Costs and Insurance

Insurance for Long-Term Care: An Essential Primer

Jacqueline Marcell Health Guide January 11, 2007
  • When I suddenly had to become a full-time caregiver to my elderly parents, both of whom had health problems and were starting to develop dementia (namely Alzheimer’s), I had never even heard of Long-Term Care Insurance. After we burned through their life savings and started chipping away at mine, I was advised to apply for financial assistance for them through the government’s Medicaid system ("Medi-Cal" in California)–a program for those at the poverty level. It was a long process with mounds of paperwork and numerous investigations, but finally my parents were approved.

    I was so happy that monetary help would finally be on the way, well, until I discovered that the financial assistance would only pay to place my parents in a nursing home, not even in assisted living, and with very little help to keep them in their own home.

    Since their levels of care were so different (my mother needed nearly all ADL’s (Activities of Daily Living) done for her, there weren’t any facilities that would allow my parents to be together. Instead, they’d be across the street from each other in different wings of the facility. After fifty-five years of marriage, they were adamant about wanting to stay together in their own home, in their own bed, where they could continue to cuddle and kiss–as they so frequently did. And, since my father could be so "challenging" with terrible temper tantrums, and with quite a long record of manipulative disruptive behaviors–none of the facilities wanted to deal with him anyway.

    It was really hard to accomplish, but I committed to keeping my parents together in their own home and attending Adult Day Health Care five days a week. Then, with the help of two marvelous caregivers, after four more years of loving each other–they passed, just a few months apart. And even though caring for every aspect of my parents’ last years was the hardest thing I have ever done–I am proud to say I gave them the best end-of-life experience I possibly could.

    Had I only known to insist that we buy Long-Term Care Insurance for them prior to their illnesses–their many years of in-home care could have been paid for, and I could have saved myself so much heartache, not to mention a small fortune. I encourage you to learn from my mistakes and look into LTC insurance long before you need it-for your loved ones as well as yourself. Like fire insurance, hopefully, you’ll never have to use it.

    Also, be sure to call your local Area Agency on Aging, Department of Aging, and Alzheimer’s Association, and ask if there are any financial programs, waivers, or grants available in your area that you can apply for.

    STARTLING STATISTICS

    * An estimated 4.5 to 5 million Americans have Alzheimer’s disease. In a Gallup poll, 1 in 10 Americans said that they had a family member with Alzheimer’s, and 1 in 3 knew someone with the disease.

    * Increasing age is the greatest risk factor for Alzheimer’s. One in 10 individuals over 65 and nearly half over 85 are affected. Rare, inherited forms of Alzheimer’s can even strike individuals in their 30’s and 40’s.

  • * A person with Alzheimer’s disease will live an average of eight years and as many as 20 years or more from the first onset of symptoms.

    * More than 7 out of 10 people with Alzheimer’s disease live at home, where family and friends provide 80 percent of their care. The estimated value of this informal care is $257 billion annually.

    * One half of the U.S. population has a chronic condition. More than one quarter (26.6%) of the adult population provides care for a chronically ill, disabled or aged family member or friend, which translates to more than 50 million people involved with caregiving.

    * 37% of caregivers are living in the same household as the person they care for. 54% are between 35 and 64 years of age. 59% of the adult population either is or expects to be a family caregiver, and 2 million more caregivers will be needed in the next twenty years.

    * An estimated 43% of Americans age 65 or older will spend time in a nursing home. By 2012, 75% of Americans over age 65 will require long-term care. Long-term care costs are rising at 6% annually.

    * The annual cost of Alzheimer’s care in the U.S. is at least $100 billion, and it will soar to at least $375 billion by mid-century, overwhelming our health care system and bankrupting Medicare and Medicaid.

    * Alzheimer’s disease costs American business $61 billion a year, which is equivalent to the net profits of the top 10 Fortune 500 companies. $24.6 billion covers Alzheimer health care, and $36.5 billion covers costs related to caregivers of individuals with Alzheimer’s, including lost productivity, absenteeism and worker replacement.

    THREE WAYS TO PAY FOR LONG-TERM CARE

    LTC insurance pays for care in the home, assisted living, board & care, and in nursing/dementia homes. Medicare and regular health insurance does not cover the cost of long-term care. The average cost for a person who needs long-term care is $40,0000-$70,000 annually, plus the cost to the caregiver who may have to leave his or her job. Three ways to pay for long-term care:

    1. Pay for in-home caregivers and assisted living/nursing homes out of pocket. This is expensive and can often deplete a family’s life savings.

    2. Meet a very specific poverty level and qualify for government assistance through the Medicaid program. Options are limited, only paying for nursing homes that accept Medicaid.

    3. Buy Long-Term Care Insurance. This protects your family’s assets from the rising costs of caring for someone who needs full time care. Your employer might even pay the tax-deductible premiums. Consider buying it at a younger age, when it is more affordable and accessible. It must be bought before a major chronic illness strikes.

    QUESTIONS TO ASK AN INSURANCE AGENT

    * Is the coverage comprehensive, covering all levels of care: in the home, assisted living, board & care, and nursing/dementia facilities?
    * What is the daily benefit?
    * Is there inflation protection/what kind?
    * What’s the elimination period? Is it a lifetime benefit period or a limited time benefit policy?
  • * Is there a spousal/partner discount?
    * Can you hire caregivers privately as well as from an agency?
    * Is the home care benefit based on a daily, weekly or monthly maximum, and if the benefit is not used can it be used in the future?
    * Is there a "cash benefit" option?
    * Can the premiums be paid with a "limited pay" plan, such as a 10-Pay program?
    * Does it cover home care coordination?
    * How many ADL’s does it take to trigger a claim?
    * Is there a time limit for filing a claim?
    * Does it cover the cost of Adult Day Care & Adult Day Health Care, hospice and respite programs?
    * Is it a tax-qualified plan?
    * Is the company highly rated and have they ever raised premiums?
    * If you live in CA, CT, IN or NY, does the carrier offer a "Partnership Plan" allowing for retention of assets without spending down for Medicaid eligibility after the LTCi policy expires?
    * Can you see the company’s published annual audit to check their track record for paying claims?

    You can learn more about Jacqueline and find information about her book at ElderRage.com.

Most Popular

Health and Well Being of the Caregiver
7 Great Gifts for Caregivers