Long Term Care Insurance Data

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WoW2012
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Re: Long Term Care Insurance Data

Post by WoW2012 »

ifish100 wrote: Mon Jan 27, 2020 12:37 pm Thank you d0gerz and HereToLearn. Clear answers to the pot of money question and the 90d waiting period.
I will engage the insurance agent and get into the nitty gritty, I know better what to look for. It seems like the big things are the 2 ADL assessment and how big the pot of money is that is guessed at being needed.

It sounds like the term (time) is kind of a red herring, that is confusing they even mention it. You are buying potential access to a pot of money for you and your spouse, saving some money by getting the married couple discount. The access is determined by the gatekeeper certifying you have 2 ADL shortfalls. I like what HereToLearn said, it may not be applicable to the most common normal aging cases, that would have been my guess too.

I hope the LTC insurance claims department is not as frustrating to deal with as the claims department on automotive policies. The nice friendly local sales agent, then when dealing with the claims department a very cold phone call dealing with people with bad attitudes, just worried about keeping as much of their money as possible.

It will be interesting to dig into the LTC insurance. I have a lot to learn.

Thanks everyone.

Filing a long-term care insurance claim is hard, for 5 reasons:

1) it’s brand new for everyone. Even though over one million people have received benefits from their long-term care policies, most of us have never filed a long-term care insurance claim. Your doctor has lots of experience filing medical insurance claims, but little or no experience filing long-term care insurance claims. Who do you turn to for help?

2) Before approving a claim the insurance company needs to review the policyholder’s medical records. To prevent medical records from getting into the wrong hands, privacy laws have created roadblocks which are designed to protect you. These same roadblocks, however, can cause delays in getting your medical records from your doctor’s office to the insurance company’s claims personnel.

3) The policyholder is usually not the one submitting the claim. If a relative of the policyholder is submitting the claim the doctor’s office needs to know the relative has the legal authority to represent the policyholder. Until the doctor’s office is satisfied that you have legal authority to represent the policyholder, they can’t send any records to the insurance company. That’s why legal documents like a durable power of attorney should be in place well in advance.

4) Most communication with the insurance company has to be done via “snail mail” or over the phone. Sending health information via unsecure fax or email is a potential HIPAA violation subjecting the insurance company to huge fines. This can add to the frustration and delay the approval process even longer.

5) Lastly, insurance laws in most states require the insurance company to either approve or deny the long-term care insurance claim within 60 days from the date they received the claim form. If the medical records have not been received within that time, the claim has to be initially denied.

When my relative decided to file a claim on her long-term care policy in 2017 I did NOT handle her claim for her. Even though I’m a licensed insurance agent and I’ve specialized in long-term care insurance for 25 years, I didn’t handle her claim.

We contacted one of the larger national home care agencies and they handled it for us. This particular home care agency processes THOUSANDS of long-term care insurance claims every year. All we had to do was sign a couple of HIPAA forms and they took care of the rest. Her claim was approved in only 3 weeks.

They handled the claim for free. It makes sense.
The home care agencies get paid by the long-term care insurance companies.
They have a financial incentive to set up a system to speedily process long-term care insurance claims.
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JoeRetire
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Re: Long Term Care Insurance Data

Post by JoeRetire »

gmaynardkrebs wrote: Sun Jan 26, 2020 6:01 pm
WoW2012 wrote: Sun Jan 26, 2020 5:56 pm
gmaynardkrebs wrote: Sun Jan 26, 2020 4:57 pm
JoeRetire wrote: Sun Jan 26, 2020 4:42 pm
gmaynardkrebs wrote: Sun Jan 26, 2020 4:16 pmthose in the middle can't afford the premiums.
Some of us can.
The quote I got from the Federal program for me and the missus was over $10K/yr for the plan we were interested in. I may still do it, but that's a lot of $$$.
The average long-term care insurance premium is about $200 per month. You must be a lot older than the average buyer. It rarely makes sense for someone to buy LTCi if they are over age 69!
Yes I'm 69, spouse is 65. We are in excellent health, but yeah, I should have bought earlier.
Ouch.

