Poll: Do You Have Long Term Care Insurance?

[COcheesehead]

I looked at it a couple of years ago, and the finances look pretty much like prepayment for care. Basically, the policyholder doesn't get much financial leverage because they are insuring against a high-probability event. Not much difference from buying insurance against your shoes wearing out.

There’s leverage when LTC is purchased as a rider on a life policy because your coverage is based on your death benefit, not premiums paid.

 

[imoldernu]

Coming back, because except for my earlier post, I haven't seen discussion on:

How much and how long will Medicare or a Medicare supplement pay for Long Term Care? If you are at all concerned about the finances of Healthcare after retirement, you should know about the dollars you won't have to pay.

What is the criterion for acceptance for any LTC whether government or a Long Term Care Policy? For some things, LTC won't pay without legal approval.

Does the LTC policy pay if a person is cared for in the home?

Many, many LTC policies, went under or or bowed out of the business, in the '90's and for some years after. Our original policy was with Travelers Insurance, transferred to Met Life, and then management taken over by S.H.I.P in Pennsylvania.

You didn't know about S.H.I.P.? You should, whether you plan on taking LTC insurance or not.
Information here:
https://www.seniorsresourceguide.com/directories/National/SHIP/

 

[COcheesehead]

Coming back, because except for my earlier post, I haven't seen discussion on:

How much and how long will Medicare or a Medicare supplement pay for Long Term Care? If you are at all concerned about the finances of Healthcare after retirement, you should know about the dollars you won't have to pay.

What is the criterion for acceptance for any LTC whether government or a Long Term Care Policy? For some things, LTC won't pay without legal approval.

Does the LTC policy pay if a person is cared for in the home?

Many, many LTC policies, went under or or bowed out of the business, in the '90's and for some years after. Our original policy was with Travelers Insurance, transferred to Met Life, and then management taken over by S.H.I.P in Pennsylvania.

You didn't know about S.H.I.P.? You should, whether you plan on taking LTC insurance or not.
Information here:
https://www.seniorsresourceguide.com/directories/National/SHIP/

I know with my Dad you had to find a facility that took Medicare patients. We found that those have waiting lists.
With a life policy rider, they pay you in cash so it can cover care in home or in a facility.

 

[gerntz]

Got in cheap at megacorp 30+ years ago. While premiums have gone up, particularly recently, still well less than a month's cost at LTC facilities. We'll stick with it.

 

[audreyh1]

I know with my Dad you had to find a facility that took Medicare patients. We found that those have waiting lists.
With a life policy rider, they pay you in cash so it can cover care in home or in a facility.

Medicaid?

 

[Mr._Graybeard]

I bought a policy 6 years ago but DW was denied. Two years later I was diagnosed with type 2 diabetes and would not have qualified.

Maybe it's just my cockeyed way of looking at things, but I find it odd that LTC insurers would reject someone with diabetes, a heart condition, cancer, COPD, etc. It seems to me that the real budget-breakers are insureds who are sound in body but in cognitive decline. Of course, I've never been in the insurance business.

 

[zippy2020]

DH and I both have LTC policies, purchased through our state pension fund. I was 48 and he was 46. At age 50 he suffered a haemorrhagic stroke and would obviously not have qualified at affordable rates ever again had we been dumb enough to let the policies lapse, LOL.

We live in a high-labor/expensive area. Well-rated full-care senior facilities start at $3800/mo for independent living, rising to $8000–12,000/mo for Memory Care or Skilled Care; e.g., 24/7 monitored care.

Also, note that without exception, every facility we talked to raises their rates July 1st. Every year, without fail. Increases apply to monthly rent and extra services, and range from 2–4%.

A couple of updates for folks:
– Length of stay in Skilled Care (nursing) is now just shy of 3 yrs, due to increases in mortality but declines in morbidity.
– The fastest growing group globally are those aged 80+
– Over the last few years the greatest price increases in U.S. healthcare have been for home healthcare. These are low-wage/high-turnover jobs; the price trend is expected to continue.

