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Old 10-03-2010, 07:23 PM   #21
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I looked at LTC a while back, and decided against it. While LTC may be needed by 60% that does not mean that medicare will not pay for part of it. I believe I have related the case of my MIL and FIL, both required rehab, and short stay in nursing home. Medicare picked up the bill. Anyway, in our case, our cola'd pension and SS cover all our expenses. Our savings and other income is enough to cover one of us in a LTC situation. So it is a risk we are willing to take.
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Old 10-03-2010, 07:24 PM   #22
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Dementia should be an automatic trigger without an elimination period. Anyone who has had a parent in a nursing home for several years can tell you why LTC is important to have. Whether you think it's worth the price of admission is a different story.
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Old 10-04-2010, 10:47 AM   #23
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My question to all, at this stage of the thread, is: Does anyone know of anyone currently reaping the benefits of having paid premiums for LTCI? If so, how's that going?
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Old 10-04-2010, 10:48 AM   #24
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Self-insuring is a good idea for the most part, but if you end up doing what my dad did your family may wish you had the LTC coverage.

Dad had plenty of money to cover his and mom's needs until (what I think was) early dementia set in and we didn't recognize it.
He began playing with futures in the stock market (with mom begging him not to the whole time) and subsequently made some devastating financial decisions.

As a result if he didn't have the policy today there would be absolutely no way either my mom or I could afford to pay for the care he needs.
She and I did try to keep him at home for several years and the stress was just too much for both of us. He now resides in a fairly nice assisted living facility.

The sad thing is he told me when he knew he was losing it that he didn't want to live this way....
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Old 10-04-2010, 11:04 AM   #25
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My question to all, at this stage of the thread, is: Does anyone know of anyone currently reaping the benefits of having paid premiums for LTCI? If so, how's that going?
Yes, my dad. He bought a policy from John Hancock in 1996.
The policy allows for in-home care or in-facility care.

We kept him at home and the policy was paying for about three years and now he is in a LTC facility (assisted living).

When he was at home we had caregivers, but they were really less than desirable help. $28/hour to the provider company and $10/hour to the caregivers. Because of policy restrictions we could not directly hire in-home care providers. And some of the caregivers we had were, to be frank, absolutely awful. Wouldn't do half the things they were supposed to be doing and wanted mom to wait on them!!!

The initial qualification period for a claim was (if I remember right) about 60 days. After that the policy is paying, but only a fixed amount. We have found that you can negotiate with a LTC facility on the daily rate. Many of them are willing to come to the amount your policy pays or at least close to it.

The policy does go up 5% per year.

As far as actual payment, however, the bill must be paid first (the facility requires advance payment each month) but the benefits are paid by John Hancock in arrears. And then they take up to 45 days after that to pay. That is, 45 days after they receive the claim. So we had to cover at least a month in the beginning to get him started. Each month a letter is sent return receipt (found that if we didn't do that the claims got lost in the mail room) requesting payment on the claim and including a copy of the bill from the facility.

Finally, there is the 'approval' process with John Hancock for any provider. Even if the facility has other residents that are on John Hancock policies every person that is there under a John Hancock policy has to have the facility send paperwork to John Hancock to be reviewed and approved.

Yes, it is somewhat frustrating but it surely beats the alternative, which is having him at home. That is an extremely frustrating situation.
(if you're interested in learning about how frustrating a caregiver can be read some of the posts on Family Caregiver Support | Caregiving for Elderly Parents | Caring.com or write me privately....)

Hope I answered your question. Let me know if you have any questions for me.
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Old 10-04-2010, 11:17 AM   #26
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My question to all, at this stage of the thread, is: Does anyone know of anyone currently reaping the benefits of having paid premiums for LTCI? If so, how's that going?
Most skilled nursing patients are in their 80s at the time of admission, just FYI. You might surface a few here via elderly family members, etc. but doubt many of them have LTC.

One of my hesitations about this is that even if I need it, it will likely be 20 years from now. That's a lot of premiums, a lot of increases in premiums, and a perhaps a nontrivial risk of insurer insvolvency over 20 years (to my knowledge, LTCI does not have a state-mandated reserve backup plan as do annuities). And the longer you have been paying in to the policy, the more reluctant you will be to terminate and leave all that money on the table.
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Old 10-04-2010, 11:19 AM   #27
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The only LTC carrier I would personally buy from is NML. When they decided to start offering LTC, they brought the guy over from Genworth who set up Genworth's program.