Working with our financial adviser, she educated us on the factors affecting Long Term Care Insurance premiums, went over the numbers regarding the cost of care in our area, told us the arguments for and against getting LTCi, and strongly suggested that if we decided we wanted to purchase LTCi, we do so before age 60. She was very helpful.

LTCi is very complex, and rather expensive. Sometimes you need outside help to learn enough to make the right decision for your circumstances.
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capjak
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Re: Long Term Care Insurance Data

Post by capjak »

My mother had a stroke and was in assisted living for 5 years and a little less than 1 year in nursing care facility. It was less than more costly areas but still over $350,000 +. In addition, my father had his living expenses. I would say that you would need $500,000+ set aside for LTC in the event either you or your spouse ends up in LTC at an advanced age. If this occurs at a younger age <70 than much more than that or go the Medicaid route.

This led me to purchase a no limit (time) policy (whole life + LTC rider). I also looked at a shared benefit traditional LTC insurance from Mutual of Omaha which allowed the sharing of the benefit if one of the spouses did not need LTC (i.e. both policy limits could be used toward the cost of the 1 person that remained in LTC).
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gmaynardkrebs
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Re: Long Term Care Insurance Data

Post by gmaynardkrebs »

JoeRetire wrote: Mon Jan 27, 2020 1:47 pm
gmaynardkrebs wrote: Sun Jan 26, 2020 6:01 pm
WoW2012 wrote: Sun Jan 26, 2020 5:56 pm
gmaynardkrebs wrote: Sun Jan 26, 2020 4:57 pm
JoeRetire wrote: Sun Jan 26, 2020 4:42 pm
Some of us can.
The quote I got from the Federal program for me and the missus was over $10K/yr for the plan we were interested in. I may still do it, but that's a lot of $$$.
The average long-term care insurance premium is about $200 per month. You must be a lot older than the average buyer. It rarely makes sense for someone to buy LTCi if they are over age 69!
Yes I'm 69, spouse is 65. We are in excellent health, but yeah, I should have bought earlier.
Ouch.

Working with our financial adviser, she educated us on the factors affecting Long Term Care Insurance premiums, went over the numbers regarding the cost of care in our area, told us the arguments for and against getting LTCi, and strongly suggested that if we decided we wanted to purchase LTCi, we do so before age 60. She was very helpful.

LTCi is very complex, and rather expensive. Sometimes you need outside help to learn enough to make the right decision for your circumstances.
One of my concerns back then, and even today, is that I'm paying all this money now, but what if my company abandons the market, as many have done, and leaves me high and dry when I actually need care? Many other companies have been allowed to raise their rates, which means I might not be able to afford the premiums when I'm older.
WoW2012
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Re: Long Term Care Insurance Data

Post by WoW2012 »

gmaynardkrebs wrote: Mon Jan 27, 2020 2:12 pm One of my concerns back then, and even today, is that I'm paying all this money now, but what if my company abandons the market, as many have done, and leaves me high and dry when I actually need care? Many other companies have been allowed to raise their rates, which means I might not be able to afford the premiums when I'm older.

There are currently 13 different companies that sell long-term care insurance policies today. However, last year, over 100 companies paid claims on long-term care insurance. How can that be? If most companies have "abandoned the market" why are they still paying claims?

Long-term care insurance companies are required BY LAW to honor the claims of every policy they've ever sold. When you read that a company has "abandoned the market" it means they decided to stop selling new policies. They still have to honor all future claims of all the policies they ever sold.

Regarding rate increases, policies today have different rules from the policies that were sold years ago. Rates canNOT be increased because you get older or make a claim or have a change in health. And the new rules do not allow the insurers to profit from rate increases. In fact, under the new rules (called the "Rate Stability Regulation") they have to lower their profits if they seek a rate increase.
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gmaynardkrebs
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Re: Long Term Care Insurance Data

Post by gmaynardkrebs »

WoW2012 wrote: Mon Jan 27, 2020 2:29 pm
Long-term care insurance companies are required BY LAW to honor the claims of every policy they've ever sold. When you read that a company has "abandoned the market" it means they decided to stop selling new policies. They still have to honor all future claims of all the policies they ever sold.
Interesting....but suppose a company exited 5 years ago. Do you mean they've continued to collect premiums from the policyholders for the last 5 years? Can they raise the premiums?
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willthrill81
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Re: Long Term Care Insurance Data

