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Long Term Care Insurance – You Don’t Need It As Badly As The Insurance Companies Say You Do

by Neal Frankle

You might not need long term care insurance, despite the hoopla you’ve been reading over the last 20 years.

What is long term care insurance?

Long term care insurance

Long term care insurance may not provide as much coverage as you would like.

Basically, it’s a type of health insurance that pays for skilled, intermediate, and custodial care in your own home, adult daycare setting, assisted-living facility, or nursing home.

People who buy this insurance want to protect themselves financially in case they become unable to care for themselves because of a chronic illness, disability, or cognitive impairment, such as Alzheimer’s disease.

Most people buy long term care for a combination of reasons:

  • They don’t want to burden their children.
  • They want to stay in their own home in case they get sick.
  • They want to make sure they have the care should they need it.

Who needs long term care coverage?

According to the Insurance industry, just about everyone.

“Research by Conning & Company shows that 60% of people who reach age 65 will require long term care at some time in their lives. If we extend the Conning & Company stat a bit to include the odds that either person in a couple or spousal situation will need long term care the odds increase dramatically. One widely respected publication, Wall Street Journal, states “… a couple turning 65 has a 75% chance that one of them will need long term care.” This high risk can also affect the entire family where the children are at risk of a negative inheritance, also according to the Wall Street Journal.”

Wow. That’s frightening. (You don’t think the insurance industry is trying to scare us by design do you?)

Before you put your insurance agent on speed-dial, there’s more you need to know. While you may need long term care services some time in your life, you may not need those services for all that long.

In fact, according to Elderweb.com, close to 80% of the people who go in to a long term care facility, are discharged in less than a year. That means you may be able to self-insure because your total cost may be much less than you think.

If we assume that the average cost is about $200 a day for facility care, and you stay for a year, that adds up to $73,000. That’s not chicken feed, but it’s not a fortune either.

Want more bad news, Mr. Long Term Care Salesperson? Even the U.S. Department of Health and Human Services says 47% of us go home or go under within a year.

long-term-care-insuranceThere seems to be some discrepancy between Eldercare.com and the Department of Health but I think it’s safe to conclude that you have a 50% to 80% of needing long term care for less than a year – if you need it at all.

Even if you do buy it, it won’t solve what is likely your greatest concern – the desire to stay in your own home. Why? Because the policy won’t pay enough to sustain you there.

Here’s what I mean. Let’s say you buy a policy that pays $200 a day in benefits which is typical. The $200 a day might be enough to pay for facility care. But that same $200 a day won’t go nearly as far when you spend it on home care. Depending on what your health needs are, the cost of keeping you home may far exceed $200 a day. That being the case, you’ll end up in a long term care facility anyway.

Those are just a few of the problems with this coverage.

Other things to think about include:

  • Will the company who sells you this policy be around to pay when you have a claim? In case you haven’t heard the news, insurance companies actually can go out of business.
  • You may never have a claim that pays you more than you paid the company. At least half the people who need care, need it for less than a year.
  • You may not qualify for benefits. All policies have restrictions. Make sure you understand what they are. Some companies go so far as to make you go before their own doctors for review before they approve a claim. Avoid those types of policies like the swine flu.

What to look for with long term care insurance

Am I saying you don’t need this coverage? I am not. For some people, having this kind of insurance is a life saver. If you decide you want to have this coverage, here’s what to look for:

1. Find a strong insurer. You are buying a policy now but you may only use it in 20 to 30 years. You can check online ratings from A.M. Best, Moody’s, Standard & Poor’s, or Weiss. The first three services are free; Weiss charges $7.95 for each company rating online and $15 by phone.

2. Don’t buy too soon. Although salespeople will try to get you to buy a policy as young as 40, you may not need it until you reach age 80. By then, new systems may develop making your policy obsolete. Want an example? 15 years ago, long-term-care insurance did not pay for care in assisted-living facilities – now it’s a standard. I suggest you start thinking about it at age 60 and buy the policy at age 65 – if at all.

3. Buy a flexible policy. To qualify for benefits, you’ll have to be unable to perform a certain number of “activities of daily living.” Make sure your policy calls for no more than two such activities and make sure one is bathing. According to the U.S. Department of Health and Human Services 1999 National Nursing Home Survey, 94 percent of nursing-home residents receive help with bathing.