Medicare does not pay for extended stay LTC. You are eligible for the 120 day paid Skilled Care if you were admitted to a hospital for at least 3 days (NOT for "under observance"; you must actually have been admitted as a patient) and if you are discharged directly to a facility under doctor's orders. Take one step out of a car towards your house and Medicare will not pay.

Medicaid is the states-administered program for all other medical programs for children, the poor, and the elderly. It is 50% financed by the Feds and 50% matching funds by each state. A state can refuse to participate, such as TX and other states did regarding the ACA Medicaid expansion, thereby forfeiting the Federal matching funds. Funds accepted from the Feds must adhere to the Fed guidelines to meet minimum standards.

Medicaid pays for 80% of the elderly residents currently in American nursing homes who have run out funds.

Neither program pays "everything." You need Depends? Pay for them yourself. A pair of slippers or a bathrobe? Nope. A newspaper? A chocolate bar? No and no. A comb or hairbrush or toothbrush.....yeah, not getting those either.

Because there is no comprehensive Federal eldercare program (e.g., the LTC equivalent of Medicare), seniorcare facilities are varied in type and services. Unless specifically designated as a Medicaid-only nursing home, a NH, whether for-profit or non-profit, does not have to accept Medicaid patients automatically. Indeed, many do not.

We investigated 9 facilities near us for my MIL in 2012-13. All were full-care, well-rated, pleasant places. None accepted Medicaid-only patients, period. They varied in policies regarding lack of funds/current residents. 3 would keep indigent residents, helping them apply for Medicaid admission, and then supplementing care costs from general funds. 6 facilities were flat-out "No money, you leave NOW."

There are waiting lists here for Medicaid nursing facilities. I've never been in a good one. Every one I've visited, I wouldn't put a dog in. According to our state rankings (published and on-line) not one Medicaid facility ranks above the bottom third, for safety or staff turnover.

My MIL was 84 yrs old when she entered the facility. It's third-ranked in the state, has a gorgeous 5-acre campus and has wonderful staff. At her first meal as a resident, she discovered her three tablemates were, respectively, 89, 91, and 99 (the 99 yr old is still alive and in AL, at 103).

She loved living there and even became a bocce ball whiz at 85 – who knew! Pretty good for someone with moderate dementia. Although she died unexpectedly from a brain aneurysm just shy of 86, it should be noted that it is not at all unusual for dementia patients to live 10+ years.

There are exceptions to this, of course – there are over 50 different causes of dementia. A very few are caused by physical issues and can be reversed. The majority cannot; it is progressive and eventually fatal.

Even if you do not develop dementia, you have no guarantee your good health will continue. Don't forget that 25% of disability recipients are under age 65. Medicare does not pay 80% of everything that might happen to you. In fact, when end-of-life issues are totaled in, Medicare only pays about 55% of everything spent.

 

[bingybear]

My Dad had most of his medical costs in the last two years on earth. Lived to be almost 90. Money can go fast at the end, unfortunately.

+1 with question. Any idea what the division of expenses between LTC and medical care?

LTC - stuff covered by a typical LTC policy
Medical care - stuff not covered by typical LTC policy, but buy medical coverage

this may be hard to sort after the fact.

IIRC It is often noted that most of ones medical expenses occur during the last year of life. I'm wondering how one would divide LTC/medical expenses for late in life.

 

[Dtail]

DH and I both have LTC policies, purchased through our state pension fund. I was 48 and he was 46. At age 50 he suffered a haemorrhagic stroke and would obviously not have qualified at affordable rates ever again had we been dumb enough to let the policies lapse, LOL.

We live in a high-labor/expensive area. Well-rated full-care senior facilities start at $3800/mo for independent living, rising to $8000–12,000/mo for Memory Care or Skilled Care; e.g., 24/7 monitored care.

Also, note that without exception, every facility we talked to raises their rates July 1st. Every year, without fail. Increases apply to monthly rent and extra services, and range from 2–4%.

