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Murph, you got a great deal. No wonder insurance companies increased premiums and stopped writing LTC policies.

This is a perfect example of one of Ray's earlier points. Since insurance companies can increase premiums at will, there is no guarantee that your great deal will continue to be a great deal. I suspect a lot of LTC policies were priced optimistically. Then as folks age and start to use those policies, companies discover this and have to raise premiums as needed to cover their costs.

Up 'til now medical science has been getting better at keeping people alive but not necessarily healthy, which means even longer stints in continuing care facilities. Fortunately, it looks likes we may be getting a handle on increasing health span; much exciting stuff going on right now. (OT: Google up "nicotinamide riboside".)
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People are finding that it's safer to self-fund and keep that big LTC premium in your own pocket.

Yep. I read the original WSJ article https://www.wsj.com/articles/millions-bought-insurance-to-co... (if you don't have a subscription, you may be able to google the title in quotes to gain access). It talks about the mistakes that insurers and regulators made, like bowing to sales pressures to keep premiums low, and flat. It also provides information about a specific case:

Long-term-care coverage often feels like a godsend to people already drawing benefits. “I would be destitute. I don’t even know if I would be alive,” says Ailene Adkins, 69. She has an autoimmune disorder and resides in an assisted-living facility in northern Virginia at the expense of Manulife Financial Corp.’s John Hancock unit.

She bought the policy in 1993 and paid slightly more than $12,000 in premiums before filing her claim. John Hancock has paid $1.2 million for her care since 2001.


She has a point. If she didn't have the care she has, would she have lived for the 17 years since 2001? The insurance company estimates that her premiums were based on probably assumed she would have died by now - much earlier than now, in fact. The insurance companies appear to have completely missed pricing in the additional longevity that better care that they were going to be paying for would provide.

AJ
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Important info to post, intercst. This is a big concern to those of us who did our due diligence, relying on actuarial "science" purported by LTC sellers and purchased policies many years ago. The GE/Genworth debacle is especially troubling because of their prominence in the marketplace.

States were also complicit by launching "partnership" plans, seeking to transfer risk to insurance companies for looming Medicaid shortages due to aging population on the program.

Lots not to like about this.


Gary
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“Never in our wildest imagination did we consider that the company would double the premium,”

People are finding that it's safer to self-fund and keep that big LTC premium in your own pocket.


Something I've been saying for a long time. But people say "No, no, no, you are being stupid by not getting a LTC policy to protect yourself from large nursing home expenses."

Too many people want to believe a comforting story and will even attack (verbally) anybody who tells them that it's just that----a pretty story that has little basis in fact.

Beats me why people agree to take a policy where the premiums can be changed by the counter-party. They just want to believe SO BAD.

Same thing about people who are gung-ho into dividend growth stocks, IMHO. The story is so attractive that they will not hear any negative words.
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“Never in our wildest imagination did we consider that the company would double the premium,”
People are finding that it's safer to self-fund and keep that big LTC premium in your own pocket.


Something I've been saying for a long time. But people say "No, no, no, you are being stupid by not getting a LTC policy to protect yourself from large nursing home expenses."


When I had a recent portfolio review with my Fidelity Advisor, we discussed LTC Insurance along with many other things. I showed how my plan to retire in two years included funding Medicare Part D & Part whatever starting at 65, along with money to pay the full amount of medical insurance between retirement and age 65 Medicare eligibility. When we go to LTC, I said that there was no way I could afford that now or in the future, and he said that more and more people were going that way (himself included) because of the premiums.

It's got to be doubly bad for people who have paid the hefty premiums and have had the insurance gone unused only to be faced with the doubling of premiums. I know it's "sunk cost" mentality, but knowing that doesn't make people immune from human nature.
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States were also complicit by launching "partnership" plans, seeking to transfer risk to insurance companies for looming Medicaid shortages due to aging population on the program.

???

That risk is transferred to the states, not the insurance company as once the policy has been paid in full, individuals qualified for Medicaid without the need to spend down their assets.

Partnership policies do not require lifetime coverage. They could qualify with as little as 3-5 years worth of coverage IIRC. After that, the state has to start paying.
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When we go to LTC, I said that there was no way I could afford that now or in the future, and he said that more and more people were going that way (himself included) because of the premiums.
...
It's got to be doubly bad for people who have paid the hefty premiums and have had the insurance gone unused only to be faced with the doubling of premiums.


Yes. It's not so much the large premiums, it's that the company can increase the premium at whim. What kind of stupid blindness do people have to be to take that deal?


