Why Buy Long Term Care Insurance? The Short Answer.

The following information is not advice, it’s just my thoughts and opinions. I’m just a girl on the web, not currently licensed in insurance or anything else in any state. You should absolutely seek the counsel of an insurance agent licensed in your state before taking any action at all. Coverages and programs discussed may or may not be available in your state.

Recently someone asked me what I knew about Long Term Care insurance, and whether or not I thought it was a good thing to buy.

The answers to that are a little, and yes.

Why buy it?

Because generally Medicare doesn’t pay for long term care. They only cover nursing home costs under very specific conditions for a very short period of time, and eventually they stop paying at all.

And most long term care isn’t as an inpatient in a nursing home, it’s at home for what they call “custodial care” or “activities of daily living” – toileting, bathing, dressing, eating, transferring (getting into and out of bed) and continence. Medicare doesn’t cover that at all.

Long Term Care Insurance (LTC) starts covering if you can’t do two out of the six activities of daily living for a period of (usually) at least 90 days. Coverage can also be triggered if you require substantial supervision because of a cognitive impairment (like Alzheimer’s). It can cover care at home, in a nursing home or in the community (i.e. Adult Day Care). You also have to be eligible and pay for services for an Elimination period (which you choose). You can also choose how long the policy will pay (usually 3 years, 5 years and lifetime).

Some people think they can just go on Medicaid. They can, but not unless they meet very specific guidelines on assets and income. Many people think they can just give their assets to their kids to protect them, but you can’t. There are HUGE penalties if you try to do this.

In my opinion LTC is very important if you want to protect your kids from having to foot the bill, and if you want to have an estate to pass on to them. Sure, you can sell your house to pay your expenses. Nursing homes cost about $150-$160 a day now, which is $55k – $58k a year. My grandmother was in a nursing home for twelve years before she passed.

Many people thing they don’t need Long Term Care because they have family that can take care of them.   But is that a burden you really want to place on them?  That’s a position I never want to put Son in.  He’ll want to, he’ll even do it, but what kind of life would that be for him?

And I never want my son to have to wipe my tushy.  Dignity is important to me, and it would already be a huge blow to mine to have someone else do that.  I would be mortified if that someone else was my son.

I want my son to live his life, not spend it taking care of me.

My Dad has LTC, thank goodness, and my Mom would qualify for Medicaid without having to divest any assets (the one advantage to her poverty). You can bet that my husband and I will get LTC, probably when we turn 55.

Either that or we’ll retire to Guam. If you have to be sick, might as well be sick in a tropical paradise.


Concierge Doctor Plans – Not Frugal But Perhaps Money Well Spent

A few years ago I started hearing about so-called Concierge doctors. These doctors limit the number of patients in their practice and charge membership fees (for goodness sake!) for the privilege of being their patient. The knowledge was floating around the periphery of my brain, but aside from the initial internal outrage at the gall of those doctors I really didn’t give it much thought.

Then, about four years ago, Husband started feeling poorly, and he wasn’t feeling better several months later. He didn’t have his own doctor, having not darkened one’s doorstep in over ten years. Since my own doctor wasn’t nearby I started calling around trying to find a doctor for him; at least once his 40 lb weight loss and debilitating fatigue finally got to him.

It was an exercise in frustration. After at least fifteen calls the only doctor I could find that could see him within two months was in a Concierge practice. When the receptionist explained to me that the doctor would be happy to see Husband the next day, but first there would be a $3000 membership fee to join the practice my eyeballs very nearly popped straight out of my head. Three thousand dollars? Before the doctor even saw him? Outrageous! I wound up calling my doctor and making the trek with Husband the next day (we found out he was diabetic, with a blood sugar level of over 400 that day!).

The next few months were spent getting Husband every test imaginable and getting his diabetes under control. We’ve had lots of interesting (read: awful) experiences with doctors along the way, and I’m sure I’ll blog about them at some point.

I honestly had not given the subject of concierge medicine much thought since then. Until last week.

