Long Term Care Insurance: You Get What You Pay For

Don and his father sat in the office drawing up a plan of care that would address Don’s mother’s increasing needs. It was an emotional meeting because Dad had always taken care of Mom in their fifty-two years together. It was very hard to consider entrusting her care to someone else.

In a world where spouses can literally die taking care of each other, one short term planning goal was to find reliable professional caregivers to keep her at home as long as possible. They also needed to outline a long term care plan for when Mom could no longer remain safely at home. Mom had Alzheimer’s Disease, a progressively debilitating, cognitive disease which eventually robs its victims of memory and renders them unable to care for their most basic needs.

Together we outlined a menagerie of short term services that included home modifications, private duty and licensed caregivers, day care services and respite care. She remained at home safely for several years at which point she moved to a special care residence for the memory impaired and eventually on to a preferred nursing home. While these changes and transitions were painful for her family, the costs of her care could have been equally painful.

Fortunately, Don was a financial planner who had the foresight to sell his parents Long Term Care (LTC) Insurance prior to his mother’s diagnosis. That policy eventually would pay for every service rendered, including the cost of home modifications and the actual care planning process. She continues to live at a nominal fee, in the nursing home, thanks to her son’s proactivity. This family was lucky. They worked with someone who had their best interests at heart. The professional son knew his product and he knew how to choreograph it to be of the greatest benefit to them.

Not everyone is so fortunate. Take the elderly couple who took out a LTC policy in their 80’s – to the tune of nearly $9000 per year. They had done some planning already by setting up a trust ten years before to protect their assets. They had $30,000 per year in income and $6000 in personal savings. With nursing home rates in Central New York at $200+ per day, where would they come up with the additional $120 to co-pay the daily cost of the nursing home when the need arose? Answer. They wouldn’t. They would, however, pay that $9000 combined premium every year until one of them needed care, at which point they will apply for and be eligible for Medicaid. They were throwing their money away on premiums.

Then there’s the woman who had complete care of her husband with Parkinson’s Disease. She and her husband had purchased a LTC policy ten years before and it was now time to file the claim. As the situation progressed, the issue of Medicaid was addressed. They had purchased two “Partnership” Policies, LTC insurance plans specially designed to “partner” with the State of New York to provide Medicaid benefits once the claim period is exhausted (The strength of such a policy lies in the guarantee of the protection of assets, regardless of the amount of the client’s net worth at the time of the Medicaid application). When asked about Medicaid planning, she indignantly replied “WE’RE not EVER going on Medicaid”. This woman had no idea why she had purchased such a policy which would not benefit her in the ways in which it was designed.

Countless people have also purchased policies that “aren’t worth the paper they’re written on”. Many people are scared off by high annual premiums and they compromise on features to lower those premiums. Some insurance salespeople “undersell” to make the product affordable. Recently a middle aged couple were considering a policy that would pay them $80 per day for two years with a very high deductible and a simple inflation factor figured into it. They were willing to pay out $200 per month for the policy without considering the following factors:

-The average stay in a nursing home is 2.5 years

-The current costs per day are pushing $300. 24 hour home care can cost even more.

-When they retire and are on a fixed income, will they be able to come up with the $120 per day co-payment when it comes time to file a claim?

-When they are retired or on a fixed income, will they be able to continue to keep up with the cost of the premiums?

Many people have paid into insurance plans for years and eventually cancelled them because they could no longer afford them. Don’t take a plan out to begin with, if you suspect it may one day be out of reach.

Everything is a gamble, especially in the insurance industry, which is ruled by statistics. The son of an elderly woman inquired as to the cost of LTC insurance for his mother. She was nearly 80 years old and the costs were staggering. A policy that would meet her needs was nearly $8000 per year. He and his mother chose to invest in it. That was last April. Earlier this year she suffered a few setbacks and in March moved into a residential care facility at a cost of $40,000 per year. One more year of premiums (her "deductible") and her insurance company will take care of her for the next five years. The gamble worked in this woman’s favor.

LTC insurance isn’t for everyone. Be sure when you meet with an agent that they are reputable and have a sound understanding of long term care. Many of the people who sell ineffective policies are not dishonorable people. They have often been trained in products and annuities and investments, but they may not know anything about long term care. Be sure they have a solid understanding about care and service features. Ask them if they know about Medicaid and rules of eligibility. Know what you are paying for and remember that if it seems too good to be true, it probably is.

You may find yourself with a representative from one company offering you quotes including various plan features. Just like anything else, different companies offer similar products at different prices. Comparison shop for quotes from a variety of companies. The savings could mean thousands of dollars in the long run. Be sure to also work with a solid company that will still be around when it’s time to file your claim.

LTC insurance is the only way to fund the costs of long term custodial care. The right LTC insurance plan can protect you from the catastrophic costs of nursing home and other types of care. Have an expert review your current policy to be sure it is designed to meet your needs. Make an informed decision before buying a policy; it may be one of the most important investments you ever make.

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