Post by willthrill81 »

gmaynardkrebs wrote: Mon Jan 27, 2020 2:50 pm
WoW2012 wrote: Mon Jan 27, 2020 2:29 pm
Long-term care insurance companies are required BY LAW to honor the claims of every policy they've ever sold. When you read that a company has "abandoned the market" it means they decided to stop selling new policies. They still have to honor all future claims of all the policies they ever sold.
Interesting....but suppose a company exited 5 years ago. Do you mean they've continued to collect premiums from the policyholders for the last 5 years? Can they raise the premiums?
Yes, they've continued to collect premiums, and they have the ability to increase premiums subject to the requirements of the insured's state. If the company goes bankrupt, the state guaranty association will supposedly step in to honor the terms of the policy.
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mrc
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Re: Long Term Care Insurance Data

Post by mrc »

gmaynardkrebs wrote: Mon Jan 27, 2020 2:12 pm One of my concerns back then, and even today, is that I'm paying all this money now, but what if my company abandons the market, as many have done, and leaves me high and dry when I actually need care? Many other companies have been allowed to raise their rates, which means I might not be able to afford the premiums when I'm older.
This was our conundrum when deciding whether to accept 15% annual rate hikes for the next several years, or let the policy lapse. The policy is older and quite good. But if Genworth folds, and the state takes over, the guarantee limit is $300K, and we can self-insure that much. So, we are letting the policy stand with just a max benefit of premiums paid.
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mrc
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Re: Long Term Care Insurance Data

Post by mrc »

willthrill81 wrote: Mon Jan 27, 2020 3:00 pm … If the company goes bankrupt, the state guaranty association will supposedly step in to honor the terms of the policy.
Which, in our state, would render an unlimited benefit amount policy worth a max of $300K. Something people must consider: Would you buy or continue a policy with a max benefit of your state's guarantee amount?
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WoW2012
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Re: Long Term Care Insurance Data

Post by WoW2012 »

mrc wrote: Mon Jan 27, 2020 3:32 pm
gmaynardkrebs wrote: Mon Jan 27, 2020 2:12 pm One of my concerns back then, and even today, is that I'm paying all this money now, but what if my company abandons the market, as many have done, and leaves me high and dry when I actually need care? Many other companies have been allowed to raise their rates, which means I might not be able to afford the premiums when I'm older.
This was our conundrum when deciding whether to accept 15% annual rate hikes for the next several years, or let the policy lapse. The policy is older and quite good. But if Genworth folds, and the state takes over, the guarantee limit is $300K, and we can self-insure that much. So, we are letting the policy stand with just a max benefit of premiums paid.
Genworth has about $19 Billion in LTCi reserves.
They receive about $2.5 Billion in premiums every year.
And they incur about $2.0 Billion in claims every year.
That's a lot of billions they would have to burn through to even come close to "folding".
mrc
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Re: Long Term Care Insurance Data

Post by mrc »

WoW2012 wrote: Mon Jan 27, 2020 3:36 pm
mrc wrote: Mon Jan 27, 2020 3:32 pm
gmaynardkrebs wrote: Mon Jan 27, 2020 2:12 pm One of my concerns back then, and even today, is that I'm paying all this money now, but what if my company abandons the market, as many have done, and leaves me high and dry when I actually need care? Many other companies have been allowed to raise their rates, which means I might not be able to afford the premiums when I'm older.
This was our conundrum when deciding whether to accept 15% annual rate hikes for the next several years, or let the policy lapse. The policy is older and quite good. But if Genworth folds, and the state takes over, the guarantee limit is $300K, and we can self-insure that much. So, we are letting the policy stand with just a max benefit of premiums paid.
Genworth has about $19 Billion in LTCi reserves.
They receive about $2.5 Billion in premiums every year.
And they incur about $2.0 Billion in claims every year.
That's a lot of billions they would have to burn through to even come close to "folding".
All of that is subject to change over the next 35 years. Not worth the risk to us. I would have felt better if they had a higher credit rating.
By the time you know enough to choose a good financial adviser, you don't need one. | bogleheads.org is my advisor: The ER is 0.0% and the advice always solid.
WoW2012
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Re: Long Term Care Insurance Data