I have personally seen how Medicaid works and have NO WISH to be in that position, ever............
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Old 10-04-2010, 11:23 AM   #28
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The only LTC carrier I would personally buy from is NML. When they decided to start offering LTC, they brought the guy over from Genworth who set up Genworth's program.

I have personally seen how Medicaid works and have NO WISH to be in that position, ever............
Their rates are significantly higher than Genworth/JH for a similar policy. Better financial stability and less risk of a rate increase, but given the cost difference, basically has one built in already.
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Old 10-04-2010, 11:39 AM   #29
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In case you missed it:

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John Hancock just announced that it will ask state regulators to allow it to increase premiums for many of its long-term-care insurance policies by an average of 40%.
Kiplinger.com
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Old 10-04-2010, 11:47 AM   #30
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In case you missed it:

Kiplinger.com
The 40% will likely apply only to policies with 5% compound inflation riders and the increases will depend on the specific riders. Policies with CPI-adjusted benefits supposedly will not have any increases. As I said earlier, compound inflation policies probably won't exist 5-10 years from now and they will start watering down what options are available. If you had told someone 10 years ago that an affordable health insurance policy might have a $5,000 or $7,500 deductible, they'd have said you were nuts. This is only my personal opinion of course and I very well could be wrong.
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Old 10-04-2010, 12:55 PM   #31
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Near the end of her life, my mother needed to be in a nursing home and had no long term insurance. But managing the situation wasn't all that bad. Medicare and her supplementary insurance paid almost everything -- the supplementary insurance (Aetna through the Ohio PERS system) paid up to 100 days per year in a nursing home so long as it counted as rehabilitation rather than custodial care. And much of the time she was home with me, Medicare paid for home care, which a was a small crew spending several hours with her several times a week: a RN, a physical therapist, and two other specialists. Not a great experience for me, but doable.
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Old 10-04-2010, 01:15 PM   #32
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My question to all, at this stage of the thread, is: Does anyone know of anyone currently reaping the benefits of having paid premiums for LTCI? If so, how's that going?
Well, in family Nords that's an issue.

Anyone spending 24-48 hours with my father would classify him as suffering from effects similar to short-term dementia. Whether that's caused by diet, alcohol, blood-pressure medication, other circulatory issues, dementia brain damage, or Alzheimer's is purely conjectural because he insists that everything is fine and he doesn't want to be "some doctor's lab rat". I can sympathize with the emotions but not the logic. According to one geriatric care provider, "There's no reasoning with these people because many of them are no longer capable of it."

So, in my inexpert opinion he's ready to reap the benefits of his Hancock policy. He's certainly paid enough since the 1990s to merit the privilege. Whether he'll survive the consequences of his symptoms long enough to do so is quite another question.
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Old 10-05-2010, 12:55 PM   #33
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The need for LTC is the type of risk that I think makes sense to insure against. Unfortunately, the market doesn't sell a policy that meets my needs. What I'd want:

- A stable company with a long history of paying claims reliably and not raising rates (accurate underwritning/accurate cost projections are signs of competence. Not many insurance companies have demonstrated competence WRT LTCI).

- Shared coverage: We only need coverage if one of us needs LTC and the other is still living without it, so a shared benefit policy is more efficient than buying two individual policies. Once one of us dies, if the other needs LTC then SS, sale of the house and other assets, our nest egg, and a pension check will cover the bill. In the unlikely event that we both need LTC at the same time, I'd be wiling to gamble that the period we'd both need help would be short.

- True insurance: We can self-insure for a big chunk of this risk, and would like to do so. I'd like a 24 month exclusionary (waiting) period, and then about 7 years of shared benefits at a modest $/day benefit rate (again reflecting the fact that we can self-insure somewhat. We don't need every nickel of care paid for by the insurance).

We haven't found a policy like that. If we could, I'd guess the premiums might be fairly reasonable, given the self-insurance we're willing to do.
This sounds like something we might be interested in too.
If you find anything close, please be sure to post info on it.

Thanks!
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Old 10-05-2010, 01:04 PM   #34
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One of my hesitations about this is that even if I need it, it will likely be 20 years from now. That's a lot of premiums, a lot of increases in premiums, and a perhaps a nontrivial risk of insurer insvolvency over 20 years (to my knowledge, LTCI does not have a state-mandated reserve backup plan as do annuities). And the longer you have been paying in to the policy, the more reluctant you will be to terminate and leave all that money on the table.
AFAIK, LTC policies are covered by state insurance guaranty associations just like every other type of retail insurance policy. And insurers are definately required to put up reserves on their books by the state insurance regulators.

