Long Term Care Insurance - my experience

[REWahoo]

I too would prefer not to use it but I have a progressive neurodegenerative disease so unless something else takes me fairly soon I will use it.

In your situation taking out a LTCI policy was likely a very wise financial decision. All the best.

 

[Scuba]

I wish you the best.. My MIL who milked cows for over 65 years, raised a huge garden. played softball and hunted ducks in her spare time developed this horrible disease. Just sayin.....she spent 7 years in a memory care unit probably because she was healthy as a horse.

Exactly. My MIL is extremely healthy other than her Alzheimer’s. She’s never been overweight, has no chronic diseases, and her doctor recently said her recent lab results were better than most 60 year olds. Unfortunately she has had Alzheimer’s for over 7 years and it is definitely progressing. She is 87 and is still aware enough of what is happening that she knows her brainpower is slipping away. So sad and hard for her. I try to encourage her and pep her up by reminding her of the capabilities she still has.

 

[Lewis Clark]

... Coverage is $314 per day for 5 years. Of course, we still have the 90 day exclusion period. ...

The issue of LTCI can be a very emotional one. My father used the benefits from his policy for about 15 months in a nursing home until he died. The insurance company did not balk at paying per the policy terms so it was a good experience from the insurance policy perspective. But he died before using all of the benefit.

His was my first experience with the nursing home industry as a customer. I learned that nursing homes do not have to accept everyone who wants to move there. Sort of like applying to college in that respect. The nursing homes we checked out were more likely to accept new customers if they had LTCI because at least part of their fee was insured and not dependant on personal resources or government programs.

This is how I think of LTCI in an effort to keep some of the emotion out of the decision:

In general, I believe insurance is for covering potential major expenses that are beyond what I would be able to pay on my own, or beyond what I would want to pay on my own.

Assuming the daily payout is $314 for a maximum of 5 years, I would be buying $314 / day * 365 days/year * 5 years = $573,050 worth of coverage. If I can cover the $573,050 from my own resources (without depleting funds for the surviving spouse) then LTCI is not something I would buy.

I would evaluate whether I thought the premiums were worth the cost for $573,050 of coverage. I would consider that many policies raise the premiums every year or two, often with large increases. My mother still has her LTCI policy. Every year or two she is faced with the choice of paying much higher premiums or reducing her coverage.

Since many people with LTCI do not use the full policy benefit, and many use no benefit at all, I would choose the option for the maximum daily payout over the shortest possible length of time. That way, I would maximize the benefit I receive from the policy.

 

[harllee]

I have posted about my mother's situation with her LTCI elsewhere but here it is briefly: DM is age 92, moderate dementia and heart failure, has fallen a couple of times and ended up in the hospital but is in her apartment now. She lives in a nice fee for services CCRC, in an independent living apartment with caretakers but looks like she will have to move to very expensive memory care soon. She has a LTCI policy that she took out over 35 years ago. The premium started low but now it is costing a small fortune every month and goes up annually by about 10%.

The policy has the 90 day wait period and pays an about $150 per day for 3 years. It also has a provision to pay for homecare (HAH!). I have spend untold hours over the last 4 months trying to get the insurance company to pay for mother's homecare but the the company has turned down her claim because DM can still do "activities of daily living" meaning she can still bring a spoon to her month, still get out of bed using a walker next to the bed, go to the beside toilet using her walker. I am appealing the denial and I have recently hired a consultant (at $125 an hour) who specializes in denied LTCI claims. The consultant says most claims for home care are denied but she thinks we have a good case for payment. I think the insurance company is delaying in the hope that my mother will die before the have to pay anything.

I have done the computations and mother has now paid into the policy more than she will ever receive. I am sure in a few instances the policies make sense IF the company will pay. But the problem is that often companies will not pay and they delay.

Based on my experience I would never buy a LTCI policy.

 

[JoeWras]

DW says we need to keep it.

I want to keep peace, so we keep it.

 

[John Galt III]

My Mom's ltc policy does not pay for home care. Anyway, I got some quotes for home care, and it was horribly expensive, imo. $50 an hour, and a 4 hour minimum per day. Getting this every day would be $6,000 per month down the drain. This was in Princeton, NJ. I hope it is less expensive elsewhere. Don't know.

