The long term care insurance dilemma

We are pretty much self insured, and what I cannot fathom is buying LTC insurance "when you're younger and get a better deal" and yet I repeatedly see where they can increase your premiums at will. How on earth can you assess the value of a policy when they can ratchet it up to the point you drop it, perhaps a year or two when you could collect? Seems like a great business model for them but for you "buying a pig in a poke." Whatever that means.

It's not a great business model for the insurers, either. That's why they keep increasing rates and why so many no longer provide it. There's a lot of adverse selection involved; people who come from families where everyone dies of a heart attack before age 60 are unlikely to buy it. When rates get increased, the ones who keep paying are the ones showing early signs of dementia. OK, that's an exaggeration, but people who buy and keep this coverage are the ones most likely to need it. I'd also guess that if you do get into a nursing home and have adequate coverage, you'll live longer than someone who tries to age at home because they don't have the money for LTC.

I've come to the same conclusion as you, though- we're self-insuring.
 
We are pretty much self insured, and what I cannot fathom is buying LTC insurance "when you're younger and get a better deal" and yet I repeatedly see where they can increase your premiums at will. How on earth can you assess the value of a policy when they can ratchet it up to the point you drop it, perhaps a year or two when you could collect? Seems like a great business model for them but for you "buying a pig in a poke." Whatever that means.

If you are referring to my comment... Well, we didn't buy it because we "get a better deal". Heck no.

Bought it after seeing friends in their 50s suffer big time when spouses had early dementias. Both needed care for about 3 years before passing. LTCI would have been huge for the surviving spouse, to help their future be more secure.

I'm not saying this is correct. Just saying why we did it for a relatively short term plan (15 years or so). It was admittedly a bit of an emotional knee-jerk.
 
yet I repeatedly see where they can increase your premiums at will.


IIRC, looking at the file my Mom's premiums were about $4K/yr when she initiated coverage when she was in her late 70s. They are about $6K/yr now. When they increased the premiums about 2 years ago they offered to cut the benefit rates in lieu of some of the increase. Hobson's choice.
 
The case for buying long-term care insurance - CBS News

Saw this article on LTC insurance and thought of this thread. The author is obviously pro-LTCI and cites some concerning statistics about the odds of needing LTC:




The above information is reflected in this chart:

I saw this but I think it's just too vague. for example 70% of people at 65 need some type of ltc. what does that mean? my dad needed assistance with simple things in his home which was taken care by having a helper come in 3X's a week. very affordable.

I'm only 55 so I've elected for right now to decline. I did get a rider on my life insurance policy that allows me to use it to pay for LTC if needed
 
We bought a Genworth plan a few years ago for my DW who is in good health and it is $57 a month, lots of restrictions as mentioned by others. Our thought was we would buy it for one of us with her having the likely longer life, thus more likely to need it. We have reduced our risk by 50% the way we look at it.
we had a proposal for 2k/each a year and thought it was not worth it for us... but all these plans need evaluate for our individual situations. If the situation was proportionate... I would not do it. in that case they would not pay enough for the premium. However, maybe your cost was lower than our estimate
 
We started paying on a policy a few years ago. We're using it for early onset issues. We'll drop later and self insure assuming we don't need it.

Seems backwards? Maybe. I guess you could say we're treating it a bit like term life. We won't end up paying $100k into it.

Nords has had many stories on this and it is very enlightening. I've cooled off quite a bit on LTCI.
I think they got it from this govt. website: How Much Care Will You Need? - Long-Term Care Information
Now where the govt. got it I haven't drilled down to see.
And then there's recent data from a research group at Boston College. It's possible that they're objective, because I doubt that the long-term care insurance industry would have published these conclusions:
http://crr.bc.edu/wp-content/uploads/2014/11/wp_2014-12.pdf

That's the inspiration for this post:
Why I Won't Buy Long-Term Care Insurance - Military Guide
Frankly, I don't want to burden my spouse with the hassle of dealing with LTC insurers. Heck, I wouldn't even want Jim Cramer to suffer that fate.

As for insurability, I've learned that the Federal Long-Term Care Insurance Program will turn down an applicant if there are existing veteran's disability concerns.
 
As for insurability, I've learned that the Federal Long-Term Care Insurance Program will turn down an applicant if there are existing veteran's disability concerns.

Aren't disabled veterans covered for LTC through the military?
 
It does include home care, and part of that is unpaid home care by a family member. That's a pretty broad definition.

That's an interesting tidbit MichaelB. Thanks.

I believe the LTC usage stats also include relatively short (up to 100 days) stays for rehab due to surgery, recovery from an debilitating injury, etc. that are covered by Medicare.
 
Thanks everyone, for your insights. Well, at this point I think that I will get some general information and pricing and decide from there. I can see the pros and the cons of both. You're taking a chance that the insurance company will still be in existence 20 or 30 years from now and also regular price increases on an already expensive premium are a concern. Self insuring for a couple hundred thousand is one thing - but paying for long term stays for two adults is another matter.

