LTC -- how do you plan on covering this risk?

[youbet]

i wish our area ran 3k it is 9-10k a month .

If you're referring to jkern's post, he said $7k/mo, not $3k.

 

[youbet]

the NHs that take a big % of Medicaid patients will be pressured to keep cutting costs resulting in barely-adequate care.

We found out that that is a big deal here in Illinois. When we were shopping for a NH for my MIL in the Chicago suburbs, no facilities we liked were accepting Medicaid patients off the street. Because MIL could private pay for a year+, and because her SS and some military benefits would partially pay each month beyond that, we were able to negotiate her into a better place. This facility accepts no Medicaid cases from the street and only about 15% of the total patients are Medicaid. Those 15% are folks, like MIL, who ran out of money while in residence and were in a Medicaid qualified bed at the time they ran out of money. The facility gets most of MIL's SS, all of a small military benefit and is waiting patiently for Illinois Medicaid to start paying.

The bottom line is you want to be in a home where most of the residents are private pay and the quality of the facility and the staff reflects that the residents are free to move somewhere else if they are dissatisfied and can find what they think is a better place for their private pay money.

If you can only private pay for a year or two, be careful to pick the right place since once on Medicaid, you won't be welcome at many other places.

If you are on Medicaid from the get-go, get ready for a tough search, at least in NE Illinois. I've heard it's easier to find a decent place that takes Medicaid folks off the street downstate.

 

[youbet]

I would think the state would have to enforce the law uniformly. If the law does not define limiting rules and guidelines, they likely could have counter suits and appeals to the Supreme Court of the state.

I could see this stuff if $ were shifted late in life, but not just because someone is related. JMO

Bear in mind that the Penn case did not involve Medicaid or the State of Penn.

A man from Peru brought his mother to live with him in Penn. While here, she was in a car accident and wound up in a NH to recover from the injuries. When she was released from the NH owing $96k, she left and returned to Peru without paying. The mother had not qualified for Medicaid at the time of her release from the NH. The NH sued the son for the $96k.

This is a bit different than a parent being in a NH on Medicaid and after the parent's death the state sues a child to recoup the Medicaid money. Anything is possible with government and politics, but I'm not concerned about it happening to me (my MIL is in a NH partially on Medicaid right now) when she passes.

(I hope I don't regret saying that! This is Illinois!)

 

[bingybear]

We found out that that is a big deal here in Illinois. When we were shopping for a NH for my MIL in the Chicago suburbs, no facilities we liked were accepting Medicaid patients off the street. Because MIL could private pay for a year+, and because her SS and some military benefits would partially pay each month beyond that, we were able to negotiate her into a better place. This facility accepts no Medicaid cases from the street and only about 15% of the total patients are Medicaid. Those 15% are folks, like MIL, who ran out of money while in residence and were in a Medicaid qualified bed at the time they ran out of money. The facility gets most of MIL's SS, all of a small military benefit and is waiting patiently for Illinois Medicaid to start paying.

The bottom line is you want to be in a home where most of the residents are private pay and the quality of the facility and the staff reflects that the residents are free to move somewhere else if they are dissatisfied and can find what they think is a better place for their private pay money.

If you can only private pay for a year or two, be careful to pick the right place since once on Medicaid, you won't be welcome at many other places.

If you are on Medicaid from the get-go, get ready for a tough search, at least in NE Illinois. I've heard it's easier to find a decent place that takes Medicaid folks off the street downstate.

This has been true for at least more than a decade. If you come in as medicaid, the choices are restricted... but if you can pay for a year or so... many more are available. This was also true for my mother... but I was out of country when she needed a NH initially.

 

[jazz4cash]

I read every LTC thread with interest. We don't have LTC insurance so we are in the self insurance crowd...and probably more into the hoping for good luck, roll the dice crowd than I care to admit. My one concern is that one of us could end up needing extensive LTC and impoverish the other. I am not so concerned if the last to die blows through all the assets....don't have a desire to leave a large estate.

Given my concerns, why don't I got for LTC insurance? At this point I just don't feel good about any of the plans offered.