A good policy will cover care not only in nursing homes but also in assisted- living facilities. A home-care benefit should include adult day care, hospice services, and respite care (temporary overnight care).

4. Cover future costs. Buy inflation protection. Remember, you may not tap in to this policy for decades and long term care costs and other insurance rates are going up quickly. Most policies allow for a 5% annual compounded inflation rider. Buy it.

5. A four-year benefit should be enough. Nearly 90 percent of all people over age 65 who enter a nursing home stay fewer than five years. The average is 2 1/2 years.

Long-term-care insurance is risky and expensive. Your long term care insurance rates could go up and you may have to drop the coverage, losing everything you paid in. Many policies have clauses that can keep you from collecting. And there’s no guarantee that long-term-care insurers will be around 20, 30, or 40 years from now when you need them to pay.

Long-term-care insurance may be a lousy deal, but right now it’s just about the only deal. Have you had any good or bad experiences with long term care insurance? Did the companies pay out or was it like pulling teeth? Would you recommend it to others?

This is a guest post by Neal Frankle. Neal found himself in a financially fragile situation at the age of 17. Both his parents passed away while he was still in high school, leaving behind a small insurance settlement. Neal sought out a financial advisor to help him invest his nest egg so that it would help put him through college. Instead, the advisor charted a self-serving course and was on the verge of burning through the money when Neal realized what was happened and fired him just in time to avoid losing everything.

The experience had a deep impact on Neal and formed in him a lifelong desire to help people learn to make smart financial decisions. Today, with more than twenty-five years of experience in the financial services industry, Neal is an author and avid blogger. To learn more, visit www.wealthpilgrim.com.


Published or updated January 25, 2013.
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{ 35 comments… read them below or add one }

1 dawn

I thought this was a really good post on an important topic, although I’m not sure I agree with you 100%. For one thing, I think you may be lowballing the daily cost of long-term care at $200 a day. I also question your statement that the vast majority of people require long-term care for less than 5 years. Aren’t nursing homes the wost-case-scenario “last stop” for many seniors who become incapacitated?

Unfortunately, the aging process being what it is and absent untimely death due to accident, we’ll all eventually come up with some health condition (like Alzheimer’s) that requires long-term care, and even if family can initially handle it, many do so for as long as they are able and then are forced to put mom or dad in a healthcare facility like a nursing home.

It’s unfortunate that in our current health system, those who need long-term care insurance the most, ie those with a chronic health condition, cannot qualify for coverage because they have a pre-existing condition.

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2 Wealth Pilgrim

Dawn,

Excellent points.

At first glance, I also thought that everyone would need long term care at some point in their lives but the facts don’t support it.

The reason that very few people need coverage for more than 5 years is that many people die in these facilities – or before they get there.

You also could be right about the $200 cost – depending on where you live. It’s a national average.

Thanks!

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3 Miranda

Thank you for this helpful look at long-term care insurance! My husband and I want to live in some sort of adult active community with some services when we get older, and we will probably look for some sort of insurance that would allow for such services. But I like that I don’t really have to worry about it until we are much older. And maybe, if we do things right, we won’t need long term care insurance at all, since we’ll have enough saved up through retirement accounts and other investing…

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4 fredct

Miranda, if you’re healthy enough to be in an ‘active’ community, wouldn’t LTC not be applicable at that stage in your life. Generally LTC is for people well passed (either in age or ability) the ‘active’ stage.

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5 Wealth Pilgrim

Nice forward thinking Miranda!

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6 Rita

Both dad and mom had long term care. Dad had Altzimers and because he had the insurance he was able to stay in his home for at least 2 years longer than he could have without it. Mom had it too. This is her 9 th year since her stroke and the long term care paid for 4 years in her home before nursing home. Mom inquired about long term care just months before being diagnosed with cancer and the treatment caused the stroke from what I understand. The insurance was a blessing.

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7 DDFD at DivorcedDadFrugalDad

Nice post!

My view on this is a simple one– you need disability insurance until you are 65 or retired and then you should replace it with long term care insurance from then on . . .

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8 Richard Varney, Jr.

“My view on this is a simple one– you need disability insurance until you are 65 or retired and then you should replace it with long term care insurance from then on . . .”