When we go to LTC, I said that there was no way I could afford that now or in the future...
When our company had a seminar on LTC, the presenter had a tough audience that consisted of all engineers. People quickly totalled up the lifetime premiums they'd be paying (20 years * $xxx/month), and it was a lot. They they compared the maximum annual benefit to the total premiums paid---and loudly announced that you'd have to spend several _decades_ in a nursing home before these crossed. And that was even without taking into account that they can increase the premiums at any time.

That redirected the discussion to a different area, and the presenter easily admitted that if you had a million dollars or more that it made more sense to self-insure.
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DH and I are at a crossroads with this. Through my employer we were offered a reasonably priced LTC policy with good coverage. Then, the company pulled of out it's partnership with my (very large state affiliated) employer. Then, it announced premium would be going up 70%. And, after checking with other LTC companies, even at a 70% increase, the premium and coverage is very good - in comparison. But it is a HUGE amount of money.

We are both watching our mothers age. Mine has been in a nursing home for almost 9 years with Alzheimer's and is physically healthy and may live several more years. His mom has multiple minor health issues and is currently living with BIL but may live for many more years and possibly will be going into a facility as her issues get harder to manage at home. It's hard to not want coverage for ourselves when we see them needing a lot of care 24/7 everyday.

We are trying to make a decision on whether to cut our losses when the premiums jump or stay with them, since it is still a better deal than other LTC out there. We are not wealthy or even very well off (probably considered on the very low end of middle class) and have a small amount of debt: 2 car loans, 2 student loans and need to do much needed renovations on the house.

I keep seeing all that money going out every month as money we could put toward the debt and then the house. He sees it as planning for future needs. BTW, DH played football in high school and college and had multiple concussions and so is at a higher risk for dementia as he ages. So he's very worried. Almost thinking we should keep it for him but cancel mine.

Any insight and constructive comments/advice would be very welcome.
JK
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People are finding that it's safer to self-fund and keep that big LTC premium in your own pocket.

Honest question....at what point are you well enough off that you can consider your LTC to be self-funded? What does LTC cost - $100k/yr? That would be ~$2.5M in assets needed. Double that for a couple? For those of you that consider yourself to be self-insured... are you carrying this much in assets?
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Mine has been in a nursing home for almost 9 years with Alzheimer's and is physically healthy and may live several more years.

Mine was same way, but was there for not quite 2 months. Insurance is a game of probabilities. Consider life insurance. At first glance, it seems like it's a can't lose propostion for you---you are betting the insurance company that you will die. How can you lose that bet?

From googling: "The national median daily rate in 2014 for a private room in a nursing home was $240, The average length of a nursing home stay is 835 days."

Another search: "According to the U.S. Bureau of the Census, slightly over 5 percent of the 65+ population occupy nursing homes, congregate care, assisted living, and board-and-care homes, and about 4.2 percent are in nursing homes at any given time."

Another: "Forbes Jan 5, 2016 - They estimated that 58% of men and 79% of women aged 65 and older would need long-term care at some point, and that average lengths for care were 2.2 years for men and 3.7 years for women. ... A five-year stay in a nursing home would total $456,250 at today's prices."

Y'know, $456K is a lot of money. When we put my Mom in, we all noted that at that rate, in 10 years her money would all be gone.

Last time I looked, LTC policies have a maximum daily benefit and a maximum annual (lifetime?) benefit. How much in total are you going to be paying in premiums? At today's current premium. Is that premium frozen, or can the insurance company increase it?

We are trying to make a decision on whether to cut our losses when the premiums jump or stay with them, since it is still a better deal than other LTC out there.

This is beyond crazy. You already *KNOW* that your premium is too low (in comparison to other LTC policies), so you should realize that the premiums will be going up in the future. He sees it as planning for future needs. Do your plans account for the possibility that you pay the premiums for the next 10 years, but then have to drop the policy when the premium increases so much that you can't afford it? 10 years of premiums down the drain. You hvae to drop the policy just when the chances of needing it are higher. Ugh.

Here's an advice: Set a goal of $1 million net worth (401K, IRA, etc.) Put your money toward that instead of giving it to some insurance company for a feel-good LTC policy.

---------------------
We are trying to make a decision on whether to cut our losses when the premiums jump or stay with them, since it is still a better deal than other LTC out there. We are not wealthy or even very well off (probably considered on the very low end of middle class) and have a small amount of debt: 2 car loans, 2 student loans and need to do much needed renovations on the house.

