Facts about insurance | Joe Sperling JD | Independent Insurance | Rockville and Montgomery County Maryland

Do Women Need  Long-Term Care Insurance?

In a word Yes! Women generally live longer than men, may be widowed, divorced or single, and are far more likely than men to need long-term care services and use them longer. Women are usually the caregivers, and it takes a toll. Women comprise 75% of unpaid caregivers. The majority of nursing home residents and patients suffering from Alzheimer's disease are women. Women are twice as likely to exceed three years on claim. Over 67% of all LTC benefits are paid for care of women. A huge number when
one considers that the insurance industry pays out more than $6 Billion in claims annually.

Don't delay purchasing LTC insurance. Rates for women will be going up as carriers shift to gender-specific pricing.

​Why Should Advisers Address Long-Term Care Protection With Their Clients?

1. Your clients look to you for sound advice. They may assume if you don't bring it up, it must not be that important. Long-Term Care protection is that important.
2. Clients may be ignorant (not a derogatory term, simply means they don't know about it) and may assume to be true a lot of myths about Medicaid, Medicare and the cost of care. Most clients have no idea about the real-life consequences of one needing extended health care.
3. Liability! If you don't have the discussion, and they burn through their estate, their heirs may come after you for not advising your client to get LTC protection.
4. Help your clients retain financial control and physical independence.
5. Protect your client's family from being fractured, deeply stressed and financially devastated.
6. Preserve your client's retirement plan for its intended purpose.
7. Solidify your relationship with your client by showing you are willing to ask the (sometimes) hard questions.

There are many reasons why a person should not wait to obtain Long-Term Care insurance

Premium rates are based on age of applicant. The older you are, the more it costs. You will never be younger than you are today.

Carriers are more likely to increase rates on a new policy series (rather than increasing premiums on older policies).

Policies have been under-priced due to higher incidence of claims and more costly claims than anticipated, as well as other factors. As a result, rates are going to increase. Underwriting will become more strict as carriers seek to improve their claims experience. Applicants may be disqualified due to medical conditions. The older the applicant, the greater the percentage of declinations. For example, of those age 60 to 69 who applied for coverage, 24% were declined, while for ages 70 to 79, 41% were declined.

Fewer carriers are offering Long-Term Care insurance. UNUM, Met Life, Prudential and American General are not issuing new policies. As the LTC market consolidates, there will be fewer plans from which to choose. Once a policy is in force, even if the carrier does not offer new policies, it will honor existing contracts.

Finally, by purchasing Long-Term Care insurance, your family will be able to take comfort in knowing you will have the resources for the care you will need. Everyone will sleep better.

What is the "caregiver crunch" I've heard about?

​There are currently over 66 million Americans serving as unpaid family caregivers. Due in part to more dispersal of families, high divorce rates, and more women with careers, there will be a shortage of family caregivers in the near future. Those who are available will contribute financially, and likely miss time from work, or have to quit their job, resulting in less income, reduced retirement savings and more stress in their own family.  Not a pretty picture.

Among the paid caregivers, the labor shortage is getting worse due to attrition caused by the high injury rate, unpleasant work, physical drain and low pay. Nursing home staff suffer greater percentage of injuries than factory or construction workers, and are only surpassed by firefighters, sports teams and animal slaughterhouse workers.

Families can't be expected to fill in the gap. Children care about their parents, but parents don't want their children to care for them.  Elder spouses likely can't do it. They can't lift their spouse now, much less when they are 80 years old.

We need to be prepared with a plan. The plan may include appropriate insurance protection as it is becoming clear that those who need care will increasingly have to pay for it themselves.

Worry is not preparation.   Hope is not a good strategy.

How big a factor is Alzheimer's disease in retirement and long-term care planning?

In a word: HUGE.  It is the single greatest concern of a large majority of senior Americans, and rightly so. Approximately one in every eight American age 65+, and nearly half of those 85+, have the disease. Although the subject of significant study, it is currently incurable. The incidence of Alzheimer's disease doubles every five years over age 65. The duration of suffering can last from a low of four to eight years following diagnosis, to as long as 20 years. Cancer and heart disease are bigger killers, but Alzheimer's disease is the most expensive. The cost of care can be astronomical. The burden on unpaid caregivers, primarily family members, although not easily quantified, was nearly $210 billion in 2011. It is not the cost of drugs or other medical treatments, but rather the care needed to just help sufferers get through daily life. The Alzheimer's Association projects the cost of care (including health care, long-term care and hospice) to reach $1.1 trillion by 2050.