Husband’s grandmother, G-d bless her, turns 95 next week. Mama’s got all her marbles and then some, but has some issues with her sight, blood pressure, hearing… all a pretty normal part of living ninety-five years. She tells me that her parts are wearing out; I tell her they’ve still got a lot of wear. After all, she still regularly beats me at rummy, makes a mean Pasta Fagioli, and can gossip up a storm.

When I heard her doctor was switching over to a concierge set-up my initial reaction was negative. It seems to me to be flirting pretty boldly with double-billing, and on a fixed income the new $1500 a year membership fee seemed ridiculous for her to pay if she didn’t have to. After all, there are plenty of doctors around.

She went to hear about it with her son and daughter-in-law, who practically forced her to sign up. I saw her immediately afterwards, when she was contemplating calling and canceling the transaction. Based on my own preconceptions I was privately hoping she would.

Then I started reading the brochure, and I started thinking about it.

Mama has had a lot of problems with doctors. Well, not really the doctors. The doctors are usually pretty good, or at least have good intentions. But they are hampered by the current state of health insurance in this country, which makes it nearly impossible for doctors to see enough patients to pay their student loans, malpractice insurance and earn a living without having to resort to fast-food-like service. And some of it is because of office personnel who inexplicably think we owe them something because…I don’t know why. Because we pay their salaries? Either way her care has suffered, and she’s been hospitalized unnecessarily more than once and avoided a stroke due to an overdose of medication by the hair on her chinny chin chin.

My mother-in-law found her this new doctor a few years ago and everything has been pretty smooth since. Sure, there are screw-ups with labwork and appointment times occasionally, but much, much better than before.

This doctor has decided to join an already-existing concierge-type network plan. For her $1500 annual fee she’ll get a much more comprehensive than normal yearly physical, a personalized wellness plan, a CD of all her medical records, VIP access at Cleveland Clinic and concierge service at any of their member facilities, travel services and more.

All of which is good, though some of it is simple marketingspeak. The real benefit, the real reason to do it, is the access to the physician.

Appointments will be available either same-day or next-day with no waiting. And they will last, theoretically, as long as Mama needs. The doctor is available 24/7, and if she tells her that she needs to go to the hospital she’ll meet her there (if you’ve ever spent hours waiting in an Emergency Room you may think the $1500 cost is worth it for that alone).

How can she do it? She’ll be limiting herself to 400 patients (200 less than the plan normally requires), down from about (I’m guessing) 2000 now. That means she’ll be able to actually manage all of Mama’s care, be familiar with what’s going on with her, help her make decisions that are right for her. Mama is 95; she just wants help making the little things that keep coming up (like a recent onset of vertigo) and making her chronic ailments more comfortable until The Big Thing comes along.

Why not make it less stressful? Why not spend $125 a month to give her easier access, so that she can get care and answers right away? Why not? As I said to her, “Mama, why not spend your money to make yourself more comfortable? What better thing are you going to spend your money on?” She lives with my mother-in-law and doesn’t have many expenses. And even if she could not afford it we would all chip in to get her this kind of service with a doctor she already trusts. She’ll always have all of the creature comforts she needs. And if she’s not wasting money on prescriptions she shouldn’t be taking and wasting time and money waiting and schlepping and… well, I’m obviously a convert.

Surprised the heck out of me.

I’m not sure I’d feel the same way about some of the other fee-for service or retainer-type concierge set-ups ($15000 a year? Come on!). This plan is much more.

And this isn’t insurance. It doesn’t cover procedures or prescriptions or any other gaps in coverage on her policy.

The annual fee may be paid through employer Section 125 plans, and is compatible with flexible spending accounts (FSAs), medical savings accounts (MSAs), and health reimbursement accounts (HRAs). The fee may also be paid through the newly established health savings accounts (HSAs).

I don’t think these plans are right for everyone, by far. For Husband and I it would be $250 a month, which is about $249 a month over what we could afford to spend on it. But if you’ve got the money, or if you’ve got a chronic or acute illness, what great peace of mind you can have for a measly $125 a month. And, in Mama’s case, her kids will rest easier, and all of us will worry a little bit less.

We want her around as long as possible, but we want her comfortable, and happy.

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