About Insurance for Long Term Care or Medicare

Insurance for Long Term Care
Insurance for Medicare

Long term Care Insurance-- Why Should You Buy It?

1. It will help you keep your independence and dignity. Here's how. . . some of you will spend all your assets on care while others plan to give their money away or put it in trust. With no assets you will now qualify for a welfare program called Medicaid. Medicaid typically pays for a semiprivate room in a nursing home, and; not all nursing homes take Medicaid patients. In many states it's not easy to get Medicaid to cover home care or pay for assisted living. Many people want to stay at home, but with Medicaid may not be able to. And assisted living is rapidly becoming a preferred alternative to nursing home care for certain disabilities but Medicaid may insist on a nursing home instead. 
2. If you are married and you have a need for long term care, your spouse may be forced to pay for an outside caregiver. The cost is likely to come from your combined income and assets. If the need for paid care drags on too long, your spouse may be left with minimal cash assets for future needs. Insurance solves this problem and allows your spouse to keep the assets.  
3. Many healthy caregiving spouses won't spend their money and choose to "tough it out" on their own without help. If care of a disabled spouse drags on too long, this can have a devastating effect on the physical and emotion health of the caregiver.
4. Surveys reveal that healthy caregivers often don't spend their money for help but they will use insurance if available. Insurance allows the healthy caregiver to buy much-needed respite from paid professionals, while at the same time, retaining the assets and possibly avoiding an early death from the mental and physical stress of care giving. 
5. If your children or extended family promise to take care of you if the time comes that you need care, insurance will help them do that. Probably neither you nor your children have thought of the prospects of moving you from place to place, changing your dirty diapers, cleaning up after "accidents" in the bathroom or helping you with bathing and dressing. Insurance will pay for aides to help with these tasks.
6. If you are single and a need for long term care arises, insurance can pay for and coordinate that care. With insurance you won't have to feel you would be a burden for family or friends. 
7. If you have the desire to leave assets behind when you die, insurance will help preserve those assets from the cost of long term care.

How to Buy Long Term Care insurance

There are hundreds of long term care insurance companies selling hundreds of different types of policies. It can become very confusing. There are various conditions for home care and nursing home care, waiting periods, qualifying periods, inflation clauses and the list goes on. Here is a checklist of some of the things you need to know before you purchase a policy.

LONG TERM CARE INSURANCE BUYING CHECKLIST
the more "yes" answers you get the better off you are  

•  Is the insurance company rated at least A, A+ or A++ by A.M. Best?
•  Is it a large diversified company selling more than just long-term care insurance?
•  Is the insurance representative an expert in long-term care insurance? (Because of its complexity, almost all LTCi experts only sell LTCi; they seldom sell anything else.)
•  Does the representative own a personal long-term care insurance policy?
•  Is the policy you like tax qualified and if not, do you understand the ramifications?
•  Are there at least 6 ADL's allowed for certification?
•  Does it allow "standby assistance"?
•  Is it a "pool of money" as opposed to a "stated period"?
•  Do you understand how the elimination period works? (This is extremely important.)
•  Does it have an absence of prohibitive cost containment provisions?
•  Is there an absence of "capping" of automatic benefit increase riders?
•  Do you understand how the waiver of premium works?
•  Does the assisted living facility benefit pay the same as for nursing home?
•  Are you buying adequate home care coverage?
•  Does the company lack a history of rate increases?
•  Does the policy pay for homemaker services?
•  Are the requirements for providers of home care reasonable and not excessively strict?
•  Does the policy offer an alternative plan of care for coverage that doesn't exist today?

Underwriting Individual Policies

The uniform insurance code adopted by all states requires individual policies to be fully and medically underwritten. This means an insurance company must verify, through means legally available, the applicant's medical history, lifestyle and potential for cognitive impairment prior to issuing the policy. Once this has been done the company cannot refuse to pay claims based on a condition that did not exist at the time of application. On the other hand the underwriting process also allows a company to refuse to cover someone who poses a significant risk for future claims. The underwriting process prevents the future denial of claims based on the fact that the insurance company was unaware of the risk at the time that it issued the policy. The insurance code also allows a company to defer coverage for pre-existing conditions, after issue of the policy, for a certain time period, say six months. The majority of insurance companies do not use pre-existing conditions and for the majority of companies, the policy is in effect at the time it is paid and issued .

Companies are protected from fraud by being able to deny claims if an applicant deliberately withheld information that would have affected whether the policy would have been issued or not. If an applicant in good faith did not reveal information that would not have significantly affected the issuing of a policy, then the insurance company cannot challenge any future claims after the policy has been in force two years or longer. If an applicant did not state his or her age properly, the policy benefits will be altered to reflect the amount of benefit the premium would have bought at the correct age.