Alzheimer's disease is truly the wild card in planning for retirement and long-term care.

Medicare Standards Revised for Skilled Nursing Care

On January 24, 2013, a settlement agreement between the parties in a class-action lawsuit in the U.S. District Court, District of Vermont, was approved. The agreement provided that Medicare would no longer require "improvement" in order for benefits to be available to patients needing skilled care. The new rule applies to physical, speech and occupational therapy by a trained professional.

Patients still need a doctor's order specifying that the particular treatment is medically necessary, however it can be to maintain or prevent deterioration of the patient's condition.  For therapy in a nursing home, the prior hospital stay, 100 day limit and payment caps apply. For patients who are homebound, there is no time limit or payment cap. It will take time for Medicare providers, contractors, claims processors and even the staff at 800-MEDICARE to get the word. The advice for beneficiaries is to be prepared for a claim denial, plan to appeal as quickly as possible, and obtain a free "self help" packet from the Center for Medicare Advocacy. The packet can be obtained online at www.medicareadvocacy.org.

What is the essence of Long-Term Care insurance and why do I need it?

Long-Term Care insurance (LTCi) pays for assistance provided to individuals who can no longer perform the day-to-day activities normally associated with independent living due to disease, disability, illness or the frailty that may come with aging. Most people assume the risk of needing Long-Term Care is like that for an accident, and tell themselves "It won't happen to me."  For some, they may be right. But the reality is 70% of them are wrong. They will need it. So what if they are wrong? The emotional, physical and financial impact on the entire family is huge. To protect against the risk, LTCi is essential. LTCi policies offer a myriad of features and options. The three more important moving parts are (1) the daily or monthly maximum benefit, (2) the benefit multiplier or length of benefit period, and (3) the level of inflation protection. Inflation protection is considered by many experts to be the most vital, with 5% compound being the gold standard. Increasing cost of premiums is shifting many buyers to 3% compound. Although writing the premium check for $5000 per year is not fun, the alternative of writing a check to pay for care costing $8000 per month now, or $30,000 per month in 30 years, is far worse. And consider, according to a study released by the U.S. Department of Health and Human Services, an overwhelming majority, nearly 97%, of policyholders receiving benefits from their LTCi policy are satisfied with how their claims are handled.

How good is the nursing home at taking care of your mother?

When considering relocating your loved one into a nursing home, emotions can run high, for all concerned. Although it should not, expediency may trump careful analysis. If it is possible to conduct a meaningful examination prior to placement, or if complaints by the in-place resident prompt a more thorough review, consider the following:
1.  Can the facility provide dignity through privacy, or are all rooms shared? If shared, what efforts are made to offer some privacy? Are there actual partitions or merely thin curtains between beds?
2.  Is there an activity schedule? Is it real? For most nursing homes, the primary activity is mind-numbing sitting and looking at walls. Look in on scheduled activities, but do so unannounced. Do the residents appear to be happy?
3.  How does it smell? Not just in the main reception area, but also in the corridors and the residents rooms. Fresh or foul?
4.  How is the food?  An area of frequent complaint, mealtime is understandably stressful for the staff. Some residents are served n their room, while others congregate in a dining room.  Ask to sample what is being served. Watch the servers. Are they respectful of the residents?
5.  How are the physical therapy facilities?  Well equipped or meager? Is the equipment ancient or modern? Does the facility have equipment recommended by your loved one's doctor? Is there a physical therapist on staff?
6.  Are the nurses and caregivers permanent employees of the facility or are they short term agency personnel who work for a staffing agency? It is not unusual for a nursing home to have 15-20% of their manpower as agency temps, but a higher percentage is a concern. It takes time for a resident to bond with and trust the caregivers.
7.  How is the facility rated? check them out at the website:  health.usnews.com/best-nursing-homes.
8.  Visit often. Talk to the staff each time. Show your interest in the resident. Be involved without being annoying. Residents with frequent family visits receive better care, more attention. It wouldn't hurt to take a little something (like cookies) for the staff as a "thank-you".