Most disability insurance (through your employer) pays only 2/3rds of your salary. However, you CAN get a supplemental disability insurance policy from Aflac that will make you 100% whole with regards to income should you suffer that type of a loss.

But disability only covers your income which satifies your daily living expenses. Remember: it does NOT cover costs associated with Long Term Care (LTC). This means LTC can, (and will), wipe out your income whether or not you are disabled. Does your mortgage payment or car payment go away when you become disabled?

Bottom line: LTCi is there for those that wish to protect their assets no matter what age the covered person is. If you want financial protection from this type of loss at 40, take it when you are 40. If you want the protection when you are at age 65, you can take it now (with an inflation rider) or at at 65 (for a higher premium).

The choice is yours. It really comes down to how important your assets are to you.

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9 Wealth Pilgrim

DDFD, I’m with you.

Rita, I’m sorry for the medical struggles your parents had and I am of course happy they had the coverage.

I hope I don’t give the impression that this is a bad thing to buy……I just think we should be informed consumers. Most people probably don’t need it but for those who do, it really is a blessing.

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10 Lonnie

Thank you for a most interesting and thought provoking post. I would like to add a few comments if I may.

I have always thought of Long Term Care Insurance as a love letter to your family. You know that they want to help you,and they will if they can. But, you will find that due to the emotional and financial strains on family and friends, caregivers tend to get as sick or sicker as the afflicted.

In regards to the age as to when one should purchase Long Term Care Insurance, it should be noted that over 40% of people receiving Long Term Care are UNDER the age of 65. Think of people in accidents. Car accidents; motorcycle accidents; Accidents happen.

When determining the “sweet spot” for the “right” time to purchase Long Term Care Insurance, I believe that you will find that premiums most Insurance companies charge markedly increase when one turns 50. I purchased my policy when I was 49 and locked in those savings for the rest of my life. I have an inflation rider on my policy which will keep my benefits in line with increased cost over time of Long Term Care.

As you mentioned, I cannot stress enough the importance of the financial strength and stability of the Insuring company in making your Long Term Care Insurance decisions. A lot of “weaker” companies are either no longer in the Long Term Care Insurance market, or have raised their premiums to existing policies (sometimes as high an increase as 45%) as is their wont after three years.

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11 Jason

Ok I’m new to this stuff, i see now i can reply directly to your post…. My question is how are you able to lock in those savings for life? are you saying your premium is locked in at your rate for being 49?

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12 Jason

Good facts and points, a good reference for information. Thanks for posting this. however some of them contradict each other. For example you state that “There seems to be some discrepancy between Eldercare.com and the Department of Health but I think it’s safe to conclude that you have a 50% to 80% of needing long term care for less than a year – if you need it at all.” and then you state in #5. “5. A four-year benefit should be enough. Nearly 90 percent of all people over age 65 who enter a nursing home stay fewer than five years. The average is 2 1/2 years.” Average is 2 1/2 years, that’s over twice as long as what you stated previous, saying that you have a 50% to 80% of needing it for less then a year. So which one is it? Ive always read the average to be true, 2 1/2 years, but what are you wanting your readers to believe to be true? Again, very good article and very educational for the most part. Just need some clarification. Thanks

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13 Jason

Question for Lonnie,

how were you able to lock in those savings for the rest of your life? Are you saying you were able to lock in at you rate at age 49, and it will never go up? if so how and what company?

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14 bruhozer

OK
I’ve kind been thrown into this discussion because my mom went around my family’s back and jumped on a LTHC policy from Bankers Life that does not look so good to me. First of all the parent company Conseco, Inc has gone bankrupt and is on the verge of it again. Yea I’m not wild about that. The sales person had her put her B Of A IRA with her company in an IRA probably an anuity that will cover her long term care and get her a dividend check each month. When I called the sales person today they tried to sell me on the company and told me how they would put their Mom into the same thing. Yea I’m not buying that either. My Mom is 78 and has some health concerns but is in pretty good shape and until recently been working and driving ect. I’m always skeptical of a company that make cold sales calls and prey on the elderly who can just make a snap decision without any research into the company. Now I guess I will be back pedaling to get her out of it or re-evaluate it
C

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15 Dwight

I came across this page in my quest to find out how people feel about LTCi. I would like to respond to several of the posted commentary, and by the way not in a combative way but more informational. Specifically though I will comment on bruhozer.