Another soap-box I regularly climb upon is this: It is very expensive to be poor.
Poor people have to drive crappy cars because they can't afford a new/good car. The crappy car breaks down all the time and they have to throw hundred of dollars--which they don't have--into repairs.
Poor people have to pay oodles of money for payday loans. They're short of money...so they throw a huge chunk of their next paycheck away, leaving them even shorter of money.

I suspect that approximately nobody who has a net worth more than ~$5million has a LTC policy. Part of the reason they have money is that they didn't waste it.
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Honest question....at what point are you well enough off that you can consider your LTC to be self-funded? What does LTC cost - $100k/yr? That would be ~$2.5M in assets needed. Double that for a couple? For those of you that consider yourself to be self-insured... are you carrying this much in assets?

$100K is 4% of $2.5M. That 4% figure is for a 95% success rate for a 30 year timeframe. If you are in a nursing home, you don't need to be thinking of a 30 year period.

Sell everything and go to cash. $2,500,000 at $100,000 a year will last 25 years.

At $100K/yr, $1,000,000 will last 10 years. The chances of both of a couple lasting 5 years is small.


~$2.5M in assets...are you carrying this much in assets?

You have this backwards.
People don't get to $2.5M and then decide about LTC policy.
They get to $2.5M by saving and investing wisely and not throwing money away.
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jeffbrig writes,

<<<People are finding that it's safer to self-fund and keep that big LTC premium in your own pocket.>>>

Honest question....at what point are you well enough off that you can consider your LTC to be self-funded? What does LTC cost - $100k/yr? That would be ~$2.5M in assets needed. Double that for a couple? For those of you that consider yourself to be self-insured... are you carrying this much in assets?

</snip>


I'd say anyone (single or married) with more than a $1 million retirement portfolio should self-insure. But you don't need to fund 30 years in a nursing home -- just enough to get your nose under the tent in a good one that accepts Medicaid. (Which all but a few high-end nursing homes catering to the very wealthy do.)

The good nursing homes have long waiting lists for admission. But they'll admit a private patient paying the full freight before a medicaid patient with a lower monthly reimbursement. And they'll admit someone who can pay for 5 years as a private-pay patient before someone only wealthy enough to pay for for 3 years.

intercst
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Ww are actively considering moving to a CCRC, https://en.wikipedia.org/wiki/Continuing_care_retirement_com... which includes LTC as part of the program. Whether CCRC or just LTC, it is expensive to get old. Best to manage your resources so you don't have to go into a state run (or church run) place where they basically just warehouse you.

CNC
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CountNoCount writes,

Best to manage your resources so you don't have to go into a state run (or church run) place where they basically just warehouse you.

</snip>


What percentage of nursing homes are "state run"? Or do you mean a private nursing home that accepts Medicaid and is subjected to state inspection to make sure standards are met? (Note: inspection varies a lot by state -- more "inspection" in New York, very little inspection in a crapholes like Texas and Florida.)

https://www.cbsnews.com/news/nursing-home-ant-bite-death-pay...

intercst
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It's got to be doubly bad for people who have paid the hefty premiums and have had the insurance gone unused only to be faced with the doubling of premiums. I know it's "sunk cost" mentality, but knowing that doesn't make people immune from human nature.

I know that it's a sunk cost, but that's real money that could have been saved and invested and used toward paying for your care. This is exactly why I've never bought LTC insurance - I'm a disciplined saver and would rather take my chances with self-insuring.
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People are finding that it's safer to self-fund and keep that big LTC premium in your own pocket.