 

[harllee]

My Mom's ltc policy does not pay for home care. Anyway, I got some quotes for home care, and it was horribly expensive, imo. $50 an hour, and a 4 hour minimum per day. Getting this every day would be $6,000 per month down the drain. This was in Princeton, NJ. I hope it is less expensive elsewhere. Don't know.

At my mom's CCRC here in NC, home care through her CCRC is $25 an hour, minimum 2 hours. She has home care 2 hours in morning and 2 hours in evening. Her LTC policy says it pays up to $60 a day for home care which would be a big help but they have denied the claim. Grrrr.

 

[retire48in2018]

Older policies are more generous on $/day, some even link to typical cost of care vs fixed $/day.

I would look into it if coverage was more catastrophic - or shifting risk. Like, I pay $60/day (or whatever)- they cover rest, etc. the last time we looked, it was not very good coverage, from a risk/cost.

It’s like some private health insurance policies that cap their coverage to $100k (or similar)…..in a true catastrophic situation - that’s when I need it. No - to such a capped health insurance policy.

Risk shifting coverage would be of interest only.

 

[Sojourner]

She still recognizes people and can carry on limited conversations, but she asked me if her life could just be ended when she no longer recognizes people or cannot communicate any longer.

Unfortunately, I don’t know how that can legally be done anywhere in the US despite her wishes. Perhaps there are ways and I’m just not aware?

AFAIK, this cannot legally be done anywhere in the U.S. I think there are certain countries in Europe (Netherlands? Switzerland?) where it's allowed for people with late-stage dementia, but in the U.S. the problem is that the afflicted person cannot give consent due to their legal "incompetence".

 

[RetiredHappy]

Mine pays $300 per day, with 3% increase each year and it includes home care. It covers maximum amount equivalence of 5 years at maximum amount per day. It only costs me $117 per month and I am keeping the plan in the foreseeable future. We used to own a home care company and our clients with LTCI had never been denied claims. It takes a carefully written plan of care, doctor's letter and sometimes LTCI independent nurse to assess the client to ensure approval. Our plan is to stay home until we die.

 

[harllee]

Mine pays $300 per day, with 3% increase each year and it includes home care. It covers maximum amount equivalence of 5 years at maximum amount per day. It only costs me $117 per month and I am keeping the plan in the foreseeable future. We used to own a home care company and our clients with LTCI had never been denied claims. It takes a carefully written plan of care, doctor's letter and sometimes LTCI independent nurse to assess the client to ensure approval. Our plan is to stay home until we die.

Wish I had you to help with my mother's LTC insurance. I have the plan of care, doctor's letter and they have denied her claim because she can still use a spoon and use the toilet. You have a great plan for $117 per month. Mother's is over $500 per month and they refuse to pay. I guess I will have to sue them.

 

[RetiredHappy]

Wish I had you to help with my mother's LTC insurance. I have the plan of care, doctor's letter and they have denied her claim because she can still use a spoon and use the toilet. You have a great plan for $117 per month. Mother's is over $500 per month and they refuse to pay. I guess I will have to sue them.

Did the insurance send an independent nurse out to assess her? Presumably the facility wrote up the Plan of Care? The person who wrote it must not have written it properly.

 

[harllee]

Did the insurance send an independent nurse out to assess her? Presumably the facility wrote up the Plan of Care? The person who wrote it must not have written it properly.

I am not expert in any of this. I have hired a consultant (at $125 per hour) to help me. The insurance did not send anyone out they just rejected the claim on the basis she could do the activities of daily living. The consultant says that almost all the LTC companies are rejecting claims for home health care now.

 

[ncbill]

Curious about palliative care only for dementia - what does that mean in practical terms? My MIL was diagnosed with Alzheimer’s 7.5 years ago and until 1-2 years ago, still had a decent quality of life living by herself at home. We did have to move her into a nice Memory Care facility this year. She still recognizes people and can carry on limited conversations, but she asked me if her life could just be ended when she no longer recognizes people or cannot communicate any longer.