Post by WoW2012 »

gmaynardkrebs wrote: Mon Jan 27, 2020 2:50 pm
....but suppose a company exited 5 years ago. Do you mean they've continued to collect premiums from the policyholders for the last 5 years? Can they raise the premiums?
Yes, they continue to collect premiums from their LTCi policyholders.
Yes, they can request a rate increase, subject to the rules in effect when the policies were sold.

I bought my policy about 12 years ago. The company stopped selling new policies about 11 years ago. I've never had a rate increase. I'm still paying the same premium today that I was when I bought my policy.
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celia
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Re: Long Term Care Insurance Data

Post by celia »

ifish100 wrote: Sun Jan 26, 2020 9:49 am 1) 70% of all people over 65 will eventually need long term care. Note this would mean "some type of LT care" like it could be an aid coming to the house not necessarily in a nursing home. The scary monthly cost of course.

Just because someone "needs" long term care, that does not mean they need/want to go to a nursing home.
For example, after I broke my ankle and needed surgery, the doctor recommended I go to one but I declined since my house and family situation were supportive of me staying home. I had a co-worker who had a similar medical situation around the same time, but since she rented an apartment on the second floor and lived alone, she went to one. I could have used my LTC policy (after my vacation and sick leave time were used up) but I chose to save all the days for the future.

I saw statistics a while back that said something like half of the people who needed LTC were cared for by relatives and a fourth went to group homes or had part-time help come to their house. A lot of that choice is dependent on what the "needs" are and if the patient is cognitively impaired or not. My example of ankle surgery fell under the < 90 day need and not [yet] cognitively impaired. :wink: My insurance paid for rental of a wheel chair and relatives provided the driving and meal preparation. :wink:
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celia
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Re: Long Term Care Insurance Data

Post by celia »

celia wrote: Mon Jan 27, 2020 4:12 pm
ifish100 wrote: Sun Jan 26, 2020 9:49 am 1) 70% of all people over 65 will eventually need long term care. Note this would mean "some type of LT care" like it could be an aid coming to the house not necessarily in a nursing home. The scary monthly cost of course.

Just because someone "needs" long term care, that does not mean they need/want to go to a nursing home.
For example, after I broke my ankle and needed surgery, the doctor recommended I go to one but I declined since my house and family situation were supportive of me staying home. I had a co-worker who had a similar medical situation around the same time, but since she rented an apartment on the second floor and lived alone, she went to one. I could have used my LTC policy (after my vacation and sick leave time were used up) but I chose to save all the days for the future.

I saw statistics a while back that said something like half of the people who needed LTC were cared for by relatives and a fourth went to group homes or had part-time help come to their house. A lot of that choice is dependent on what the "needs" are and if the patient is cognitively impaired or not. My example of ankle surgery fell under the < 90 day need and not [yet] cognitively impaired. :wink: My insurance paid for rental of a wheel chair and relatives provided the driving to physical therapy and meal preparation. :wink:
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Chicken lady
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Re: Long Term Care Insurance Data

Post by Chicken lady »

Hi iFish100, edited to correct poster's name - got it wrong first time

I suggest you look at the life path of your parents. What level and intensity of care did they need as they aged? Medical care is advanced over even 15 years ago extending individual's lives - changing our ability to accurately assess the odds that you or I'll need LTC insurance.

Then there's the home care issue. Many policies provide in-home care, would that be a priority for you and your spouse? If you're uncertain, go take a look at local nursing homes where you might end up and see if that preview helps you focus on your priorities.

Some people estimate how much they could pay for care and buy a policy to cover the other costs (up to x amount). There are many ways to calculate affordability. If your goal is to save money that won't be spent on insurance - this is a hybrid approach that lets you win a bit more than going all in on LTC insurance.

