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Frequently Asked Questions About Long Term Care Insurance

Q: What is long term care

Long term care is any type of care that a person needs whether at home or in a facility such as a nursing home or an assisted living community …

Q: Why are most people unprepared for the cost of an average long term care stay?

The average stay today is 3 years and the average cost in the Baltimore area (where I am based at, in other areas it will be different) is about $4,000 a month or $50,000 a year. Fewer than 20% of those that need long term care are able to cover the cost for just one spouse let alone both … The reality is that most people cannot save enough.

Q: What are the options? There are basically three options: Those who are rich (w/more than $1,000,000 to $1,500,000 in liquid assets outside of real estate), can "self insure"

  1. For those who are poor (broke with less than $2,500 in assets and very sick) Medicaid or medical welfare will cover the cost of long term care
  2. For those caught in the middle, private long term care insurance is the most viable option
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Q: What is long term care insurance?

Long term care insurance covers a person against the costs of home health care, community-based care (assisted living, etc) and of course nursing home care. It works in conjunction with Medicare or private health insurance.

Q: Will Medicare cover me?

Not for very long… For those that qualify, Medicare will pay up to 100 days of LTC. The average length of a covered stay in 1996 was 27 days. Besides, do you want to rely on the government? Remember also that they pay the full amount for only the first 20 days, after which you pay the first $81.50 a day.

Q: What are the odds that a person will need LTC? According to a recent study published in the New England Journal of Medicine:

  • For a man over 65, the odds are 1:3 or 33% that he will need LTC in his life,
  • For a woman over 65, the odds are 1:2 or 50% that she will need LTC in her life
  • Women are more likely to need LTC because they live longer. Q: Can everyone qualify for LTC insurance? Unfortunately, no. All the money in the world can’t buy a LTC insurance plan. It takes a little good health as well. The best time to apply for coverage is when you are healthy. Your premiums will be lower and you will be more likely able to get coverage.

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    Q: How much does LTC insurance cost? Premiums are based on three factors:

    1. Age
    2. Current Health
    3. What features you design into the plan (there are five variables in each plan)
    Long term care insurance plans have level premiums and are guaranteed renewable. That means your rate is the same for the life of the plan.

    Q. I've looked at a plan - which inflation rider should I choose if any?

    Choosing an inflation rider is based on your age when you take out a policy and your life expectancy...

    Q.What is Long-Term Care Insurance?

    Generally speaking, long-term care insurance is designed to help you pay for the day-to-day help you may require if, because of an injury, chronic illness or old age, you need assistance with basic activities such as dressing, bathing or eating--whether at home, in your community, or in a nursing facility.

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    Q.What are the age limits?

    Each policy is different. Long-Term Care Insurance can generally be issued to older children and adults of any age. Some policies limit the upper age of eligibility.

    Q.What is the cost of Long-Term Care?

    The cost is based on your age at the time of application; premiums vary depending on the level of benefits chosen and options selected.

    Q.How is the Benefit paid?

    The benefit is paid directly to the insured or whomever he or she designates.

    Q.Will this insurance cover someone with a pre-existing condition?

    Once the policy/certificate is issued, most programs will cover all pre-existing conditions. Some plans, however, allow more less-healthy people to enroll, but when it comes to claim time, will deny more benefits because of pre-existing conditions.

    Q.Are there health questions to answer when enrolling in LTC insurance?

    Yes, but in some cases, if you are working full-time (or could be if school were in session), you may be eligible for a streamlined underwriting procedure where the evaluation of your health condition is simplified. If you are not working, then it is a good bet the evaluation of your health condition will be carefully reviewed.

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    Q.How long is the underwriting process?

    Generally, it takes 30-45 days for processing of your application and health questions, provided the forms have been completed correctly and all questions have been answered. If additional information is needed from your physician, the process could take longer.

    Q.Is there any written material on long-term care insurance that would tell me more about it and help me to decide if I should consider buying a policy?

    Yes. A very good booklet called the "Shopper's Guide to Long-Term Care Insurance" has been published by the National Association of Insurance Commissioners. You can get one from NEA Member Benefits by clicking on  Consumer Guide. Please see your licensed agent for the NEA MemberCare Long-Term Care Program for details regarding other consumer guides and materials your state may publish or which are available in your state.

    Q.How can I find more information about the financial condition of an insurance company that sells long-term care insurance?

    You should always check on the financial solvency of insurance companies offering long term care or any other insurance. Independent rating agencies make evaluations available to consumers. The ones that are most often talked about and respected include A.M. Best, Standard & Poor's, Fitch and Moody's. You can call the rating agency, check your local library or ask your agent to provide you with current information.  You can also call NEA Member Benefits for current information on suppliers of programs for NEA members. You should note that insurance ratings are an indicator of stability and not a warranty of an insurer's current or future ability to meet obligations to policyholders, nor are they a recommendation of a specific policy form, contract, rate or claim practice.

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