Feature Articles: Insurance
Long Term Care Insurance
Joyce Cavanagh, Ph.D., Former Consumer & Family Economics State Specialist, College of Human Environmental Sciences. University of Missouri Extension
Who buys long term care insurance?
People who have purchased long term care insurance give
many reasons for buying this coverage including:
- Desire to preserve assets for spouse and/or other heirs.
- Wish to maintain independence.
- Have the ability to choose where and how services are provided.
- Desire to avoid Medicaid.
- Provide peace of mind that care needs will be met.
There are also reasons why people should not
purchase long term care insurance:
- Income and assets are too low. People with very few assets to protect or who would find it a struggle to pay premiums (before and during retirement), are probably not good candidates for long term care insurance.
- Health status or age make insurance unavailable or prohibitively expensive. If you have a health condition, you may find it difficult to buy a policy and if an insurer will sell you one, the premium may be more than you can afford.
- No heirs. If you have no heirs, you may not have as much reason to protect assets with long term care insurance.
What types of long term care policies are
there and how do I choose one?
Long term care policies are available as
individual or group policies (usually cheaper
than individual policies). Many employers, are
now offering employees the option of purchasing
long term care insurance as an employee benefit.
It may be possible to purchase coverage for the
employee, his/her spouse and
parents/parents-in-law. In most cases, it is
necessary to pass a health examination in order
for coverage to be approved.
Consider the following when choosing a policy:
Types of Services Covered. Most
policies today offer coverage for a full range
of care services including services provided at
home, in an adult day center, in assisted living
facilities, and in a nursing home. Many also
include coverage for respite care, hospice care,
or other 'alternative care setting.'
Daily Maximum Benefit. Most long term care insurance
policies are 'indemnity' policies (the policy
pays a fixed dollar amount for each day you
receive covered services). In order to purchase
a policy with the appropriate maximum daily
benefit, you will want to find out what the cost
of services is where you live or will receive
services. Call nursing homes and home health
agencies and ask about their fees.
Duration of Benefits. Policies usually limit benefits to
a maximum dollar amount or a maximum number of
days. You can designate the length of time
benefits will be paid from one year to a
lifetime. The longer the length of time, the
higher the premium will be. For most people, a
policy covering 3 - 5 years will be more
cost-effective.
Benefit Triggers. All policies contain provisions that
determine if and when benefits are payable,
which are referred to as benefit triggers.
Typically benefits are payable when a person
can't perform a certain number of Activities of
Daily Living (ADLs) such as bathing, eating,
dressing, continence, transferring and using the
toilet. Cognitive impairment from Alzheimer's
disease should also trigger benefits. It is
important to understand what the company will
use to determine when benefits will be payable.
Inflation Protection. Inflation protection, which
increases the insurance benefit by the rate of
inflation, is essential to ensure that you have
adequate coverage years from now. In Missouri,
companies must offer you inflation protection,
which should be in writing.
Many consumers are reluctant to pay for policies that offer inflation
protection because the premiums cost more. But,
if you buy the policy when you are in your 50s
or 60s, the inflation protection rider is the
only way to be sure that the coverage will be
adequate when you need it in 20 or 30 years.
How are premiums determined?
Premiums are based on a number of factors
including:
Age. Cost of coverage depends on
your age when you first purchase a policy.
Premiums are lower for younger people. But, the
younger you are when you buy the policy, the
longer you will pay the premiums. The premiums
you pay for your policy generally remain the
same each year; they will not increase as you
get older.
Benefits. The higher the benefit level you select and the
longer the benefit period, the higher the
premium will be.
Waiting Period. A waiting period is the time it takes
before your policy becomes effective. Some
policies require that you pay for a specific
number of days in a nursing home or a specific
number of home health visits before benefits
begin. The longer the wait, the lower your
premium.
What is the tax status for premiums?
Policies issued after January 1, 1997, which
provide tax incentives, are classified
tax-qualified plans. Policies issued before 1997
were 'grandfathered' into the law and are
considered tax-qualified. Premiums for
tax-qualified plans are deductible to the extent
you itemize and have medical expenses in excess
of 7.5% of adjusted gross income. Benefits
received are non-taxable.
Policies issued after January 1, 1997, which do not provide tax
incentives, are classified as non tax-qualified
plans. Premiums for these policies are not
tax-deductible and it is not clear whether
benefits received are taxable or not.
What are some basic tips I should follow when shopping for long term
care?
- Compare policies. Premiums can vary widely from one company to another. Determine how long the company has been in the long term care business (best if they have been in business for at least 10 years). Be alert to low premium quotes from companies new to this coverage.
- Ask for an Outline of Coverage. Missouri law requires that an agent leave this with you when he or she makes initial contact.
- Understand the policy. Under no circumstance should you purchase a policy you do not understand.
- Free Look Period. Missouri law requires that you have 30 days from the date of purchase to review a policy and decide whether to keep it. If within those 30 days you are not satisfied and terminate the policy, your entire premium must be refunded.
- Keep the name, address, and phone number of the agent and company you dealt with when purchasing the policy.
- NEVER PAY CASH! Pay by check and make it payable to the insurance company, not the agent.
Where can I find more information?
If you would like more information on long
term care insurance, refer to the following
sources:
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Last update: Tuesday, March 18, 2008
