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Long-term health care questions to consider

March 16, 2014
By SAMUEL ZIMMERMAN , The Leader Herald

What are some of the questions you should ask before you buy long-term care insurance?

Most Americans today can expect to live to a ripe old age. The life expectancy of a 50-year-old is now 79 for a male and 83 for a woman. What's more, over a fifth of today's 65-year-olds can expect to survive past age 90.2 While increasing longevity is good news, it increases the likelihood of needing long-term care at some point in your life. Long-term care costs can be significant and are not covered by Medicare or Medigap insurance. Whether or not you choose to buy long-term care insurance to defray such costs will depend upon a number of factors.

Safeguard your

later years

If you are considering long-term care insurance, it is critical that you plan early and choose wisely among the available options. The cost of long-term care policies may increase dramatically with the age of the subscriber. According to the National Association of Insurance Commissioners, a 50-year-old can expect to pay premiums averaging $888 per year, increasing to $1,850 at age 65 and $5,880 at age 75.3 Purchasing a policy when you are younger and healthier can help contain costs and maximize benefits.

Determining which long-term care features and benefits may be most meaningful to you requires an understanding of your projected financial situation as well as your anticipated health insurance coverage in your later years.

The following questions can help you decide whether long-term care insurance is right for you, and if so, what features and benefits may be most meaningful to you in your later years.

What does 'long-term care' entail?

Long-term care encompasses a range of services that pertain to personal care as opposed to medical care: everyday tasks, which include bathing, dressing, moving around your surroundings and eating, as well as services that support independent living such as house cleaning, medication management, shopping, cooking, using the telephone or even paying bills. These services can be delivered at home, in an assisted living facility or nursing home, and costs can be high. According to the 2012 MetLife Market Survey of Long-Term Care Costs, the annual cost for an assisted living facility averages $42,600 per year and a nursing home averages $90,520 per year. Expenses can run even higher, depending on where you live and the facility you choose.

Doesn't Medicare cover these services?

Medicare coverage works in two phases: In phase one, Medicare will fully cover short-term nursing home stays up to 20 days for patients recovering from an acute illness or injury; in phase two, partial coverage maxes out at 100 days. During this second phase, individuals are responsible for daily co-payments unless a Medigap policy is in force. After 100 days, Medicare coverage expires leaving the elderly fully responsible for funding an array of often critical support services on their own whether those services are delivered in a nursing home, assisted living facility or at home. In addition, Medicare does not cover any assisted living expenses or adult day care expenses. While Medicaid will pay for long-term care in certain qualifying nursing homes, only those with minimal assets and income may qualify for benefits.

Does the new

healthcare law help?

Although there was an attempt to include a long-term care supplement within the Affordable Care Act, it was suspended indefinitely from the program due to questions surrounding its financial sustainability. Issues regarding pre-existing medical conditions and limited appeal to lower-income populations would result in extraordinarily high premiums, and therefore, the program was eliminated.

This column was provided by Samuel Zimmerman, a financial adviser with Morgan Stanley Smith Barney LLC in Gloversville. The Leader-Herald invites area financial advisers to submit columns. For information on how to submit one, call Tim Fonda, managing editor, at 725-8616, Ext. 277.



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