A couple of updates for folks:
– Length of stay in Skilled Care (nursing) is now just shy of 3 yrs, due to increases in mortality but declines in morbidity.
– The fastest growing group globally are those aged 80+
– Over the last few years the greatest price increases in U.S. healthcare have been for home healthcare. These are low-wage/high-turnover jobs; the price trend is expected to continue.

Medicare does not pay for extended stay LTC. You are eligible for the 120 day paid Skilled Care if you were admitted to a hospital for at least 3 days (NOT for "under observance"; you must actually have been admitted as a patient) and if you are discharged directly to a facility under doctor's orders. Take one step out of a car towards your house and Medicare will not pay.

Medicaid is the states-administered program for all other medical programs for children, the poor, and the elderly. It is 50% financed by the Feds and 50% matching funds by each state. A state can refuse to participate, such as TX and other states did regarding the ACA Medicaid expansion, thereby forfeiting the Federal matching funds. Funds accepted from the Feds must adhere to the Fed guidelines to meet minimum standards.

Medicaid pays for 80% of the elderly residents currently in American nursing homes who have run out funds.

Neither program pays "everything." You need Depends? Pay for them yourself. A pair of slippers or a bathrobe? Nope. A newspaper? A chocolate bar? No and no. A comb or hairbrush or toothbrush.....yeah, not getting those either.

Because there is no comprehensive Federal eldercare program (e.g., the LTC equivalent of Medicare), seniorcare facilities are varied in type and services. Unless specifically designated as a Medicaid-only nursing home, a NH, whether for-profit or non-profit, does not have to accept Medicaid patients automatically. Indeed, many do not.

We investigated 9 facilities near us for my MIL in 2012-13. All were full-care, well-rated, pleasant places. None accepted Medicaid-only patients, period. They varied in policies regarding lack of funds/current residents. 3 would keep indigent residents, helping them apply for Medicaid admission, and then supplementing care costs from general funds. 6 facilities were flat-out "No money, you leave NOW."

There are waiting lists here for Medicaid nursing facilities. I've never been in a good one. Every one I've visited, I wouldn't put a dog in. According to our state rankings (published and on-line) not one Medicaid facility ranks above the bottom third, for safety or staff turnover.

My MIL was 84 yrs old when she entered the facility. It's third-ranked in the state, has a gorgeous 5-acre campus and has wonderful staff. At her first meal as a resident, she discovered her three tablemates were, respectively, 89, 91, and 99 (the 99 yr old is still alive and in AL, at 103).

She loved living there and even became a bocce ball whiz at 85 – who knew! Pretty good for someone with moderate dementia. Although she died unexpectedly from a brain aneurysm just shy of 86, it should be noted that it is not at all unusual for dementia patients to live 10+ years.

There are exceptions to this, of course – there are over 50 different causes of dementia. A very few are caused by physical issues and can be reversed. The majority cannot; it is progressive and eventually fatal.

Even if you do not develop dementia, you have no guarantee your good health will continue. Don't forget that 25% of disability recipients are under age 65. Medicare does not pay 80% of everything that might happen to you. In fact, when end-of-life issues are totaled in, Medicare only pays about 55% of everything spent.

Very good informative post. With my uncle, they charge fees equal to his SS/Pension income and provide very good service. He does however have an irrevocable trust which protects all his other monies.

 

[COcheesehead]

+1 with question. Any idea what the division of expenses between LTC and medical care?

LTC - stuff covered by a typical LTC policy
Medical care - stuff not covered by typical LTC policy, but buy medical coverage

this may be hard to sort after the fact.

IIRC It is often noted that most of ones medical expenses occur during the last year of life. I'm wondering how one would divide LTC/medical expenses for late in life.

It’s been 9 years now, so my memory is fuzzy. He did not have LTC coverage and he/we paid a lot out of pocket. We were selling his assets towards the end to pay for some things. He died with a positive net worth, but just barely, $40,000.

 

[TwoByFour]

I am not adverse to sucking some carbon monoxide. LTC, to me is, not really living anyway. DW however is not keen on the CO idea so we will just pay for it for her, if need be. My research into LTCi was not encouraging. It seems to be an urban myth at this point.