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THIS!!!
A policy to cover the first spouse only would be very attractive to me. We just met with a Met Life rep about another matter and the topic of LTCI came up so I asked if such a policy existed and he just kinda stared into the distance. Anybody know of any way to cover the first spouse and preserve assets for surviving spouse?

 

[bingybear]

THIS!!!
A policy to cover the first spouse only would be very attractive to me. We just met with a Met Life rep about another matter and the topic of LTCI came up so I asked if such a policy existed and he just kinda stared into the distance. Anybody know of any way to cover the first spouse and preserve assets for surviving spouse?

So how do you "cover the 1st spouse? But what if the first spouse does not stay in all that long?.. and then returns to the community. How I would think of covering the first spouse... but two LTCi policies at the same time as a couple and pay for a shared benefit rider. Assuming the 1st spouse uses all their benefit and the other does not, they then tap into the other policy. Now the question is how much to fund the policies.

As for impoverishing the other spouse, look up a medicaid compliant annuity. This may be a way to keep form impoverishing the community spouse if the one in LTC is obviously never coming out.

 

[Independent]

I read every LTC thread with interest. We don't have LTC insurance so we are in the self insurance crowd...and probably more into the hoping for good luck, roll the dice crowd than I care to admit. My one concern is that one of us could end up needing extensive LTC and impoverish the other. I am not so concerned if the last to die blows through all the assets....don't have a desire to leave a large estate.

Given my concerns, why don't I got for LTC insurance? At this point I just don't feel good about any of the plans offered.

Exactly my concern. The second to die can sell the house and use all the financial assets. That will pay for care to the point that we are dead or don't care.

But, I don't want he first to be the one who needs extensive care, then bankrupts the other. A shared pool LTCi policy might work, a good state partnership plan may work. Unfortunately, I think I need to research this more.

 

[bingybear]

Exactly my concern. The second to die can sell the house and use all the financial assets. That will pay for care to the point that we are dead or don't care.

But, I don't want he first to be the one who needs extensive care, then bankrupts the other. A shared pool LTCi policy might work, a good state partnership plan may work. Unfortunately, I think I need to research this more.

Look at a medicaid compliant annuity. These are there to allow the first in to qualify for medicaid and not impoverish the community spouse. But they are not there to fund the heirs.

 

[imoldernu]

A few things... covered in other threads.

Re: Medicaid and nursing home in Illinois... likely in other states.
For non-nursing home spouse. Not a simple one sentence explanation, but likely similar for most state. Cover age, situation, spend down etc. If you should plan to make this a possible part of your retirement planning, the ten minute read could save later mistakes and certainly very much money. The five year lookback is extremely important. Using the law properly could result in hundreds of thousands of dollars in savings.

Illinois Legal Aid | Disabilities Guidebook: Medicaid (for Adults)

Note that the "staying in the home" refers to the spouse. The alternative would be selling the home and using the proceeds to pay the nursing home expense. In the first case, a five year stay in the nursing home would leave the surviving spouse with the home, still living there until death, which could be ten years later. Selling the home would essentially leave the survivng spouse with paying the nursing home the income from the home sale and the minimum cash allowed (perhaps $50K) to live on and no home.

The use of medicaid assumes that after the 2nd spouse passes away, the nursing home expense would be paid from the receipts of selling the home. In other word, a iien on the property. Obviously the better option.
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On the matter of LTC insurance. The poiicy should be studied in great detail. Very simply... the early policies were based on statistical presumptions that were very wrong. Our simple policy of $100/day purchased in the early 1990's guaranteed no increases in premiums except for some narrow exceptions which have not come to pass. That said the original guarantor (Travelers) sold to Conseco, who also resold, until the policy came to rest in a Pennsylvania non-profit Trust Fund... Senior Health Insurance of Pennsylvania... SHIP. Most current and new policies have escalation costs. SHIP - Welcome

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We can only plan on situations as they exist today, but without looking at the many possibilities... five to thirty years in the future, making decisions based only on current assets or income sources... inheritance, SS, Pension etc... without considering alternatives, could be costly.