Unfortunately, I don’t know how that can legally be done anywhere in the US despite her wishes. Perhaps there are ways and I’m just not aware?

No curative care, including all antibiotics...even oral.

The latter kept mom alive, bedridden, for nearly a decade, even though her HCPOA specified "no IV antibiotics."

By the time she became bedridden she was already complete care, unresponsive, with no ability to communicate.

 

[RetiredHappy]

I am not expert in any of this. I have hired a consultant (at $125 per hour) to help me. The insurance did not send anyone out they just rejected the claim on the basis she could do the activities of daily living. The consultant says that almost all the LTC companies are rejecting claims for home health care now.

We still have friends in the home care industry and they are not seeing the same issues that LTC companies are rejecting home care claims. Good luck!

 

[Sojourner]

Based on what I've seen with older relatives, LTC insurance does not appeal to me at all. Every person I've known who went into memory care or nursing homes—except for one—died within a year or so. The one who lasted much longer than a year might have benefited from LTCI in some way, but even without it, she was still cared for and had all her basic needs met in the facilities where she resided. She was suffering from Alzheimer's, so her awareness of her surroundings was dim and confused, at best. She had only meager savings and a small inheritance from her mother to draw from, in addition to Social Security. That was enough to get her the care she needed. Nothing fancy, but enough. Hard to imagine how LTCI would have improved her situation substantially.

 

[Scuba]

AFAIK, this cannot legally be done anywhere in the U.S. I think there are certain countries in Europe (Netherlands? Switzerland?) where it's allowed for people with late-stage dementia, but in the U.S. the problem is that the afflicted person cannot give consent due to their legal "incompetence".

That is also my understanding, even if someone documents these wishes pre-dementia diagnosis, the medical profession does not allow a practitioner to end someone’s life despite the patient’s wishes.

 

[Scuba]

No curative care, including all antibiotics...even oral.

The latter kept mom alive, bedridden, for nearly a decade, even though her HCPOA specified "no IV antibiotics."

By the time she became bedridden she was already complete care, unresponsive, with no ability to communicate.

So sad about your mom. I hope someday our country will have a more sensible approach and not just prolong life when there is no quality of life. The “no antibiotics” clause is helpful depending on what medical conditions come up.

 

[Koolau]

My mom's LTCi turned out to be a good buy. SO glad we had it.

 

[harllee]

My mom's LTCi turned out to be a good buy. SO glad we had it.

Did you have trouble getting the insurance to pay? I have been battling my mom's insurance company for 4 months now. They have denied the claim. I have now hired an expert consultant and we are appealing, the consultant says denials are very common now.

 

[AudiDudi]

Did you have trouble getting the insurance to pay? I have been battling my mom's insurance company for 4 months now. They have denied the claim. I have now hired an expert consultant and we are appealing, the consultant says denials are very common now.

Isn't it jsut auto deny the initial claim and home the person goes away?



A friend has both his parents (mid 90s) in a memory care facility - the cost is a bit over $12k/mo. He's never mentioned if they had LTCI but I doubt they do and $60/day wouldn't do a lot.

 

[Koolau]

Did you have trouble getting the insurance to pay? I have been battling my mom's insurance company for 4 months now. They have denied the claim. I have now hired an expert consultant and we are appealing, the consultant says denials are very common now.

Not in the slightest.



Keep in mind this was ca 1998. I've heard that some LTCi companies fight tooth and nail not to pay. But that wasn't my experience.

 

[Koolau]

Isn't it jsut auto deny the initial claim and home the person goes away?



A friend has both his parents (mid 90s) in a memory care facility - the cost is a bit over $12k/mo. He's never mentioned if they had LTCI but I doubt they do and $60/day wouldn't do a lot.

Sorry. What did I miss? $60/day??

 

[AudiDudi]

Someone a few posts back mentioned the LTCi policy paying only $60/day.

 

[Koolau]

Someone a few posts back mentioned the LTCi policy paying only $60/day.

Yeah, I just found it. I guess i was confused since I couldn't imagine a payout that low (I'm sure it must have been inflation adjusted??)