 

[kevdude]

I said no, that we'll self insure. To be honest though, I haven't really looked into it seriously. I've heard too many stories about insurance companies not paying and about the average life span once in a nursing home/LTC facility. I think we'll have to look into it though. DW was recently diagnosed with Type II Diabetes, so it sounds like she may not qualify based on some of the comments.

 

[DeborahB]

I do not want to live a sub-quality life. If I need nursing care to recover from a broken leg, that’s one thing. Before I slip into senility I have an exit strategy planned. I will keep enough assets to pay for assisted living for a couple of years, but I don’t want to live that way for long.

 

[HI Bill]

Before I slip into senility I have an exit strategy planned.

I wish you luck! My mom was affected by dementia, and for the first four years or so, she denied its effects. BTW, I also have an exit strategy. Let's hope that we are both able to execute the plans if needed! My worst nightmare would be to have a stroke and be paralyzed in a nursing home. Having visited long term care facilities (assisted living, memory care, mental health care), I have no desire to EVER go back.

 

[youbet]

I was thinking of the concept that one starts their nursing home stay by paying X amount of money for X years, so they are accepted in and when the non trust monies run out, they are effectively allowed to stay on while converting to medicaid support.

What is the advantage of the irrevocable trust vs just giving the money to whoever the beneficiary of the trust is? In either case, the money is no longer yours. Is it because you have some strings attached such as some controls because the beneficiary is a minor, etc., ?

I assume the irrevocable trust would be subject to the five year lookback period just as gifting would be.

 

[Dtail]

What is the advantage of the irrevocable trust vs just giving the money to whoever the beneficiary of the trust is? In either case, the money is no longer yours. Is it because you have some strings attached such as some controls because the beneficiary is a minor, etc., ?

I assume the irrevocable trust would be subject to the five year lookback period just as gifting would be.

Yes the irrevocable trust is subject to the 5 year lookback. The beneficiaries would be myself and siblings.
I guess it more comes down to having all the siblings control the trust and using it for the parents' best interest, vs. theoretically passing it down to the children and one child for example decides that he/she needs the monies for themselves.

 

[DeborahB]

I wish you luck! My mom was affected by dementia, and for the first four years or so, she denied its effects. BTW, I also have an exit strategy. Let's hope that we are both able to execute the plans if needed! My worst nightmare would be to have a stroke and be paralyzed in a nursing home. Having visited long term care facilities (assisted living, memory care, mental health care), I have no desire to EVER go back.

I have also seen what it’s like, and that’s also my worst nightmare. I think if you refuse intervention you wouldn’t live long. Hoping.

My executors and I are very much in agreement about what to do.

 

[mickeyd]

Is this the weekly LTC poll? Guess so. I still self insure.

 

[aja8888]

Is this the weekly LTC poll? Guess so. I still self insure.

Hmmmm...I'm not sure if I voted in this poll or the one previous. Oh well, I still will self insure too.

 

[Chuckanut]

Another LTC article, this time from the WSJ, most likely behind a paywall:

https://www.wsj.com/articles/the-od...re-11559836590?mod=searchresults&page=1&pos=6

A more detailed look at long-term care, published in 2015 by Health and Human Services and revised in 2016, looks at the risk of people developing a disability and needing help with “activities of daily living,” such as bathing, dressing and eating. The study estimates that about half (52%) of Americans turning 65 today will “develop a disability serious enough” to require long-term services and support—and about one in six (17%) will end up spending at least $100,000 out-of-pocket for such services. (Go to aspe.hhs.gov and search for: Long-Term Services and Supports for Older Americans.)

It contains these interesting statistics:
The following percentages of adults turning age 65 in 2015-19 can expect future out-of-pocket expenses for long-term services and support to total:

Here are a few of the expense ranges:

$0 67.2%
< $10000 4.7%
$75,000 - $99,000 3.2%
$250,000+ 8.6%

The two highest percentages are $0 and +$250,000. All the other ranges are in the 2% - 5% area.

One really needs to read the entire government document mentioned above to get a feel for how this all works out.