I will stick with the same coverage I originally signed up for and take the premium increase hit. I have no kids, nor do I have relatives in a position to assist, so I don't have much choice.
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Old 09-07-2009, 06:43 PM   #51
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I don't know Rich, I don't see the difference between LTC ins and any other type of ins.. Ya never know when your going to need any of it. I paid disability at about 4K a year for 25 years and never knew if I would need it, thank God I didn't. I gave it up 3 years ago at retirement and I guess you could say I lost all that money.

You say LTC ins may not be needed for 20 or 30 years or maybe never. Same with disability ins., home owners ins., car ins or any of the others. If we knew when or if we would need it we would know when or if we should get it.

It's just a big gamble and the Ins. companies mostly win.
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Old 09-07-2009, 07:37 PM   #52
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73, lots of similarities to other insurance products for sure.

OTOH, an auto policy pays for damages incurred during the 1 year policy period, then you get to buy another year's worth or from another carrier, or maybe not at all if you give up driving, etc. Comparison shop, alter your coverage and deductible and all that.

With LTC insurance, realistically, you are entering a multi-decade agreement with all the vagaries that entails. Years into it you can drop out, but you leave a lot on the table: not just past premiums and future coverage, but the actuarial edge you were promised in return for buying young. And if you want back in, you may be underwritten.

Not a warm fuzzy feeling either way.
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Old 09-07-2009, 07:55 PM   #53
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73, lots of similarities to other insurance products for sure.

OTOH, an auto policy pays for damages incurred during the 1 year policy period, then you get to buy another year's worth or from another carrier, or maybe not at all if you give up driving, etc. Comparison shop, alter your coverage and deductible and all that.

With LTC insurance, realistically, you are entering a multi-decade agreement with all the vagaries that entails. Years into it you can drop out, but you leave a lot on the table: not just past premiums and future coverage, but the actuarial edge you were promised in return for buying young. And if you want back in, you may be underwritten.

Not a warm fuzzy feeling either way.
IMO, the one of the biggest differences is few of us would face financial ruin if we lost a car, or even a home, and didn't have insurance to cover replacement and/or repair. The cost of LTC can be much more devestating.
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Old 09-07-2009, 08:30 PM   #54
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Rich, I would guess a good comparison would be disability or life ins., no? These premiums would increase with age as well. In most cases you'd be more likely to use them later in life.
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Old 09-07-2009, 09:06 PM   #55
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IMO, the one of the biggest differences is few of us would face financial ruin if we lost a car, or even a home, and didn't have insurance to cover replacement and/or repair. The cost of LTC can be much more devestating.
Purron, I understand the concern. Here's an alternative perspective.

IIRC, nursing home cost is about $75,000 per year on average with the typical stay being in the 3 year range, so $225,000 is at stake (let's talk nominal dollars for now since inflation raises benefits if you have the COLA option but premiums will be higher over the decades). LTCI typically does not cover the whole cost, but more like $100 per day -- or half the actual cost above.

So, if you are 55-60-ish you pay the opportunity cost of 25 yrs of premium at $2500 a year at 6% -- about $135,000 (not counting increases in premium over time).

On the other side -- if you need a nursing home -- you gain three years of NH expenses, paid by LTC at about one half or $109,500 (using $100/day).

You are paying $135,000 in premiums/opportunity cost for a typical net benefit of $109,000. And that assumes that every insured will need a nursing home; in reality, something like 50% will never need one, and the premiums are stll paid.

I am not trying to talk anyone in or out of LTCI. I just know that for me it's not a slam dunk. Self-insuring may be more attractive if you can reach a net worth to make it prudent and that is probably well within the reach of many on this board. If self-insuring is not realistic for some, maybe they should get LTC insurance rather than risk financial ruin.

Hope that explains my understanding of this tough decision.
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Old 09-07-2009, 09:44 PM   #56
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I had the impression that the optimal age for buying LTC insurance was 59, when I thought I became uninsurable at age 57, I thought it was too late. Maybe I should look into it anyway? I was surprised to find this information in Consumer Reports:

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Consider buying at around age 65. Although salespeople will try to get you to buy a policy as young as age 40, the coverage may be useless 40 years hence when you need it. New systems for care may emerge that will not be covered by a policy purchased today. For example, 15 years ago, long-term-care insurance did not pay for care in assisted-living facilities.
Between the ages of 55 and 60, buy long-term-care insurance only if you have a chronic condition like diabetes that could prove incapacitating over time. Otherwise, begin at about age 60 to assess whether you need long-term-care coverage, and, if so, buy at age 65. If you buy later than age 70, the policy will likely be too expensive or you may not pass the medical tests needed to qualify.
ConsumerReports.org - Long-term-care insurance 11/03: Long-term health care, elderly care, disability insurance plan.
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Old 09-07-2009, 09:57 PM   #57
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Rich, thank you for your thoughtful analysis and comments. Here's the part I have a hard time dealing with..."the typical stay being in the 3 yr range". As I mentioned, my MIL has required LTC for over 15 years now.

There's so much more to the LTCI decision than the financial analysis. Our personal experiences and fears come into play. While this does not help reach a logical decision, it is a factor.

If DH and I hadn't spent so many years immersed in the reality of nursing home care, we would likely have a very different perspective. Even so, we do plan to analyse this carefully before shelling out an extra 25% for premiums. Your input will help us do this.
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Old 09-08-2009, 12:25 AM   #58
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Purron, I understand the concern. Here's an alternative perspective.