intercst


~~~~~~~~~~~

Mrs. Fan and I have decided this is the best choice for us.
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People are finding that it's safer to self-fund and keep that big LTC premium in your own pocket.

intercst


The quip I heard years ago was, "If you have money, you don't need LTC insurance. If you don't have money, you can't afford it."

CNC
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It's got to be doubly bad for people who have paid the hefty premiums and have had the insurance gone unused only to be faced with the doubling of premiums. I know it's "sunk cost" mentality, but knowing that doesn't make people immune from human nature.

We had a policy with Prudential a few years ago. What can go wrong, Prudential has been around forever. Then Prudential quit writing new policies, leaving only folks who had already bought and the promise of increasing premiums. We hung on for a bit but the handwriting was on the wall, so we dropped the policy.

We still have the coverage with Prudential to the limit of the premiums that we paid over the years that we carried the policy. It isn't like it is money that you can invest or do anything with, but the sum total of the premiums paid is still available if the day comes that we require the care.

Buying the policy may not have been a wise decision, but the premiums may not be totally lost.
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intercst suggested:

I'd say anyone (single or married) with more than a $1 million retirement portfolio should self-insure. But you don't need to fund 30 years in a nursing home -- just enough to get your nose under the tent in a good one that accepts Medicaid. (Which all but a few high-end nursing homes catering to the very wealthy do.)

If you had $1 million in a traditional IRA and received Social Security, would you ever qualify for Medicaid nursing home benefits? Assuming a 0% return on your traditional IRA, RMD alone might disqualify you for the benefit at age 100 due to income restrictions. The IRA, at least, is excluded from the Medicaid asset restrictions.

Whether one qualifies for Medicaid nursing home benefits depends on the state where one lives. Also, it depends on Congress continuing to fund the Medicaid program. Our current Congress seems to be intent on discontinuing support for all "entitlement" programs.

My financial advisor did have me look into LTC insurance several years ago. The plan that he suggested was one from Liberty Mutual that required a health evaluation. I was rejected because I was a veteran with a disability.

If you are a veteran, you may qualify for VA health benefits that include LTC. My dad served during World War II. He wasn't a disabled veteran but received VA medical care from his late eighties until his death at 97. Those of you that are veterans should check the benefits available through the VA before committing to LTC insurance.

As a general rule, I would opt to sef-insure for LTC but, then, I'm opposed to dumping money down the insurance black-hole. The amount of money that I've received pales in comparison to what I've paid for auto, health, and home insurance.
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$100K is 4% of $2.5M. That 4% figure is for a 95% success rate for a 30 year timeframe. If you are in a nursing home, you don't need to be thinking of a 30 year period.

Sell everything and go to cash. $2,500,000 at $100,000 a year will last 25 years.

At $100K/yr, $1,000,000 will last 10 years. The chances of both of a couple lasting 5 years is small.


Thanks Ray, seems fairly obvious when you put it like that.
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At $100K/yr, $1,000,000 will last 10 years. The chances of both of a couple lasting 5 years is small.

Thanks Ray, seems fairly obvious when you put it like that.

Many nursing homes will accept Medicaid after you've exhausted your existing assets. Sometimes it is an upfront fee. For example, you pay them $400,000 (or whatever) upfront which they get to keep no matter what, and they they bill monthly against the amount. After the retainer is exhausted, they will bill Medicaid until you croak.
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... People quickly totalled up the lifetime premiums they'd be paying (20 years * $xxx/month), and it was a lot. They they compared the maximum annual benefit to the total premiums paid---and loudly announced that you'd have to spend several _decades_ in a nursing home before these crossed....

Interesting, Rayvt!

My personal experience directly contradicts what you relate:

LTC bought in 2003 at age 57 from GE Capital/Genworth ;annual premium $2392

That premium stayed the same through 2013...eleven years @ 2392 = $26312.

2014 premium: $2870
2015 premium: $3275
2016 premium: $3444
2017 premium: $4133
2018 premium: (have yet to get this number, but let's assume +20%, so $4960

Total premiums for 16 years: $44,944

Assume next 4 years of premiums go up 20%/year: total amount: $31,950

Total 20 year premiums: $76,894

Benefit for my policy: currently about $6700/month (and has an automatic 5% inflation guard).

One year's benefit = $80,400, not even counting the 5% inflation of benefit amount for the next 5 years...which would be substantial.

Bottom line for me: After 20 years, the total premiums paid equal are less than one year's worth of benefits. This counts no "insurance value" for the peace of mind these past 15 years.

For those starting now, I am sure it is different; for me, it was a good deal.

Cheers!
Murph
II and PP Home Fool
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One year's benefit = $80,400, not even counting the 5% inflation of benefit amount for the next 5 years...which would be substantial.

In my area the going rate for LTC currently runs $110K to $160K per annum plus supplies- Plus annual increases of 3% to 5%.

Best part is most request a Non refundable Advance one time fee (Low 4 figures) before they will consider your application. They require 1 or 2 months security deposit and they require 30 days notice for refund on vacating the premises. I asked at one place about the 2 months security. They said one month security penalty is payable even if the patient passes away. In the conversation they also mentioned they have a waiting list of about 1 to 2 years.

