By Nancy Castleman & Marc Eisenson
Unfortunately, the odds are pretty good -- over 40% -- that
if we make it past 65, we'll spend at least some time in a nursing
home. Over ten percent of us will stay for at least five years. Yet
Medicare and Medigap programs generally offer limited help, if any.
Oy!
If you ever need a nursing home, you'd better be very rich or
very poor. In between, and your assets go bye-bye -- fast. Some
estimates now put the average cost for a year in a nursing home at
over $61,000. In some states, it's even higher, and wherever you live,
the tab just keeps going up and up.
If you have modest assets and income, you'll eventually be eligible
for nursing home coverage through Medicaid, although you'd have to
endure the difficult process of "spending down" your life savings first. On the other hand, if you can afford to pay for several years in a nursing home, even with the stock market's current downturn, you probably don't have to worry.
Unfortunately, chances are you're in the middle, with enough assets
so you won't qualify for Medicaid, although given the performance
of your mutual fund lately, you're wondering ... and worrying. Several
years in a nursing home could rob you and your mate of your nest egg.
And even if you might eventually qualify for Medicaid ... after all
but depleting your life savings or cleverly moving them around ...
would you want to go on public assistance, deprive your spouse, or
be forced into a nursing home that accepts Medicaid?
What about home care? Could your partner take care of you -- assuming
you're the first one who needs care? And vice versa? Will your kids
help?
What Should You Do? And When Should You Do It?
The first question is easy to answer: Although it certainly isn't
for every senior, you should at least consider long-term care (aka
LTC or nursing home) insurance.
With other insurance, the "when" question is pretty straightforward,
as in you get car insurance when you buy the car. It's a much tougher
call here.
Most experts will tell you (or your folks) to start thinking
about LTC between the ages of 55 and 65. If you buy when you're younger,
you'll lock in lower rates -- and you'll be less likely to have
a medical condition that could disqualify you or significantly raise
the price tag.
While it's natural to think you'll save money by waiting until you're
older to get coverage, it ain't necessarily so! What you pay in premiums
may be so much lower if you start early, that even after many, many
years, it could still be your best bet.
On the other hand, long-term care insurance is incredibly complex,
and changing all the time, especially now that so many Boomers are
fiftysomething. The benefits might improve as time goes by, even though
the premiums might also increase. A policy you buy today at age 55
might be obsolete when you turn 85. And even then, you might never
need the care the policy would cover.
Bottom line? Buy very carefully, if at all, or you'll invest a fortune
in premiums and still not be covered when and if you need nursing
home care.
What to Look for in an LTC Policy
All insurance is a gamble, and this axiom is nowhere better
illustrated than with long-term care. What you buy and when you buy
should depend on your risk tolerance -- not the "advice"
of a salesperson. If you decide to invest the $500 to $5,000 a year
LTC will cost, here's what you'll want:
1. A daily benefit that's in line with the average daily
nursing home cost in your state (or where you expect to retire), including
medications and extras you're likely to need.
2. An annual inflation rider, preferably one that increases
the benefits by 5%, compounded annually.
3. A coverage period of at least four years. (The average nursing
home stay is 2 1/2 years.)
4. Liberal benefit "triggers," so the checks start
rolling in when you're unable to perform two out of six "daily
living activities" (for example, bathing and dressing), or when
you show evidence of Alzheimer's or something like it.
5. Coverage for assisted living facilities and home health care,
as well as for the more traditional custodial, skilled, and intermediate
nursing homes.
6. A policy that's guaranteed renewable for life, with the premiums
waived if you do become institutionalized.
7. A "qualified" policy, one that makes it possible
for you to take tax deductions for the premiums.
How Do You Decide?
Learn As Much As You Can
Fortunately, there's a lot of useful, free info on the Web. A good
place to start is with the "Shopper's Guide to Long-Term Care
Insurance" from the National Association of Insurance Commissioners.
Individual copies are free -- online at: www.quotesmith.com, by
phone: 816-842-3600, or via email: pubdist@naic.org.
Also read the booklet, "Guide to Long-Term Care Insurance,"
put out by the Health Insurance Association of America
(www.hiaa.org/consumer/guideltc.cfm).
Choose the Right Long-Term Care: Home Care, Assisted Living &
Nursing Homes, written by attorney Joseph L. Matthews, explains
how to get the most from Medicare and Medicaid, as well as how to
choose the right facility, if any, and pay the bills. Excellent.
Compare LTC Policies Online
At both Quotesmith.com and Long-Term Care Quote (www.ltcq.net), you
can get a sense of what policies would cost you based on different
assumptions.
Go for a Financially Stable Company
Be sure to check the rating of an insurance company before you sign
up. You want one that's been in this business for a number of years,
and has earned high scores from the following three free rating services:
Standard & Poor's -- www.standardandpoors.com, 212-438-2400
A.M. Best -- www.ambest.com, 908-439-2200
Moody's -- www.moodys.com, 212-553-0377
Important: An "A" rating from one company may mean "Good," while at another company, it may mean "Excellent." Be sure you know what the ratings mean.
Be Forewarned
Many of the people selling long-term care are ... well ... here's
how consumer advocate Mark Green, author of The Consumer Bible,
puts it: "Do not trust insurance agents selling long-term care
insurance. Even if the agent is honest, the policies are ... riddled
with problems." Green reports that "no policy is guaranteed
to pay 100% of your long-term care costs, and some policies that don't
keep pace with inflation can pay as little as 30%." In other words,
after those policy premiums, you still might have to pay a hefty price
for nursing home care.Yikes!
To up the odds you'll make the right decision, check these out:
Do's and Don'ts
Don't speak to only one seller.
Don't assume that all policies are alike.
Don't make a quick decision.
Don't forget that celebrities are paid for their endorsements, and probably don't need the LTC coverage they're hawking.
Don't buy a policy you can't afford. You'll stop paying the premiums long before you might need the benefits.
Do make sure you understand the pros and cons of each company and each benefit option you're considering.
Do consider family history. If your clan is full of centenarians, LTC may be more important than if your relations tend not to be long livers.
Do read the policy before you agree to it.
Do discuss LTC with the lawyer or financial planner
who helps you plan your estate. (You do have a will and a plan, right?)
How to Save Money on Long-Term Care
Comparison shop, as always. Prices for LTC can vary
considerably ... even for identical coverage.
Married? It might mean a discount of 10% to 20% on LTC.
But there may be some strings: For example, both of you may be required
to get the same policies, which may or may not be a good idea.
In excellent health? There might be a 10% to 20% discount.
Ask!
Think about a longer "elimination period." Policies
offer waiting periods of anywhere from zero to 365 days before kicking
in, and the savings for a longer wait may be worth it, even though
every uninsured day in a nursing home will cost you $167 in today's
dollars.
Live alone? Consider eliminating home care benefits.
Why? Because LTC home care is generally a part-time benefit. You'd
have to pay for additional home care. Also, someone would have to
manage multiple caregivers.
Belong to any groups? You might find a great buy via
your employer, for example. Chances are, even though you're eligible
for a discounted group rate, you'll have to foot the bill, so make
sure the policy being offered will meet your needs. (A group plan
may be especially beneficial to someone whose pre-existing condition
would lead to a much costlier individual policy.)
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