In most cases, the agent is caring and will put their family in the same policy’s they provide. Like anything ofcourse, you have the very few rotten apples…
The insurance industry is very regulated, especially when it comes to seniors. They(seniors) are highly protected with regards to contact, pressure tactics, etc. As a “field undrewriter” (the agent) has the responsibility to make certain the solution(s) being recommended are needed, suitable and affordable. They cannot recommend anything, much less continue a conversation with someone that seems to not have their wits about them.
In the case of Bankers Life, there is a 4 page needs assessment that is mandatory before any recommendation that be offered. This not only protects the agent but the applicant. You mentioned your mom is 78 and has some health concerns. If she shared those concerns with the agent and her worry box contained the idea that she may be of burden to her family when or if the need arose for LTC, it is the agents responsibility to make sure those concerns are carefully met. Like any other insurance, you can’t get LTCi at the time you have alzheimers and now need to use it. Preparation is key. Not knowing what more was offered, that annuity(depending on the annuity)could have served several purposes depending on the amount. (1) Helped to protect your mother’s assets for her family(which may have been a concern in that worry box), (2) a percentage of that monies can be utilized for LTC and (3) allowed her to enjoy the benefits of the market(profits) with the knowledge that her principal and profits are secure from loss. Certain annuities are contracts with the insurance company and comes with certain guarantees.

Regarding daily cost, it obviously just matters the city and state. I don’t know the current numbers at this time, however last year for example, New Orleans, Louisiana was the lowest at $137 per day while White Plains, NY was $351 per day. One option may be to obtain a stand-alone Home Health Care(HHC). Again, it boils down to need, affordability and suitability.

Hope this helps somehow when making or helping someone make a decision regarding insurance.

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16 craig

Dwight Thank you for your response, I do not mean to be combative in any way towards Bankers Life, however there were several red flags that came up after their cold call on my mother. In regards to the LTC policy, first she already had a policy with them that they were replacing with one that was “Better for her” I reviewed both policies the new and the old and there didn’t seem to be any difference in them except for the new premium that was over 2.5 times greater. No inflation coverage on either policy. The max daily benefit is only $100/day and about $94.00/day for home care. That hardly seems like it would be enough in California.
The second red flag was the portion of the underwriting application that you mentioned I believe that this includes the 4 page needs assessment, It asks a lot of personal questions including her annual income. The salesperson filled this all out without asking my mom anything. My mom has a very limited income maybe $20,000 annual at most including social security. The salesperson filled out the application for her and stated her income at $50,000. Also that it is not going to change over the next 10 years and that her assets other than her home would not change either. These were false statements. The questions on that portion asking how you were going to pay for the not covered stuff were answered by the salesperson as “from my income”.
I contacted HICAP re all the concerns I have and they have advised me to file a complaint with the state and or feds about the tactics of Bankers Life. I like the fact that the insurance industry is very regulated, especially when it comes to seniors. I think that seniors usually need some protection, because they don’t always make the best decisions on their own.
As for the anunity portion of my original post, my CPA advised against it for my moms situation, however the tactics by the same salesperson from Bankers Life caused her to start the rollover process from her original 401k with BofA. I was able to direct it into a better fit for her needs.

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17 dwight

Craig,

Regardless of age, an agent must always pay attention to the needs and goals of the individual. That alone will result in a win-win. One bad apple…
It seems your mom is in good hands, which is why it’s so important for family to be involved with such decisions as it truly impacts everyone. Good for you!

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18 Susan Cooper

My Dad at age 62 had joint surgery with complications and his recovery time was MUCH longer than anticipated. During his recovery time, he required full time home care for 3 months. My parents are divorced; my sister and I live 2+ hours away with full time jobs and families of our own,. We were forced to hire a home health care agency around the clock to do his personal care, as well as cooking and cleaning. It cost close to $21,000 for 3 months, but luckily he had a long term care policy which paid for all of the home services. All we had to do was submit a claim with the bill and he got a reimbursement check within a week. They were courtesous helpful and it was no hassles. I don’t know what we would have done without it. This kind of insurance isn’t just for nursing homes and old people.