Both my spouse and I have parents with a history of dementia - watching that condition play out over many years changes the whole equation of the average number of years a person needs long term care. Looking over our shoulders and seeing what could be ahead for each of us, we concluded that a bet on the need for LTC insurance was worth it. I wish there was a formula to nail down the unknowables (like dementia) that can be incapacitating yet linger for many, many years. Don't underestimate the value of hospice care either - it can be in home (or not) and intensive - just part of Medicare that people don't think about until someone needs it. There are many other unknowables - do your families have any ailments that seem to reoccur in your families?

Good luck in your search.
Last edited by Chicken lady on Mon Jan 27, 2020 9:11 pm, edited 1 time in total.
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ifish100
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Re: Long Term Care Insurance Data

Post by ifish100 »

wow2012 you seem to be very knowledgeable on the topic of LTC insurance.
- It sounds like the pot of money is the concept, the $ amount, not the 5 years or 3 years etc.
- It sounds like there is only (1) 90d exclusion, not one for each instance.
- The details on tips for getting claims processed quickly and efficiently should help others.
- It sounds like a "5 year" or $500K policies are the ones to look into, probably one for me and my wife to access the discount.
- What Independent Agent do you recommend, we were looking at Golden Care?
- Can you share what $ amount limit you chose for yourself?

Some concerns we have contemplated...
1) The gatekeeper decides if we have 2 ADL or not, if not we get nothing.
2) Insurance company decides who is a qualified provider, to even get to a qualified 90d waiting period, what if they are not handy or near where we would live? Also ironic if we are paying for it, to be told who is qualified (during the 90d waiting period).
3) When we retire we always want to live near a high level hospital for health care not rural. When you think about it getting near low cost but good nursing homes is another important consideration.
WoW2012
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Re: Long Term Care Insurance Data

Post by WoW2012 »

ifish100 wrote: Mon Jan 27, 2020 7:49 pm wow2012 you seem to be very knowledgeable on the topic of LTC insurance.
- It sounds like the pot of money is the concept, the $ amount, not the 5 years or 3 years etc.
- It sounds like there is only (1) 90d exclusion, not one for each instance.
- The details on tips for getting claims processed quickly and efficiently should help others.
- It sounds like a "5 year" or $500K policies are the ones to look into, probably one for me and my wife to access the discount.
- What Independent Agent do you recommend, we were looking at Golden Care?
- Can you share what $ amount limit you chose for yourself?

Some concerns we have contemplated...
1) The gatekeeper decides if we have 2 ADL or not, if not we get nothing.
2) Insurance company decides who is a qualified provider, to even get to a qualified 90d waiting period, what if they are not handy or near where we would live? Also ironic if we are paying for it, to be told who is qualified (during the 90d waiting period).
3) When we retire we always want to live near a high level hospital for health care not rural. When you think about it getting near low cost but good nursing homes is another important consideration.

- It sounds like the pot of money is the concept, the $ amount, not the 5 years or 3 years etc.
CORRECT

- It sounds like there is only (1) 90d exclusion, not one for each instance.
CORRECT

- The details on tips for getting claims processed quickly and efficiently should help others.
THANK YOU.

- It sounds like a "5 year" or $500K policies are the ones to look into, probably one for me and my wife to access the discount.
IT USUALLY MAKES SENSE FOR COUPLES TO BOTH GET POLICIES FROM THE SAME COMPANY AT THE SAME TIME IN ORDER TO MAXIMIZE THE MARITAL DISCOUNTS. HOW MUCH COVERAGE YOU SHOULD BUY DEPENDS UPON YOUR FINANCIAL SITUATION.

- What Independent Agent do you recommend, we were looking at Golden Care?
THEY'RE GOOD. JUST MAKE SURE THEY DON'T TRY TO CONVINCE YOU TO BUY A HYBRID POLICY. INSIST ON A TRADITIONAL LTCI POLICY.

- Can you share what $ amount limit you chose for yourself?
MY WIFE AND IS HARE TWO POLICIES THAT COMBINED HAVE ALMOST $900,000 OF BENEFITS.