Sent from my KFTHWA using Tapatalk HD
 
Aren't disabled veterans covered for LTC through the military?
I'm not sure, but I believe that the care would be priced according to financial need.

That's a heck of a question for my next eBook, though-- thanks for asking it. I'm going to have to research what the VA would do, and for which veterans, and from what care contractors, and how much it'd cost.

At this point even the VA is preferable to John Hancock.
 
I'm not sure, but I believe that the care would be priced according to financial need.

That's a heck of a question for my next eBook, though-- thanks for asking it. I'm going to have to research what the VA would do, and for which veterans, and from what care contractors, and how much it'd cost.

At this point even the VA is preferable to John Hancock.

Recall when my late aunt was on medicaid for nursing homes the program for veterans was involved (she served as a nurse in WWII). I don't know if it ever got done but such a program does exist.
 
I'm not sure, but I believe that the care would be priced according to financial need.

That's a heck of a question for my next eBook, though-- thanks for asking it. I'm going to have to research what the VA would do, and for which veterans, and from what care contractors, and how much it'd cost.

At this point even the VA is preferable to John Hancock.

Another weird confluence. This past week I have been researching this exact thing. LTC (nursing home and in some cases Assisted living arrangements) are available via the state run Veteran's Homes formerly known as "The Old Soldier's Home".

Yes, cost is based on ability to pay. You cannot be turned away except for not meeting state residency or medical requirements. They are not The "VA" they are State run entities and different rules apply in each state.

I found out I am eligible for a slot in one of Nebraska's four Veteran's Homes and also in the one big centralized one in the State of Iowa.

My hang up with this is if I ever end up in a group living arrangement
for veterans in my old age they will be the same azzholes I had to live in the barracks with in my young age!
 
Self insuring for a couple hundred thousand is one thing - but paying for long term stays for two adults is another matter.

But -- that's the problem with most long-term care insurance. That is, most of the currently available policies don't give lifetime coverage. Typically they cover 5 years or less of coverage (and 5 years costs a lot more than the 3 years that I've seen that seems to be typical of a lot of policies). They cover and pay for a set amount which is may well be the amount you could self-insure for. Once we figure in the cost of the premiums over an extended period of time, I'm not sure we would get all that much benefit.
 
I remain conflicted about LTC. Just got notice of an increase on my Genworth policy, the first increase since I bought it 4 years ago. So my conflict has escalated.
 
Can you elaborate on what ability to pay entails? I'm particularly interested in what it practically means for a married couple where the disabled veteran is likely to require some type of care (in home or SNF) and is likely to predecease his spouse by at least a decade. If the veteran requires say 5-7 year of LTC while his spouse is healthy and living in the community, are they going to have to drain their personal retirement accounts first before the military kicks in for his care? This could very well leave the surviving spouse with 10+ years to live with no assets.

Another weird confluence. This past week I have been researching this exact thing. LTC (nursing home and in some cases Assisted living arrangements) are available via the state run Veteran's Homes formerly known as "The Old Soldier's Home".

Yes, cost is based on ability to pay. You cannot be turned away except for not meeting state residency or medical requirements. They are not The "VA" they are State run entities and different rules apply in each state.

I found out I am eligible for a slot in one of Nebraska's four Veteran's Homes and also in the one big centralized one in the State of Iowa.

My hang up with this is if I ever end up in a group living arrangement
for veterans in my old age they will be the same azzholes I had to live in the barracks with in my young age!
 
I'm not sure, but I believe that the care would be priced according to financial need.

That's a heck of a question for my next eBook, though-- thanks for asking it. I'm going to have to research what the VA would do, and for which veterans, and from what care contractors, and how much it'd cost.

At this point even the VA is preferable to John Hancock.

Good luck on that project, I think it is a huge can of worms and rules vary from state to state. Since my DH is a disabled vet, please let us know here if you do any posts or updates about this on your blog..Thanks!
 
I remain conflicted about LTC.

I feel your pain.

I've posted previously that we purchased LTC policies for each of us when we were in our early 50's. Six month waiting period, 5% annual inflation adjustment, three years of coverage with an initial premium of just under $600/yr for each of us. The premium went unchanged for 14 years before we were hit with a 50% increase last year. We now pay $875/yr each for coverage that has grown to $208/day from an initial $100/day.

I'm sure we have not seen the last of the increases nor the opportunity to be conflicted.
 
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Can you elaborate on what ability to pay entails? I'm particularly interested in what it practically means for a married couple where the disabled veteran is likely to require some type of care (in home or SNF) and is likely to predecease his spouse by at least a decade. If the veteran requires say 5-7 year of LTC while his spouse is healthy and living in the community, are they going to have to drain their personal retirement accounts first before the military kicks in for his care? This could very well leave the surviving spouse with 10+ years to live with no assets.

I haven't looked into the nitty gritty yet and as he post after yours says the rules vary state to state.
 