​Special Report - Same-Sex Couples: Assets of Both Spouses at Risk

​The new rules allowing same-sex couples to qualify for federal benefits subjects same-sex couples to the Medicaid eligibility rules, which exposes the assets of both spouses to the cost of long-term care. In June 2013 the Supreme court struck down Section 3 of the Defense of Marriage Act (DOMA). That section denied federal recognition of same-sex marriage.

As a result, in those states, such as Maryland, which also recognizes same-sex marriage, same-sex couples are treated no differently than traditional husband-wife couples for Medicaid purposes. Medicaid is the program that pays for a nursing home stay for qualified individuals. to qualify for Medicaid, an institutionalized spouse must spend most of his or her current income, including social Security, Civil Service, private pension, annuity income, etc. on his or her own care. If the community spouse (the one at home) is "low income' the amount the institutionalized spouse must pay for care is reduced so the community spouse has an "allowance" to bring his or her income up to $1,892 per month. A further allowance for housing costs can raise total monthly income up to $2,898 per month (in 2013).

The community spouse is subject to a "resource allowance"- he or she can have no more than 50% of total value of what the couple owned at the time of admission of the institutionalized spouse, subject to a maximum of $115,920 (in 2013), before the other can qualify for Medicaid. Other than their home and its furnishings, one car and pre-paid burial arrangements, everything owned by either or both spouses is counted as an asset and must be spent (not necessarily on care) before Medicaid takes over.

Keep in mind the State can recover from proceeds of sale of the excluded home when sold, if still owned by the institutionalized spouse, or from the estate of the institutionalized spouse (only) following death, the amount spent by Medicaid for the person's care, provided he or she is not survived by a spouse or disabled child.

Suggestion: this can be very complicated. Consult with an Elder-Law attorney before applying for Medicaid benefits. The ruling gives extra incentive to same-sex couples to look into Long-Term Care insurance so as to protect their assets.

Are You Prepared to be a Caregiver?

​Fact: we are an aging society. No surprise, right? But did you know that if a couple is currently age 65, there is a 25% chance that at least one spouse will reach age 97? As we get older, we need care! Are you prepared to be a caregiver?

It has been reported that nearly 4 out of 10 Americans are currently caring for someone with health issues. What is the impact of being a caregiver?

1. The caregivers themselves suffer from significant levels of stress, depression, sleep deprivation and neglect of their own health.

2. Proper nutrition and exercise, on the part of the caregiver, are forgotten in the constant struggle of providing care.

3. With the increasing presence of Alzheimer's disease (approximately 15% of Americans over age 70, with another diagnosed every 68 seconds), and the constant need for care, the physical and emotional burdens are amplified.

All of this takes a very serious toll on the caregiver. And we haven't even addressed the financial drain.

If you're thinking that the federal Family and Medical Leave Act provides a cushion by requiring employers to grant unpaid leave for 12 weeks per year, the annual limit is a "drop in the bucket" when dealing with chronic needs of an elderly, frail or incapacitated person. And notice that's unpaid leave.

Are there any other concerns that must be considered by potential caregivers? You bet there are:

1. A caregiver needs to understand their role. many times a caregiver goes not even identify themselves as a "caregiver". They are simply doing what they're supposed to do to help a family member.

2. The very scary aspect of this is that a caregiver has a legal obligation to provide at least a minimal level of care.

3. As was pointed out in a recent court case in which a caregiver (the daughter) was found guilty, if one takes on the role and then neglects the patient, even with the best of intentions, the caregiver may be subject to criminal prosecution.

4. Lesson here: if you can't do it, you have to say "no" up front.

5. Don't make the mistake of thinking that being a caregiver is not that hard. It's extremely difficult, often thankless, frustrating, physically demanding and emotionally draining.

So, if there is such a thing as an "average" caregiver, what does he or she look like?