1) The gatekeeper decides if we have 2 ADL or not, if not we get nothing.
YOU'RE NOT POWERLESS. THE BETTER POLICIES ALLOW FOR 3RD PARTY MEDIATION IF THERE'S A DISAGREEMENT ABOUT BENEFIT ELIGIBILITY. THAT'S WHY YOU SHOULD USE A PRO (E.G. A HOME CARE AGENCY THAT'S EXPERIENCED IN PROCESS LTCI CLAIMS) TO PROCESS YOUR CLAIM FOR YOU, AS I OUTLINED ABOVE.

2) Insurance company decides who is a qualified provider, to even get to a qualified 90d waiting period, what if they are not handy or near where we would live? Also ironic if we are paying for it, to be told who is qualified (during the 90d waiting period).
SO WHAT. HIRE A HOME CARE AGENCY TO PROVIDE 2 HOURS OF CARE EVERY DAY FOR 90 DAYS. NO BIG DEAL.

3) When we retire we always want to live near a high level hospital for health care not rural. When you think about it getting near low cost but good nursing homes is another important consideration.
ASSISTED LIVING FACILITIES ARE A LOT NICER (AND CHEAPER) THAN NURSING HOMES AND CAN USUALLY PROVIDE THE CARE THAT MOST PEOPLE NEED.
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JoeRetire
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Re: Long Term Care Insurance Data

Post by JoeRetire »

gmaynardkrebs wrote: Mon Jan 27, 2020 2:12 pm One of my concerns back then, and even today, is that I'm paying all this money now, but what if my company abandons the market, as many have done, and leaves me high and dry when I actually need care? Many other companies have been allowed to raise their rates, which means I might not be able to afford the premiums when I'm older.
If that's your concern, then you should dismiss it. Even if a company "abandons the market", they still must honor the insurance policies already in effect.

This fear is unfounded.
It's the end of the world as we know it. | It's the end of the world as we know it. | It's the end of the world as we know it. | And I feel fine.
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ifish100
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Re: Long Term Care Insurance Data

Post by ifish100 »

Thank you wow 2012. That is good information.
HereToLearn
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Re: Long Term Care Insurance Data

Post by HereToLearn »

WoW2012 wrote: Mon Jan 27, 2020 11:45 pm
ifish100 wrote: Mon Jan 27, 2020 7:49 pm wow2012 you seem to be very knowledgeable on the topic of LTC insurance.
- It sounds like the pot of money is the concept, the $ amount, not the 5 years or 3 years etc.
- It sounds like there is only (1) 90d exclusion, not one for each instance.
- The details on tips for getting claims processed quickly and efficiently should help others.
- It sounds like a "5 year" or $500K policies are the ones to look into, probably one for me and my wife to access the discount.
- What Independent Agent do you recommend, we were looking at Golden Care?
- Can you share what $ amount limit you chose for yourself?

Some concerns we have contemplated...
1) The gatekeeper decides if we have 2 ADL or not, if not we get nothing.
2) Insurance company decides who is a qualified provider, to even get to a qualified 90d waiting period, what if they are not handy or near where we would live? Also ironic if we are paying for it, to be told who is qualified (during the 90d waiting period).
3) When we retire we always want to live near a high level hospital for health care not rural. When you think about it getting near low cost but good nursing homes is another important consideration.

- It sounds like the pot of money is the concept, the $ amount, not the 5 years or 3 years etc.
CORRECT

- It sounds like there is only (1) 90d exclusion, not one for each instance.
CORRECT

- The details on tips for getting claims processed quickly and efficiently should help others.
THANK YOU.

- It sounds like a "5 year" or $500K policies are the ones to look into, probably one for me and my wife to access the discount.
IT USUALLY MAKES SENSE FOR COUPLES TO BOTH GET POLICIES FROM THE SAME COMPANY AT THE SAME TIME IN ORDER TO MAXIMIZE THE MARITAL DISCOUNTS. HOW MUCH COVERAGE YOU SHOULD BUY DEPENDS UPON YOUR FINANCIAL SITUATION.