I'm assuming that if one pays the "non refundable slush fund" one time fee and put up a security deposit the waiting list might conveniently disappear. Or maybe I'm just a little too cynical.

Spend some time-- go shopping in your area see what is being offered. Just don't be surprised if you have to supply your own toilet paper or pay them a 15% or more up charge when they buy it for you
b&w
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Hi b&w!

My original objective was to defray the cost of LTC...not to offset it completely. My policy is a "Cadillac" one; can even choose to pay my daughter to care for me in home.

Your mileage may vary. ;-)

Cheers!
Murph
II and PP Home Fool
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In another forum, I posted a question about Medicaid Annuities and the nuances of them.

They are tricky and you should have an eldercare attorney make sure it is structured correctly.

Under today's system and set-up properly, this annuity can save a couple quite a bit in assets because Medicaid does not consider the healthy spouse's assets before they award benefits. And, Medicaid does not consider the income spun off from the unhealthy spouse's assets (usually the beneficiary is the healthy spouse) once they are in this type of annuity.

This is the direction I will take if the time comes. I hope my nursing home stay is like my Mom's (1 week) instead of the average stay of 28 months.

In the end, it probably all ends up costing the same. :(
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Hi Murph,

Bottom line for me: After 20 years, the total premiums paid equal are less than one year's worth of benefits. This counts no "insurance value" for the peace of mind these past 15 years.

For those starting now, I am sure it is different; for me, it was a good deal.


Your thoughts and experience pretty much mirrors mine. I took my policy out with State Farm 21 years ago at age 48 and may have had a premium increase but don't recall one. It compounds annually and costs $2,005/yr. Current monthly benefit is $14,430 (up from $6,000/mo. in the beginning).

I may eventually decide to self insure, but the cost benefit to my heirs seems like a good value at this point.

Bill
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Well done, Bill!

Cheers!
Murph
II and PP Home Fool
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Rayvt,

You wrote, If you are in a nursing home, you don't need to be thinking of a 30 year period.

Sell everything and go to cash. $2,500,000 at $100,000 a year will last 25 years.


nit: I'd modify that to say buy TIPS or I-bonds to deal with the inflation factor. Cash loses value over time, remember?

- Joel
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You might be surprised by the amount of increase in the future. When my mother first started with a policy I didn't think it was a good idea, but she did it anyway and the premium wasn't so large that I got very excited about it either way. Some years later when she brought it up again, the premium was much larger and it was clearly unlikely that she would ever get a reasonable benefit from it.
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Sell everything and go to cash. $2,500,000 at $100,000 a year will last 25 years.

nit: I'd modify that to say buy TIPS or I-bonds to deal with the inflation factor. Cash loses value over time, remember?


Of course! But remember my #2 mantra: "If it's not worth doing, it's not worth doing well."


Murph, you got a great deal. No wonder insurance companies increased premiums and stopped writing LTC policies.
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I saw the article in WSJ too, this is old news.....it's been going on for years.

I guess that's the problem with getting older, everything seems to be a rehash of old news.

Self funder here btw.

Lucky Dog
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I suspect that approximately nobody who has a net worth more than ~$5million has a LTC policy. Part of the reason they have money is that they didn't waste it.
=========================================
People with over $5 mill. are the people who can afford to self-fund.
For most of us mere mortals, LTC is something that should be considered.

Bill
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Murph, you got a great deal. No wonder insurance companies increased premiums and stopped writing LTC policies.

This is a perfect example of one of Ray's earlier points. Since insurance companies can increase premiums at will, there is no guarantee that your great deal will continue to be a great deal. I suspect a lot of LTC policies were priced optimistically. Then as folks age and start to use those policies, companies discover this and have to raise premiums as needed to cover their costs.

Up 'til now medical science has been getting better at keeping people alive but not necessarily healthy, which means even longer stints in continuing care facilities. Fortunately, it looks likes we may be getting a handle on increasing health span; much exciting stuff going on right now. (OT: Google up "nicotinamide riboside".)
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Another soap-box I regularly climb upon is this: It is very expensive to be poor.
Poor people have to drive crappy cars because they can't afford a new/good car. The crappy car breaks down all the time and they have to throw hundred of dollars--which they don't have--into repairs.


At least a part of this is that bad *behavior* drives costly decisions that make and keep people from saving money. That is, dumb decisions make and keep you poor. Examples:
-Have to take a payday loan because of spending cash-on-hand on tattoos and 2-pack a day cigarette habit,
-Traded reliable truck (which was "paid off" mainly because it was a gift) for flashier car which had tons of fundamental things wrong with it,
-Sister of above also received a (used) car as a gift...then wrecked it before getting around to buying insurance,
