08/15/2019
An estimated 70% of people over age 65 will need some kind of long-term care during their lifetime.
Not all of these people will need to enter a nursing home. For many, the preferred care would be received at home. It is the inability to do the activities of daily living because of a physical or cognitive reason that trigger the need for this care.
There are six activities that are considered when making this evaluation. They are transferring, continence, toileting, bathing, dressing and eating. When someone cannot do two of these by themselves, it often signals the need for aid. These are what trigger LTC policies.
When Medicare was created in 1965, it was designed to help people over age 65 get better. It was not designed for illnesses such as Alzheimer's and other diagnosis that last long term. Medicare does not pay for long-term care. It might provide up to 20 days coverage for short-term recovery if you have been admitted to a hospital for three or more days and up to an additional 80 days might be available by paying a daily co-pay. After day 100, there is no long-term care coverage from Medicare. While this might be very valuable for rehab from a stroke or hip fracture, it does not solve the problem if you need care for the rest of your life.
The only other government program for long term care is Medicaid. You must spend down most of your assets to qualify for help from this program. Even then, Medicaid covers a nursing home only, in a specially licensed facility and usually in a semi-private room with another resident. If you prefer to treat at home in private, Medicaid will not be the answer to your situation.
This means that if you have assets that you want to protect, you better have a plan. The Pension Protection Act passed in 2006 might offer some help. In some cases, it allows you to withdraw cash value from existing life insurance or annuity to purchase LTC coverage. Sometimes you can completely exchange annuity for a LTC policy on a tax-free basis. On some policies, you can accelerate the death benefit tax free to pay for long-term care.
Traditional LTC insurance where you make monthly payments is not used as much as it was years ago. Many insurance companies have left the industry and premiums have often increased at an alarming rate. These types of policies were often use it or lose it. Most people hope to never need to use a nursing home. Sometimes after paying for years, people find out they can no longer afford the coverage. This is a difficult decision. Newer types of coverage can eliminate some of these issues.
Since there is a five-year look back period, you must plan ahead. The odds of needing care increases every year as we age. While this subject is important to every senior, it may be even more important to women. When you visit a nursing home, about 85% of the population is women. This is because women often marry men several years older than themselves. Also women often outlive men of the same age by four to six years. When a husband needs help, the wife is available. Often when the women need help, she is a widow.
Be proactive and have a plan to deal with this important possibility.