- What Independent Agent do you recommend, we were looking at Golden Care?
THEY'RE GOOD. JUST MAKE SURE THEY DON'T TRY TO CONVINCE YOU TO BUY A HYBRID POLICY. INSIST ON A TRADITIONAL LTCI POLICY.

- Can you share what $ amount limit you chose for yourself?
MY WIFE AND IS HARE TWO POLICIES THAT COMBINED HAVE ALMOST $900,000 OF BENEFITS.


1) The gatekeeper decides if we have 2 ADL or not, if not we get nothing.
YOU'RE NOT POWERLESS. THE BETTER POLICIES ALLOW FOR 3RD PARTY MEDIATION IF THERE'S A DISAGREEMENT ABOUT BENEFIT ELIGIBILITY. THAT'S WHY YOU SHOULD USE A PRO (E.G. A HOME CARE AGENCY THAT'S EXPERIENCED IN PROCESS LTCI CLAIMS) TO PROCESS YOUR CLAIM FOR YOU, AS I OUTLINED ABOVE.

2) Insurance company decides who is a qualified provider, to even get to a qualified 90d waiting period, what if they are not handy or near where we would live? Also ironic if we are paying for it, to be told who is qualified (during the 90d waiting period).
SO WHAT. HIRE A HOME CARE AGENCY TO PROVIDE 2 HOURS OF CARE EVERY DAY FOR 90 DAYS. NO BIG DEAL.

3) When we retire we always want to live near a high level hospital for health care not rural. When you think about it getting near low cost but good nursing homes is another important consideration.
ASSISTED LIVING FACILITIES ARE A LOT NICER (AND CHEAPER) THAN NURSING HOMES AND CAN USUALLY PROVIDE THE CARE THAT MOST PEOPLE NEED.
I found that the home care agencies' minimum shift was four hours. (I called several agencies.) If the insured is truly unable to complete two ADLs, she may not be able to get by with only two hours or four hours of help per day. An hour or two in the morning and an hour or two in the evening could suffice, but it is impossible to hire help on that schedule. One must plan to pay out-of-pocket during this time, perhaps to lower cost providers arranged separate from the HHC agency.

One should not underestimate the hoops that have to be jumped through in order to satisfy the elimination period. The carrier must determine that the patient is unable to perform the ADLs. They conveniently send a nurse to the home to conduct periodic evaluations, but even once the patient has been identified as 'benefit eligible', there is still the issue of submitting ongoing documentation. It is not effortless for the patient who wishes to remain in her home. As I wrote above, my sense is that the approval process is easier once the patient is confined.

I handled both parents' LTC claims nine years apart. My father was in and out of hospitals and a rehab facility during his elimination period, and each of these confinements required documentation in order to have days count toward the elimination period. The only change I noticed between the two dates was the acceptance of scanned documents via email vs. fax.
WoW2012
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Re: Long Term Care Insurance Data

Post by WoW2012 »

ifish100 wrote: Tue Jan 28, 2020 12:20 pm Thank you wow 2012. That is good information.

It's my pleasure.
WoW2012
Posts: 736
Joined: Sun Dec 23, 2012 11:28 am

Re: Long Term Care Insurance Data

Post by WoW2012 »

HereToLearn wrote: Tue Jan 28, 2020 12:52 pm
WoW2012 wrote: Mon Jan 27, 2020 11:45 pm
ifish100 wrote: Mon Jan 27, 2020 7:49 pm wow2012 you seem to be very knowledgeable on the topic of LTC insurance.
- It sounds like the pot of money is the concept, the $ amount, not the 5 years or 3 years etc.
- It sounds like there is only (1) 90d exclusion, not one for each instance.
- The details on tips for getting claims processed quickly and efficiently should help others.
- It sounds like a "5 year" or $500K policies are the ones to look into, probably one for me and my wife to access the discount.
- What Independent Agent do you recommend, we were looking at Golden Care?
- Can you share what $ amount limit you chose for yourself?

Some concerns we have contemplated...
1) The gatekeeper decides if we have 2 ADL or not, if not we get nothing.
2) Insurance company decides who is a qualified provider, to even get to a qualified 90d waiting period, what if they are not handy or near where we would live? Also ironic if we are paying for it, to be told who is qualified (during the 90d waiting period).
3) When we retire we always want to live near a high level hospital for health care not rural. When you think about it getting near low cost but good nursing homes is another important consideration.