Unlike life insurance companies which often rely heavily on medical exams and current health to issue a policy, long-term care companies rely heavily on medical records and the history of past medical conditions. For older ages, companies also use a phone interview or schedule a personal interview with a nurse. In the interview the company is looking for lifestyles, activities and hobbies or pursuits to indicate whether a person is already partially disabled or not. The phone interview also helps keep agents honest who for the sake of trying to get a policy issued may have deliberately downplayed or excluded information on the application that could affect whether a policy is issued or not. Finally, the insurance company is extremely interested in whether a person is struggling with short term memory problems. The phone interview is designed to uncover this and if it is suspected a person has cognitive impairment of any kind, the interviewer will conduct a cognitive impairment survey.

In the past, companies have been more liberal in issuing policies than they are today. This change of attitude has probably come from the companies misjudging the amount of current claims resulting from more liberal, past underwriting assumptions. Because of this change, if you are thinking about buying long-term care insurance and are in good health, but you are delaying buying it for whatever reason, you should not wait until your health changes because it may be too late at that point to buy it. You should buy it now.

Rate Creep

In recent years long-term care insurance companies have been following a pattern of designing new policy forms about every two years. Part of the reason for new policies superseding old ones is that companies want to offer newer and better benefits. But I also believe that the issuing of new policies is a way to cover the increasing costs of claims. Almost without exception the new policies are more expensive at the same age than the old ones were. Many companies are reluctant to raise rates on existing policyholders and a few of them are even advertising it as part of their sales process. These companies are claiming they have never raised rates on any policies some dating back as far as twenty years.

The new code-mandated application process also requires companies to disclose in writing to the applicant, whether there have been any rate increases on existing policyholders and the details of these rate increases. Because of these pressures to not raise existing rates, I believe companies can only cover increased costs by having new policyholders subsidize the policies of previous insureds. This is certainly an advantage to existing policyholders who are concerned about future rate increases, but new policyholders are paying higher rates at the same age than existing policyholders would have paid on the old policy at that same age. This is all the more reason to buy insurance now instead of delaying the purchase. The combination of higher rates at an older age as well as higher premiums due to rate creep, could make the delayed purchase of insurance a very expensive decision.

Underwriting and Pricing Group Policies

So-called large group policies, policies offered through very large employers, are not medically underwritten when people sign on during the initial enrollment period. The question is how do companies control their risk of not getting too many people who have health problems and who may cause a large number of future claims? This is done in two ways. First, there is a concerted effort to get as many employees to sign on as possible. This helps dilute the number of people who have health problems, who would naturally be attracted to the coverage, with people who are healthy. Unfortunately, large group plans are only signing up about 6% of eligible employees nationwide. This low participation rate does not significantly weed out the ratio of unhealthy to healthy applicants and so the insurance companies offering group plans must charge higher rates for benefits than they would for underwritten individual plans.

On the other hand, the participation of younger employees is encouraged by keeping their rates very low. Since younger employees are less likely to have health problems, this helps reduce the risk of future claims for the insurance company. Also the enrollment of healthy younger employees has another benefit. These people are more likely to leave their jobs for another company and will probably not take their insurance with them. This means the insurance company will never have to make a payment for claim with younger employees who leave and the insurance company has made some additional profit that it normally would not have made with older policyholders who tend to keep their coverage for life.

The second way that an insurance company controls its future costs with group policies is to limit the benefits that are available to employees. This is done by providing only three or four choices for employees and limiting the amount of home care and downplaying the availability of inflation protection. By skimping on benefits the company will have a better handle on future claims. Limited benefits also make the policies less expensive and this helps encourage more people to sign on thus increasing the participation rate.

But limited benefits pose a huge future risk for existing group policies. By not offering automatic inflation protection and limiting home care benefits, group policies will be woefully lacking 30 years from now when claims are made. Since it is not in the best interest of the insurance company to explain this problem with group policies, employees who buy group policies think that they have adequate coverage when in reality they don't.

Insurance for Medicare

Gaps in traditional Medicare insurance have led people over the past 40 years to purchase supplemental or Medigap insurance policies to provide less worry-free coverage under Medicare.

Medicare Advantage plans were created along with the Medicare drug benefit as a result of the 2003 Medicare Modernization Act. The plans are funded by Medicare but design and administration are carried out by private-sector insurers. An Advantage plan must offer at least the same benefits of original Medicare but may offer better benefits as well. MA plans are designed around provisions of modern group insurance coverage and these plans do away with the gaps in coverage with original Medicare. Many of these plans are integrated with the new Medicare drug benefit as well.

Because of the modern design, there is no need for a Medicare supplement (Medigap) policy and the additional cost of the supplement is eliminated. The trade-off for this improvement is generally more direct out-of-pocket costs for MA beneficiaries. Eligible Medicare beneficiaries typically enroll with an MA by signing on with a designated agent of the insurer.