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19 Jackie

You are so ignorant it is scary. Given you are advising people to self insure, will you be there to pick up the tab when the need for care exceeds 1 year? Did you know that according to the Centers for Disease Control and Prevention: The average length of time since admission is 835 days .

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20 Roger

My wife is 62 and I am 63. We do not have LTC insurance and she was just diagnosed with Parkinson’s, so I doubt that any company is going to want to insure her now. So right now I am feeling like I made a very stupid mistake by not buying LTC insurance when we were younger.

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21 Ryan

Roger, I’m sorry to hear about your wife’s diagnosis, and I wish you and her the best.

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22 Dwight

Roger, I to0 am sorry to hear about your wife’s situation. However, don’t feel stupid about your decision to not have purchased LTCi. It is regarded as the “forgotten insurance” afterall. Every where we turn, we are inundated with insurance products. The problem is that we have all been used to those that offer death benefits, life insurance, but not living benefits. So, unintentionally we were steered to certain products. A good agent will help you in securing all areas without overselling or overinsuring. That being said, while your wife may not qualify, if you haven’t already, you may however qualify. Not aware of your situation, family, health, financial, etc… there are new available products that offer great living benefits including low cost, even in your senior years.

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23 Ryan

Dwight, Thanks for recommending Roger look into LTCi for himself. I should have mentioned that when I first read his comment. I agree this is a topic that many people overlook, but it is an important topic that needs to be addressed. Thanks for sharing.

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24 David

To suggest that Long Term Care insurance is not needed or insurers are out to take advantage of you is irresponsible. $73,000 is not chicken feed, but if the person had purchased a LTC policy for a annual cost of $2000 per year, it would have taken 37 years for them to break even. If they had paid 10 years then had the claim they would have come out $53,000 ahead. How much income did the person lose from liquidating the $73,000? How much did they pay in taxes because of the liquidation. So $73,000 is not $73,000…it is MORE! A 4% rate of return on the $73,000 would have covered a $2000 per year premium. How much time did the family have to spend figuring out what to do because they did not have a provider adviser helping them with a plan? If it is such bad insurance why does Warren Buffett, Bill Gates and Barbara Walters own it? Because they know how to leverage their dollars to protect risk. People have a 1 in 1200 chance of losing their home to fire. Does the average retiree or the high net worth person ever cancel their fire insurance on their home? Yet, you are suggesting that a person who has a 720 chance out of 1200 of needing long term care should not purchase coverage to cover that circumstance. You may want to personally talk to people who have had to pay for their parents care, a spouses care or their own care before you “advise” most of the world they don’t and won’t need the coverage.

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25 Mitch

How would you know that Bill Gates, Warren Buffet, and Barbara Walters own long term care insurance policies?

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26 Rita O'Clair

I take strong issue with the common comments that the LTC insurance industry is “tightly regulated.” In the State of Washington, about 13 years ago, our insurance commissioner decided that the LTC insurance industry was making obscene profits, and she lobbied the state legislature to give her the teeth with which to regulate them. What happened as a result was that all the major LTC insurance companies left the state, and refused to do business here! After 2 or 3 years, she had to go back to the legislature and request that the legislation that had been passed be rescinded. That was done, and the LTC insurance people returned. Tightly regulated?? Don’t make me laugh.
I contacted my state insurance commissioner to ask what the income/benefits ratio was for two companies whose LTC policies I was comparing. They told me they had no such information about any LTC insurance company. How can they be “tightly regulating” them if they have no data about them?
On average, LTC insurance companies are said to pay out only 40 to 45% of their incoming monies (premiums) in benefits, and this percentage is very poor compared to other insurance companies, suggesting they are drifting perilously close to scamming.
If you listen very carefully to all the questions they ask you when you are applying, you definitely get the idea that they want to protect their own interests at all costs.
I also found it very difficult to get info on what the insurance executives make in salaries and bonuses, but I would assume it is way up there.