1. The caregiver is typically a woman.

2. It's usually the wife or eldest daughter.

3. Women live longer than men.

4. They take care of their parents, and then their husbands.

The real problem comes when there is no daughter or wife to take care of the caregiver. Nearly 80% of men die married, but 80% of women die single.

Still think you're prepared to be a caregiver? Or do you think you might want to explore other options, and get some information on Long-Term care insurance that provides funds for paid professionals?

Are You Prepared to NEED a Caregiver?

We often see ourselves as much younger than our chronological age, and only get a taste of reality when that is a new ache or getting out of bed is suddenly harder.l Eventually we get old and need help with activities of daily living. Don't think it will happen to you? OK, let's consider:

1. When you don't die, you live a long life.

2. When you live a long life, you get old.

3. When you get old, you need care.

The oft repeated statistics are:

1. 70% of Americans who are 65 or older will need Long-Term Care (LTC) services at some point during their lifetime.

2. 78% prefer to receive care at home for as long as possible.

3. The average length of care at home is 3 years and the average length of nursing home care is 2.5 years.

4. The average cost for care at home is $46,000 per year (assuming 6 hours per day) and for nursing home care is $100,000 per year (for a private room) in 2013.

It is safe to assume you are in the majority of Americans and will eventually need care. What is unsafe is to have no plan for that care.

There are a number of very important steps everyone should take:

1. have a serious conversation with family dealing with the needs, desires and capabilities of all parties.

2. Discuss legal and financial issues, income, assets and obligations.

3. Make sure there is a current will, appropriate power(s) of attorney for when you are no longer able to make financial and medical decisions, and advanced medical directive (clearly stating your wishes regarding medical and life-sustaining procedures).

4. Collect and assemble documents regarding assets (such as deeds, investment reports, account statements) and debts (such as promissory notes, contracts, leases), and this may be the hardest part - give your family access to all of this information.

When the time comes that you need care, providing that care, and the condition requiring it, will run the entire family. It will undoubtedly have a profound impact. the family will want to help, and will try. But it may not be capable, or you may not want them to do so.

Due to the fact that there are only three sources of funding for care (personal assets, Medicaid after impoverishment, or LTC insurance), the need for planning is obvious. Considering the evolutionary nature of LTC insurance, it is advisable to seek the guidance of an insurance professional before the coverage is no longer affordable, or worse yet, no longer available.

Has someone you know been declined for Long-Term Care insurance?

Due to the natural tendency for people to delay applying until well into their "golden years", the answer I get with increasing frequency is "Yes".  The usual question I am then asked is "What can we do now?"
There are several options.  The default position most often considered is that family will just have to take on the responsibility for providing care. Frequently that is easier to say than to do. Family members may want to help, but a spouse may not be physically capable of lifting and caring for the person needing care. Likewise, daughters (it's usually them after all) may have their own families, careers and obligations to handle, and they may not be able to drop everything to provide care. Plus, we no longer live in a village and family may be scattered in different parts of the country.

Another option is simply to exhaust personal assets and income, and then seek to qualify for Medicaid.  While that is a straightforward approach, the significant downside is that Medicaid is an already strained program that pays for nursing homes that accept Medicaid patients. Not all do. And Medicaid does not pay for home care. Most of us would rather be at home for as long as possible to maintain dignity, control, privacy and familiarity.

A third option is a home care service plan designed to provide care services through networks of agencies or informal caregivers. It is not insurance, so there is no age limit, no health questions and membership acceptance is guaranteed.  The plan offers a choice among various amounts of hours and days of home care.

The need for long-term care will be physically, emotionally and financially draining for the family. One should not allow a declination for traditional long-term care insurance to result in resignation. Explore the alternative of a guaranteed acceptance home care service plan.

Insurance considerations in a divorce

It's no secret that divorce is very traumatic. Just ask someone who has been through it.
Whether the divorce is amicable or contentious, there is upheaval in the parties' lives, as well as those around them. In the wake of the storm, considerations of insurance may not bubble to the surface, but failure to pay attention may have a very unpleasant impact.