-Had a child with live-in boyfriend who doesn't have a full time job so there are no benefits to be had between them,
-Too busy to cook, so every lunch and supper are fast food (or more expensive restaurant)...also too busy to sit down and decide how much they spend on restaurants,
-Buy the most expensive phone on an exorbitant plan because the salesman said it would "build up her credit rating,"
-Spend all money obtained on combination of crack/meth/who-knows-what-else.

The reason I happen to know about any of those is because of relatives or friends were supporting or trying to help someone, and the money just went right through their fingers rather than acting as a "step up" to get off the money-losing treadmill. Did you ever read about the many people who win a lottery and then are worse off a few years down the road? They got the money, but didn't have the behaviors that lead to growth and improvement, but to p!$$ away every dollar they have (and then some, if loans are available).
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Poor people have to drive crappy cars because they can't afford a new/good car. The crappy car breaks down all the time and they have to throw hundred of dollars--which they don't have--into repairs.

My own experience with relatives, friends, and especially the many co-workers I've seen who are not poor, but just above that level who live paycheck to paycheck, is the flip side of this: instead of saving regular amounts from their paycheck, they purchase brand new cars, the latest i-gadget, eat out more than make their meals, and an almost endless stream of silly-but-make-me-happy purchases.

Pete
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As a retired CFP, I well remember the roll-out of Qualified Long Term Care Insurance as part of HIPAA in 1996. The Dept of OPM was seemingly one of its sponsors, as it actively marketed policies to Federal Employees from then NY Life and Hancock Ins (I think). Promises ran high and policies were cheap.

Jump forward to today and most of those originally writing QLTCi policies have discontinued them and premiums seem to be going only up. Insurers claim they couldn't help this, due to consistently low interest rates, longevity and lower lapse rates than actuaries projected. What a pile of crap. These companies knew EXACTLY what they were doing when they sold these polices at the bottom of the actuarial liability projections (read: underpriced premiums). Yes, there are always risks in such forward projections of such a new product...but that's what insurance actuaries get paid the big bucks to figure out...and they're dam good at it. But big bonuses were paid in those early days, so the insurance execs got what they wanted.

What never seems to get talked about in LTCi discussions is claim denial rates. Remember, LTCi will become relevant when most policy holders are getting near the end of the road, at a point where they are not going to be able...mentally of physically....to fight the insurer should their claim, likely filed by their adult children, be denied for any number of reasons. A local legal group specializing in denied health services insurance claims gives these as some of the more common reasons for denying LTCi claims:

You weren't hospitalized prior to needing long-term care (this applies to pre-HIPAA qualified polciies)

You do not suffer from an acute medical condition; (pre HIPAA LTCi policies)

The long-term care services that were provided to you were not provided by a registered nurse, licensed practical nurse, or other properly qualified professional as defined under your policy;

The care or services were provided to you by a family member; (this is quite common)

The long-term care services that were provided to you were not provided by a nursing home or home care provider that are certified by Medicare;

The long-term care services provided for you are available under Medicare or another governmental program;

The long-term care services that were provided to you are not covered "skilled care" as defined by the policy;

You are able to perform your "Activities of Daily Living", which usually include bathing, dressing, walking, moving from bed to chair, toilet, maintaining continence, and eating, as measured by the insurance-paid assessor. The insurer may require alternatives are used first, such as using pull-on or spandex clothing rather than buttons or zippers for the inability to dress;

The care or services that you received are unrelated or unnecessary for you to carry out instrumental activities of daily living or unrelated to needs because of a cognitive impairment;

The insurance company's doctor is saying that you do not qualify for long-term care benefits even though your doctor is stating that you do. One of the major differences of QLTCi over pre-HIPAA LTCi is "Medical Necessity" may not trigger benefits;

The insurance company has denied certain types of long-term care provided, asserting that you did not need the level of care that you were provided;

You have not provided sufficient ongoing verification of long-term care needs;

You suffer from a pre-existing condition;

Your medical condition is not covered because it is the result of one of the following: mental illness, attempted suicide or intentionally inflicted injury, alcoholism or drug addiction, war or acts of war;
Your benefit amount is less than you understood it to be.

These insurance policies are complex. Distressed insurers may employ multiple denial strategies, hoping to wear-down the claimant.

The best strategy for those with QLTCi policies is to make sure your adult children are actively involved with the purchase and any ongoing changes to the policy.

BruceM
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BruceCM writes,

What never seems to get talked about in LTCi discussions is claim denial rates.

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Excellent point!

If you cut the insurance company out of the picture and invest that big LTCi premium yourself, you alone decide when and how you'll receive LTC.

intercst
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