Now wehther you are comfy with the protection afforded by the state guaranty system is an exercise left up to the reader.
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Old 10-05-2010, 01:11 PM   #35
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AFAIK, LTC policies are covered by state insurance guaranty associations just like every other type of retail insurance policy. And insurers are definately required to put up reserves on their books by the state insurance regulators.
Thanks, Brewer. Seems that doesn't get talked about as often as it does for annuities.

Good to know, Reserves on their (the insurance company's) books doesn't feel nearly as warm and fuzzy as already-collected dollars in a state run reserve pool.
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Old 10-05-2010, 01:12 PM   #36
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Well, in family Nords that's an issue.

Anyone spending 24-48 hours with my father would classify him as suffering from effects similar to short-term dementia. Whether that's caused by diet, alcohol, blood-pressure medication, other circulatory issues, dementia brain damage, or Alzheimer's is purely conjectural because he insists that everything is fine and he doesn't want to be "some doctor's lab rat". I can sympathize with the emotions but not the logic. According to one geriatric care provider, "There's no reasoning with these people because many of them are no longer capable of it."

So, in my inexpert opinion he's ready to reap the benefits of his Hancock policy. He's certainly paid enough since the 1990s to merit the privilege. Whether he'll survive the consequences of his symptoms long enough to do so is quite another question.
Check your dad's LTC policy and see what the requirements are for having it start. In our case it was needing assistance with 3 of 5 ADL's (Activities of Daily Living: Eating, Dressing, Bathing, Toileting, Transferring, Continence). If you have to remind him daily of these items even though he is somewhat capable you may be able to get his doctor to sign the required affidavit to say he needs supervision and can then have the policy benefits start. Although it's not specifically listed, medication management figures in to it also.

Good luck to you-
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Old 10-05-2010, 01:21 PM   #37
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The only LTC carrier I would personally buy from is NML. When they decided to start offering LTC, they brought the guy over from Genworth who set up Genworth's program.

I have personally seen how Medicaid works and have NO WISH to be in that position, ever............
sorry to be a bit of a dunce, but who is "NML"?
thanks-
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Old 10-05-2010, 01:23 PM   #38
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Good to know, Reserves on their (the insurance company's) books doesn't feel nearly as warm and fuzzy as already-collected dollars in a state run reserve pool.
True, but even then . . .

"In the news today, just two weeks before the election, Governor Blowhard announced that the much-feared default on state bonds and the threatened layoff of state employees had been averted. "Last night's action by the legislature puts formerly idle money that had been languishing in various reserve pools to work for the benefit of our state. I'm proud to sign this bill today. The money we'll avoid paying in higher bond interest will allow us to pay back all the money as soon as this temporary crisis has passed . . ."

I guess there comes a point when you have to trust somebody, but it's not as easy as it was three years ago.
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Old 10-05-2010, 01:35 PM   #39
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Thanks, Brewer. Seems that doesn't get talked about as often as it does for annuities.

Good to know, Reserves on their (the insurance company's) books doesn't feel nearly as warm and fuzzy as already-collected dollars in a state run reserve pool.

State reserve pool? You mean the state guaranty fund? If so, LTC policies are definately covered.

All you ever wanted to know about state guaranty funds (but were afraid/to bored to ask): nolhga.com :: welcome
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Old 10-05-2010, 01:37 PM   #40
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True, but even then . . .

"In the news today, just two weeks before the election, Governor Blowhard announced that the much-feared default on state bonds and the threatened layoff of state employees had been averted. "Last night's action by the legislature puts formerly idle money that had been languishing in various reserve pools to work for the benefit of our state. I'm proud to sign this bill today. The money we'll avoid paying in higher bond interest will allow us to pay back all the money as soon as this temporary crisis has passed . . ."

I guess there comes a point when you have to trust somebody, but it's not as easy as it was three years ago.
Florida did exactly that with Citizens Insurance (state-run insurer of last resort), as I understand it. From what I have read, they had trouble closing the state budget gap, so they raided the kitty at Citizens with the promise to just issue some debt if a big hurricane hit. Do you feel lucky?
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