A support obligation should be protected by life insurance on the obligor. Most of us know that life insurance has three positions represented: owner, insured and beneficiary. Owner gets to name the beneficiary. Beneficiary gets the money when the insured dies. Pretty simple.  It gets complicated when, as a result of a divorce, the beneficiary (and possibly the owner) of existing life insurance should be changed, but through oversight is not. The wrong person will get the money.  As a precaution, it is usually a good idea to have the same person identified as owner and beneficiary.

Disability insurance protects income. If the insured can't work due to a disabling illness or injury, the insurance company pays a monthly benefit.  The person who depends on money from the obligor should require the obligor to have disability insurance, and should verify premiums are paid.

Long-Term Care insurance may not be quite as obvious, but is no less important.  Long-Term care is not just an old person's issue. It is custodial care that may be needed due to a serious accident or illness, stroke, non-lethal heart attack or any number of debilitating diseases such as Parkinson's. In a divorce, a support system is dismantled. Women are the most likely to need care because they live longer and are typically the caregiver before they wear out.
​For additional discussion on this topic, check out the blog by Eileen Coen, J.D. at www.divorcethatworks.com.    If you are involved in a divorce, as a party or adviser, and would like more detailed or personalized guidance regarding insurance issues, contact me by phone or email.

How can I deduct Long-Term Care premiums?   Here are six ways:

(1)    Individual deduction- amount based on age
(2)    Self-employed deduction - amount of premium paid goes directly to line 29 of Form 1040
(3)    C Corporation deduction - 100% of premium paid, not subject to age based limits, and company can discriminate (select whose policy will be paid for)
(4)    If cash value used from life insurance to pay for LTC premium, interest earned on the life policy that might normally be taxed is exempt
(5)    States (including MD) allow tax credit
(6)    Use pre-tax dollars in medical savings account (MSA) to pay LTC premium

Do you know someone dealing with Alzheimer's Disease...As a patient or a caregiver?  It's a difficult situation. What should you do?

A recent study by RAND Corporation found that nearly 15% of Americans age 71 or older have dementia. Currently between 3.8 and 5 million Americans (depending on the source of the report) are suffering with the disease. New patients are diagnosed every 68 seconds.

Alzheimer's disease is progressive, relentless, eventually (and often soon) requiring 24 hour care. Cost of care can be staggering.

Anyone who has cared for an Alzheimer's patient will tell you: "Until you have lived it, you have no idea how it will change your life and that of your family."

The impact of the disease goes way beyond the patient. It starts at the first circle - typically the spouse who will try to deal with the gradually declining patient. The stress, sleepless nights and worry will take a serious toll on the health of the caregiver. The emotional drain and physical strain often will cause the health care costs of the caregiver to soar. The next circle is the rest of the family; the children and siblings. They will try to help. But their own families, jobs, and other obligations will create guilt, anxiety, stress and resentment. The outer circle are the other unpaid and paid caregivers; friends, neighbors, and agency personnel.

Through it all, the patient is increasingly oblivious to the chaos created in his or her wake.

The person suffering with the disease can live five, ten even 20 years. Physically the patient may continue for some time in fairly good shape. Mentally, they're on another planet. Even so, Alzheimer's disease is the 3rd leading cause of death in the United States, just behind heart disease and cancer. And many seniors who die from other primary causes, such as strokes, heart attacks and cancer, will have had some indicia of Alzheimer's disease prior to death. Sadly, if you don't die from it, you die with it. One is three seniors die with Alzheimer's or another form of dementia.

Between 2000 and 2010, breast cancer, heart disease, prostate cancer, stroke and HIV were declining as the cause of death. During this same period, Alzheimer's disease was increasing 68%. It is the only cause of death among the top 10 without a way to prevent or cure, or even slow it down.  Alzheimer's disease is always fatal. The subject of extensive study, it was recently reported that Swedish researchers found experiencing stressful events in midlife (such as divorce, death of a spouse, caring for a sick relative or unemployment) makes one 20% more likely to develop Alzheimer's disease later in life.

​The best advice one can give is to be prepared with a plan. If you don't already have Long-Term care insurance, get advice from an insurance professional specializing in LTC and make an informed decision.

Most people who need care prefer to stay at home. Do you know how to select a caregiver?

Providing long-term care can be stressful. Although many families will try to "tough it out" and provide the care themselves, the result is often discord and utter frustration. But it doesn't have to be that way.