The Genworth policy my mom has lists these six criteria for payment:
BATHING- Washing oneself by sponge bath;or in either a tub or shower, including the task of getting into or out of the tub or shower
DRESSING- Putting on and taking off all items of clothing and any necessary braces, fasteners or artificial limbs.
TRANSFERRING- Moving into or out of a bed chair or wheelchair.
TOILETING- Getting to and from the toilet, getting on and off the toilet and performing associated personal hygeine.
CONTINENCE- Ability to maintain control of bowel or bladder function, the ability to performm associated personal hygeine.
EATING- Feeding oneself by getting food into the body from a receptacle (such as a plate, cup or table) or by a feeding tube or interveneously.

She needs to be deficient on 2 of the 6. On good days she can pass all of them, but she's freaking 95 years old and just shouldn't be living by herself or with a lot of checking on, at least.

She just survived a house fire and pneumonia. She's finally going into assisted living and I hope , since we all know corporations are people too, they will be understanding (after she has paid them $100k over 20 years). She will have her interview in a couple of weeks- will report.
 
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Wow, went through some of this VA stuff for my dad.

First of all, did you know about the "Aid and Attendance" benefit? We were pretty enthusiastic about this. Dad served in WWII and is eligible, even though he is not an army pensioner.

But alas, the benefit really isn't that much (can't remember exactly, but a few thousand a month), not enough to pay his LTC. It kind of seemed useless, to be honest, but I think it could work for some folks in assisted living. Dad had a 10% war disability too, and this payment would be deducted for the AA payment.

Second, all the VA LTC benefits have ability to pay in them. They also have some priority scheme. Dad would not be at the front with his (non government) pension and only 10% disability.

The application is thick. I suggest anyone considering it dig deep. You can find information out there. Also, I spoke with some finance folks at dad's home and they had indications of what it takes to get VA benefits. Assets (aside from home) need to be in the $100k or less range. Over that, and you probably will be denied. However, sometimes it takes months (1/2 year or more) go through the app, so people apply ahead and watch their assets drain during the application wait. NOTE: do not take my 100k number as firm gospel. The "real" number floats and is based on location, monthly income, etc., etc. It is just an estimate based on what I heard from finance people who were willing to talk. Very few people want to give any indication of what this number is.

What I basically found was that there are all sorts of tricks people do to hide assets, hide pensions, etc., etc. I was unwilling to do any of that and we continued our self-pay.

The process is so complex, there is a whole shady industry built around it. Supposedly, nobody can charge you for advice, but they "have ways."

As for straight VA nursing care, it was similar. But as I said, Dad was going to be at a lower priority since he was not a full military pensioner. And there were need requirements similar to the AA plan, so again, we didn't bother.

Let me summarize what I felt about this... The VA nursing or aid benefits are just a bit above Medicaid from a financial eligibility standpoint. I didn't visit a VA home. I would hope, though, that the standard of care was better. Despite what you may hear out there, Dad and us kids loved the VA. They treated him well -- even saved his life twice. Our only problem was it would take 3 months or more for many appointment lead times. I'd hope their care facilities were as good... but I don't know.
 
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The question is is the disability service connected and the percent of disability. If high then the answer is likley yes. If low you get into the means tested realm. High is 70% here is a link to an article with more info:
https://www.caring.com/articles/va-nursing-home

In this case the disability is high (I believe it's 90 or 100%) and service related -- related to Agent Orange exposure, which I believe may have some additional entitlements (at least the presumption of disability without having to prove as much).

Based on this, it seems this applies (Paying for Long Term Care - Geriatrics and Extended Care

Special Monthly Compensation
If you receive VA compensation for a service-connected disability, you may be eligible to receive additional monthly monetary benefits if you ALSO:
Require significant help with your personal care needs by another person because of your disability, or
Are bedridden because of your disability
You can use your Special Monthly Compensation payments to help pay for services that you need.


SMC rates: Special Monthly Compensation (SMC) Rate Table - Effective 12/1/14 - Compensation
Looks like from around $3,500/mo to $5,000/mo, depending on rank and status.


There is also the Aid & Attendance that someone else mentioned.

What I can't find is if these are means tested. Again, the primary concern is what about a community spouse who is depending on traditional retirement assets to live off of.
 
The question is is the disability service connected and the percent of disability. If high then the answer is likley yes. If low you get into the means tested realm. High is 70% here is a link to an article with more info:
https://www.caring.com/articles/va-nursing-home
Exactly! Which is why dad at 10% was back of the line.

If you do fall into means testing, I gave some of the rough guidelines. YMMV.
 
We have a friend who recently bought LTC for himself. $6K/year premium, he is early 60s. Couldn't buy it at all for his DW, also early 60s, but would have been happy to pay $6K/year for her as well.

We ourselves have LTC that we bought for both DW and myself in our mid 30s. We're now 57 and while the coverage cost, with Hancock, has increased by 75%, it is about $2K/year for both of us. Very good coverage as well, but I expect the cost to double every 7-8 years. We're going to hang on to it. DW's mom spent 15 years in a wheelchair due to multiple strokes. Her dad took care of her mom all that time. I have relatives on my side with early dementia.

We think this will protect each other should something go wrong with the other spouse.
 
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