IIRC, nursing home cost is about $75,000 per year on average with the typical stay being in the 3 year range, so $225,000 is at stake (let's talk nominal dollars for now since inflation raises benefits if you have the COLA option but premiums will be higher over the decades). LTCI typically does not cover the whole cost, but more like $100 per day -- or half the actual cost above.

So, if you are 55-60-ish you pay the opportunity cost of 25 yrs of premium at $2500 a year at 6% -- about $135,000 (not counting increases in premium over time).

On the other side -- if you need a nursing home -- you gain three years of NH expenses, paid by LTC at about one half or $109,500 (using $100/day).

You are paying $135,000 in premiums/opportunity cost for a typical net benefit of $109,000. And that assumes that every insured will need a nursing home; in reality, something like 50% will never need one, and the premiums are stll paid.

I am not trying to talk anyone in or out of LTCI. I just know that for me it's not a slam dunk. Self-insuring may be more attractive if you can reach a net worth to make it prudent and that is probably well within the reach of many on this board. If self-insuring is not realistic for some, maybe they should get LTC insurance rather than risk financial ruin.

Hope that explains my understanding of this tough decision.
Rich, DW and I are trying to run our finances in RE so we're self-insured for LTC. I think your numbers are too small and I'd be uncomfortable with a situation where expenditures in excess of $225k would deplete our LTC fund.

I've been using $90k/yr and want to be able to cover 8 yrs. The 8 yrs can be one of us for 8 yrs, each for 4 yrs, one for 7 and the other for 1, etc.

Using the average stay (about three yrs as you say) as a predictor simply says anytime you and DW total more than the three yr average, you're in financial trouble.......

Another complication in figuring out what number to use for self-insuring purposes is understanding what happens after the first spouse dies. For example, say I die first and DW shortly thereafter needs LTC. How does losing 50% of my pension (as it drops to survivor benefit levels for her) impact the portfolio's ability to keep her in LTC?

I've worn a couple of pencils down to nubins working on this...... and still don't feel very confident. But, like you, we're self-insuring at this time but continue to look at the situation periodically.
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Old 09-08-2009, 05:03 AM   #59
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...
I've been using $90k/yr and want to be able to cover 8 yrs. The 8 yrs can be one of us for 8 yrs, each for 4 yrs, one for 7 and the other for 1, etc.
...
From what I studied it seems to me that you are planning for longer than average LTC (leaning toward worse case). That is... that both of you have longer than average NH stays.

Planning for LTC is similar to other risk based planning... very complicated and you will accept some level of risk. My wife's grandmother lingered for 10 years in a NH after a stroke left her completely unable to do anything. You or your spouse could be the statistical outlier but there is a low probability that it will occur.

In terms of self-insure... your risk (in general terms) is forgoing asset spending on one side of the coin and winding up on Medicaid on the other side of the coin. The other risk you are trying to mitigate is ensuring that the surviving spouse is not left financially ruined.

While one of you may need some sort of care in the home... the average NH stay seems to be less than 3 years. Of course it is an average.... you or your spouse could last longer.

I would recommend you check out the rules for Medicaid in your state and follow those rules to do your planning. Usually one spouse is in the NH and the other is not. In some states, spouses can split the assets. In other states, the state has tougher rules. Some states are very tough on income that can be kept by the spouse (the one not in the NH). Do not Assume anything! You really need to include this in your planning... and the rules change from time to time.

If you have a house that is worth something and the surviving spouse has other liquid assets to spend (to live on)... the house could be the potential LTC funding mechanism for the surviving spouse.

IMO - this planning is as much about protecting assets for the surviving spouse (maybe more for them) as it is for the person receiving care. Assuming you get into a half way decent NH... you will get the care whether you pay or Medicaid pays. Plus I am fairly sure Medicaid (in some states) will pay for in home care.

You might assume that because you have money to pay that you will wind up in a better NH. It might turn out that way and it might not. You can be neglected just as easily either way.

My recommendation (if you or your spouse need care and it is workable): If you have assets, then stay at home and hire Home Health and nurses to deplete your resources. The care will be better since one spouse can oversee the care and help. The challenge with this is finding competent care. It takes more management than you would think.

You can find the stats to help with planning and there are planning guides for self insure LTC.

http://www.therubins.com/homes/stathome.htm



Quote:
While only twelve percent of nursing home residents are between 65-74, 45% are over 85 years of age. It is estimated that anyone over 65 years of age will have a 43% chance of spending some time in a nursing home. About 24% of these individuals will spend less than a year in residence at a nursing home.
------------------

Age Group Percentage of Nursing Home Population Age (1999)
65-74yrs. --12%
75-84-yrs. -32%
85+ yrs. 46%
Average Length of Stay (Point-in-Time Measure)
2.4 years varying with gender, age, ethnicity and type of facility; also influenced by the increasing use of short-term stays following hospitalization
2.51years for females
2.29 years for males
1.86 years for Hispanics
2.62 years for persons over age 85


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Old 09-08-2009, 07:57 AM   #60
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Yes, there are so many variables and assumptions that a generalizable recommendation is virtually impossible. Another morbid consideration is that most elderly in a NH die there.

One approach (one which would be first on my list if I had to decide today) is to buy life insurance for each of us (or maybe first-to-die) in a moderate amount in the range of 3 years expenses. This would allow tapping your retirement portfolio to cover NH costs, knowing that upon death the life insurance benefit would make the surviving spouse whole again.
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