The path to family harmony may simply require hiring an in-home caregiver.

How to do it?  Start with a professional assessment of the senior's needs by a geriatric care manager.  It may take a couple of hours and cost $200-$300, but it is well worth it.  Contact The National Association of Geriatric Care Managers to locate care managers close to you.

When it comes to the caregiver, that person can be hired directly or through an agency. Hiring directly may save a few dollars, but that may place the senior at risk because of inadequate or non-existent background check, difficulty in replacement if the caregiver quits or is fired, and exposure to legal problems if required taxes are not paid.

When hiring through an agency, verify that the agency is licensed by the state, is a member of the American Association for Homecare, and has an easy means of replacing a caregiver who fails to show up, becomes ill or who is simply unacceptable to the senior. No matter who is hired, during the interview process the senior must meet and approve of potential caregivers. Make sure the prospects have a very clear understanding of what is expected of them, what they can and cannot do in the home, and what special needs may exist on the part of the senior. It is also prudent to remove and store, or at least lock up, any valuables in the home, such as checkbooks, jewelry, credit cards, and documents with Social Security number and other personal data of the senior. Another suggestion is to have bank and credit account statements go to a trusted relative to monitor any activity.

To assure the senior is getting the best care, relatives and close friends should make random unannounced visits. A word about cost. Expect in-home care to run about $20 per hour. Agencies will normally require a minimum number of hours per day. There may also be expenses incurred to modify the home, such as for wheelchair access, walk-in bathtub, and a bedroom for a live-in caregiver.
​Staying in the home will help the senior maintain greater dignity, some level of control, and easier access by the family, all of which will help minimize the stress of needing care.

Why should one consider getting Long-Term Care insurance?

Because the impact on the entire family when one member needs Long-Term Care is so profound, so devastating financially, emotionally and physically, that it would be irresponsible to not do so. The family will want to help, and they will help. The insurance simply allows them to do so longer, with greater comfort, less stress and strain, and with the ability to provide higher levels of dignity and service. Cost of care? About 75% of singles and 50% of couples will spend their entire life savings within one year of entering a nursing home. Lost productivity? The annual cost to companies totals over $25 Billion per year, or about $4000 per employee. By 2020 it is projected that 1 in 3 workers will be faced with providing care for their baby boomer parents.

How long is one likely to need Long-Term Care services?

It is nearly impossible to predict with accuracy. According to US Dept. of HHS, 70% of those who reach age 65 will need LTC at some point in their lives. Of those needing care, it is estimated that 20% will need it for more than 5 years, 20% for 2-5 years and 12% for 1-2 years. It is suggested to have at least 3 years of coverage. If care is needed because the patient suffers from Alzheimer’s disease, it could be a very long period, up to 10 years or more.

If one has a lot of liquid assets, why might they still need Long-Term Care insurance?

In a word: leverage. Paying a few tax-deductible dollars in premium, to get many more tax free dollars in benefits, just makes financial sense. Shift the risk of a significant expense, just as one does with fire insurance on one’s home. As with life insurance, protect a lifetime of savings against the enormous potential cost of Long-Term Care services. It’s more satisfying to spend the insurance company’s money than one’s own when it’s time for extended health care.

What is a “State Guaranty Association” and does it cover Long-Term Care insurance carriers?

Each state maintains a guaranty association into which all insurance carriers selling policies in the state must contribute. The association protects state residents in the event a carrier fails, up to certain limits. Long-Term Care insurance is considered health insurance and covered up to $300,000 in MD and VA.

Why should I buy something I might never use?

​For protection against the risk of a devastating loss. Similar to homeowners, health, automobile, or even life insurance, you hope you won’t have to file a claim. But you still buy the coverage because the financial risks are so high and burdens on loved ones could be so great that you can’t not get the protection. Chances of losing home in a fire are 1 in 1200. Chances of needing Long-Term Care services  are 1 in 2 (and 70% for those over 65 years of age). Unlike an investment, insurance claimants rarely talk about financial benefits. It’s more about how the coverage allowed for more dignity and care in the home or a better facility. Long-Term Care coverage is “peace-of-mind” insurance.