- It sounds like the pot of money is the concept, the $ amount, not the 5 years or 3 years etc.
CORRECT

- It sounds like there is only (1) 90d exclusion, not one for each instance.
CORRECT

- The details on tips for getting claims processed quickly and efficiently should help others.
THANK YOU.

- It sounds like a "5 year" or $500K policies are the ones to look into, probably one for me and my wife to access the discount.
IT USUALLY MAKES SENSE FOR COUPLES TO BOTH GET POLICIES FROM THE SAME COMPANY AT THE SAME TIME IN ORDER TO MAXIMIZE THE MARITAL DISCOUNTS. HOW MUCH COVERAGE YOU SHOULD BUY DEPENDS UPON YOUR FINANCIAL SITUATION.

- What Independent Agent do you recommend, we were looking at Golden Care?
THEY'RE GOOD. JUST MAKE SURE THEY DON'T TRY TO CONVINCE YOU TO BUY A HYBRID POLICY. INSIST ON A TRADITIONAL LTCI POLICY.

- Can you share what $ amount limit you chose for yourself?
MY WIFE AND IS HARE TWO POLICIES THAT COMBINED HAVE ALMOST $900,000 OF BENEFITS.


1) The gatekeeper decides if we have 2 ADL or not, if not we get nothing.
YOU'RE NOT POWERLESS. THE BETTER POLICIES ALLOW FOR 3RD PARTY MEDIATION IF THERE'S A DISAGREEMENT ABOUT BENEFIT ELIGIBILITY. THAT'S WHY YOU SHOULD USE A PRO (E.G. A HOME CARE AGENCY THAT'S EXPERIENCED IN PROCESS LTCI CLAIMS) TO PROCESS YOUR CLAIM FOR YOU, AS I OUTLINED ABOVE.

2) Insurance company decides who is a qualified provider, to even get to a qualified 90d waiting period, what if they are not handy or near where we would live? Also ironic if we are paying for it, to be told who is qualified (during the 90d waiting period).
SO WHAT. HIRE A HOME CARE AGENCY TO PROVIDE 2 HOURS OF CARE EVERY DAY FOR 90 DAYS. NO BIG DEAL.

3) When we retire we always want to live near a high level hospital for health care not rural. When you think about it getting near low cost but good nursing homes is another important consideration.
ASSISTED LIVING FACILITIES ARE A LOT NICER (AND CHEAPER) THAN NURSING HOMES AND CAN USUALLY PROVIDE THE CARE THAT MOST PEOPLE NEED.
I found that the home care agencies' minimum shift was four hours. (I called several agencies.) If the insured is truly unable to complete two ADLs, she may not be able to get by with only two hours or four hours of help per day. An hour or two in the morning and an hour or two in the evening could suffice, but it is impossible to hire help on that schedule. One must plan to pay out-of-pocket during this time, perhaps to lower cost providers arranged separate from the HHC agency.

One should not underestimate the hoops that have to be jumped through in order to satisfy the elimination period. The carrier must determine that the patient is unable to perform the ADLs. They conveniently send a nurse to the home to conduct periodic evaluations, but even once the patient has been identified as 'benefit eligible', there is still the issue of submitting ongoing documentation. It is not effortless for the patient who wishes to remain in her home. As I wrote above, my sense is that the approval process is easier once the patient is confined.

I handled both parents' LTC claims nine years apart. My father was in and out of hospitals and a rehab facility during his elimination period, and each of these confinements required documentation in order to have days count toward the elimination period. The only change I noticed between the two dates was the acceptance of scanned documents via email vs. fax.

ifish seemed to be concerned about minimizing his out-of-pocket expenses and getting through the 90 day elimination period as quickly as possible. A two (or a 4 hour) visit is probably not enough to provide all the care that is needed. I was assuming that family/friends would provide some support.

Hats off to you for handling both claims. I didn't handle my mother-in-law's claim. I was more than happy to have the home care agency process it for us at no charge.
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