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27 craig

Rita: I agree that there is probably not enough regulation, but there are some controls in place even if the rules are not enforced. I think that it takes people to speak up to make those people do their job. The bottom line is always, “well was it a good bet”. There is this guy that lived to be 100 with no major health issues and he could be unhappy that he did not get sick and was unable to take advantage of the insurance he bought, then there is the other guy that was in and out of the hospital and saved his assets and $ because the insurance paid off. We all throw the dice. The thing is we don’t want is the insurance agents or company’s taking advantage of us. Charging us more than what the bet was worth. If they do that it should be regulated and if someone breaks the rules they need to pay the price. If that means that someone from the insurance industry that tries to pull a fast one or cook the books and gets caught he or she must suffer the rule of the law. That does not happen on it’s own people have to stand up and call it out.

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28 Rebecca

I purchased LTC insurance while on active duty around age 35. I may have been too young to worry about it, but i am not married and have no kids so didn’t want to burden my sisters or nephews. My premium was locked in at less than $90 a month and includes in-home care, assisted living and nursing home care. Max daily benefit of $450/day, 90 calendar days waiting period and 4% inflation protection per year. Maybe I will need it and maybe I won’t but it is a small price to pay for peace of mind.

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29 marcy

I am 55 years old and my husband is 54. I was in an accident about 27 years ago and had a severe blow to the head that left me without a sense of taste or smell for about a year. I have a furrow in my skull from that accident. I say that because a severe blow to the head increases the chance of developing Alzheimer’s disease.
I have found that I am having some difficulty remembering the appropriate word when I am speaking to a group, and on occasion having a bit more trouble organizing my thoughts. Not bad enough to interfere with my ADLs but concerns me. I’m torn between going ahead and purchasing insurance “just in case” so I can then see a doctor (after whatever time period in the insurance) if I am indeed beginning to develop dementia.

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30 Nick Salem

I am struggling weather to buy LTC also . From what i can tell it really is a form of protection of a dollar ammount , because most affordable policies have a maximum dollar ammount , componded or simple % inflation increase .
So i guess what one is looking at is let’s say at today’s dollars you want to protect $ 204 , 000 ( i am actyally looking at a policy now, with these ammount’s ) A 3 % inflation rate , $ 140.00 a day start , with most bells and whistles , 90 day waiting period , except shared policies and no return of any preminum’s . For $ 117.00 a month , level guaranteed for 10 years and i am 59 yrs old .
Now all that sounds good but i am only protecting $ 204,000 of assets and at todays nursing home rates where i live ( Houston , Tx. ) , the rates average Monthly $ 2,800 for low level nursing homes to $ 5 ,000 for alzheimers care , to $ 8,000 a month for Complete Bed ridden skilled nursing care .

So all that to explore , are the preminums justified for protecting $ 204,000 dollars of my assets , What do you think ?

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31 Dwight

Nick, allow me comment with this story. I met with a gentleman, in his 80′s, a week ago to review his insurance plans. He lives in an independent living facility. He lives there because his wife suffers from altzheimers and resides in the adjoining dependent facility. Close to 30 years ago, he purchased an LTCi policy for both of them paying roughly $50- $75 per month with an inflation rider. It has been 6 years now since his wife has been in this facility. Were it not for his foresight, he would be responsible for $8k per month. Fortunately, he is only responsible for $1,260 which is so much more palatable.

LTCi is more than just for asset protection. The true purpose of any LTC is to help in getting the patient better. Minimal financial burdens helps to heal faster. But also having options… care in home, assisted living, adult day care OR nursing home, helps. An LTCi offers those options.

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32 Brenda

We are looking at this policy where you pay it all in 10 years. $15000 year … $150,000. Is there really any advantage to paying in advance or has anyone heard of that?

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33 Jack Lenenberg

Brenda, a 10 pay may have value in insulating the policyowner from ongoing rate increases by the insurance company. Most useful however is the unlimited long term care tax deduction available to owners of C-Corporations. Many C-Corps opt for the 10 pay approach if there are significant retained earnings in the corporation due to not being constrained by the age-based limitations applicable to S-Corps, and other self-employed entities.

For individuals that do not have C-Corps, a lifetime pay not a 10 pay, may make the most sense.

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34 Dwight

Hi Brenda,

There are such policies but it truly depends on the overall benefits of such a plan, the types of money being used(qualified or non-qualified), who does it benefit? So many variables. Without all the info, I personally wouldn’t be able to assist in advising you either way.

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35 Chris Punder

A sixty year old should be able to get nursing home insurance for around $100 per month. That’s the best way to go.

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