I did a search and couldn't find any threads devoted to this, so here goes. I thought it would be of interest to relate experiences, tell others what to look for in buying the insurance, etc. It's a complicated issue to understand, but certainly worth the effort.
My husband, knowing his Dad had EOAD, was wise enough to buy a policy in his 50's. It has been a lifesaver, I'm not exaggerating. Our financial advisor has suggested that I buy an annuity with a long-term care rider, so that I will have some coverage as well.
LTC insurance can be complicated because there are so many policies which offer different levels of benefits (NH care, ALZ care, home care, housekeeping, etc) and different premiums. If an employer offers LTC you may want to check that out since often times there's no pre-existing exclusions.
Our experience was we met with a rep from GE/Genworth about 4 years ago. They do a prescreen to determine pre-ex conditions. Interesting enough, DH qualified and I didn't (RA). The benefit provided $220/day for NH/ALZ care with a 5 year max. The monthly premium was quite high $368/month. We did not buy from Genworth. A few years ago we applied for LTC through the Company's group plan - DH was accepted, I was not. I have RA and DH now has FTD, go figure. When considering purchasing LTC, understand the daily benefit it pays (i.e. $200/day for NH coverage), what type of care it pays for (NH, ALZ, Home Health care), waiting period before you can file a claim (90 days, 180 days), total maximum benefit it will pay out ($500,000), requirements to receive payments (ours says Home Health Crae must be provided by a certifed HHC angency and the aide must have a HHC certification). Most importantly read and understand the clause about if you file a claim if the policy has not been in effect for a prescribed number of years. This is VERY important. My DH applied for LTC insurance and was accepted. Policy stated that if he made a claim before the policy was in effect for 2 years, they would investigate the claim and determine if he would be covered. This is a very intimidating process. We had a claim with year 1; they sent an investigator to meet with me regarding DH's health history, work history, personal situation, etc. I was INTERROGATED and accused of excluding facts and denying DH medical coverage so he would qualify for LTC. None of the accusations were true, but they are very intent on trying to prove insurance fraud. It took then 5 months to approve the claim, and did so only after my attorney contacted the investigators. I am an HR professional and the LTC policy language even confuses me. Be very careful and have someone you trust (attorney, financial advisor) lokk at any policy you're considering.
For those whose LO's have the coverage--has anyone used it to pay for home modifications? What did they cover? I am planning to do that in the future--curious as to how it will work.
Re: the 90 day waiting period... the way it was explained to me by John Hancock agent, (#1 rated company), was that a doctor would (or could) admit me to a hospital for the required 2 (?) night stay, and then refer me to a care facility for Medicare's 90 days (most of the time)..and then they'd kick in. Otherwise, we would have to pay for the first 3 months - and they'd pay from then on. I'd give anything if DH would have agreed to buying the policy. I had an LTC policy when we were married..and over 20 years the premium has not increased (Around $1400/yr), but the benefit amount increases every other year..and is staying fairly even with the market.
Hey Nancy B, nice to hear as that is the policy we have! I didn't think it was so great, and frankly didn't understand all the ins and outs. I believe G is done paying premiums next year as that will be the 10th year since we took it out.
I have visited a number of care facilities and if I mention my John Hancock policy, they ALWAYS say that that company is the easiest they have ever worked with! Others give the families and THEM so much grief! It was just a lucky chance that I went with them when I did. I knew a John Hancock rep and he suggested I look into it since I had been single for 21 years..and didn't think I'd ever remarry. Great advice.... and I'm so grateful he walked into my life. When I bought it back in the late 80's, I don't believe I knew anyone who had Alzheimer's....very few did back then. It wasn't well known, for sure.
I am very happy with our GE/Gen worth policy. Now that my husband is a beneficiary I no longer have to pay his premiums. There is no cap on time or total outlay by the company. I pay a bit more but have an inflation factor built in. Alf bills and Gen worth pays. All I have to do is some updated paper work once a year. Their nurse evals for continued need and the hospice Dr and nurse fill out the rest. I don't even want to think about what I would do without it. Many times I thought of cancelling because of the cost.
Each company's LTC policies may offer different benefits and levels of coverage. Some have a fixed dollar coverage for NH/ALF and Home Health Care and a total lifetime benefit cap. Most offer the option to purchase the inflation factor so the reimburseable amounts stay competitive with the market rates. DH's policy is with John Hancock and once they began coverage, we no longer pay premiums. Now that they have approved the claim, they are easy to do business with. HHC agency sends them the timesheets and they reimburse DH; they also offer the option of direct payment to the HHC or NH/ALF. Because DH's HHC coverage on the policy only pays half the monthly cost, we chose to pay HHC agency directly and receive reimbursement payments from JH.
Marilynn, DH's policy doesn't cover home modifications. NancyB, in our case the 90 day waiting period began the day of diagnosis forward 90 days and fortunately DH did not have a claim during that time frame, so once the claim was approved the insurance company they covered HHC up to the max. DH is not yet Medicare eligible, but what you state is true - Medicare would cover the first 90 days stay and then LTC insurance would pay. I am truly greatful for his coverage - I do not know what we would have done without it.
We have coverage thru Golden Rule which has been aquired by another company. The policy has a fixed payout of $2500 per month for each or $5000.00 total per month. It has a 90 day waiting period that you have to pay out of pocket before it kicks in. To qualify you must need help with 2 out 6 activities of daily living
1. Feed your self - Means lift the spoon and put it in your mouth.
2. Clothe yourself
3. Bathe yourself
4. Need help going to the toilet
5. Taking Meds
6. ???
We took an option to pay for life. I wish I had gotten the inflation adder. We paid for it lump sum. $50,000.00
It will pay for home health care, but they must be licensed.
We have not used it yet but I think we will qualify on clothing and bathing.
Read all of the fine print and under stand what you are buying and when and how it pays
moorsb is very right - read all the fine print, understand what coverage you're really getting, when it pays, how it pays etc. The reason I am so engaged in this discussion is because of our recent experience and I want people to understand that LTC provisions are very complicated and the policies are not written to be straight forward and easily understood by the purchaser. They have many limiting provisions.
Some of the long-term care companies make the paperwork reporting requirements so burdensome for the nursing home that they can't or won't comply (they refuse to take a patient with such burdensome requirements), so the company doesn't have to pay. Or they require everyone to have a far higher level of licensing than any nursing home would have, so it is impossible to find a nursing home that meets their standards. Genworth was one of the companies that I've seen others complain about on that front.
Good to know about John Hancock. I've also heard that people had good policies with State Farm. I need to buy long-term care insurance for myself -- anybody have good experiences with other companies?
Shanteuse--Great experience with Unum. No difficulties in getting approval to start payments; staff is as helpful as can be with the claims process. The second is very important to me, since it involves submitting a monthly claim for reimbursement. In addition to covering residential facilities, my husband's policy covers "Home and Community Care". Consequently, we've been able to use if for attendance at 3 adult daycare programs and for covering an aide from a home health agency. All that was required from Unum to certify those companies was that they fax in their state licensing certificates.
Things not covered by the policy are: adult day programs not considered "medical" and aides that aren't affiliated with an Agency.
I would recommend that any members here who are considering buying the insurance for themselves ask their questions first on this board--those of us already using our LO's policies may be in the best position to answer questions. It's a complicated process to try to compare coverages, if you're not familiar with this type of policy.
Moorsb--#6 may be Transferring--being able to get up on one's own from a bed, chair, etc.
Marilyn, good to know that you are happy with Unum as that is the policy that I have. I pay the premium once a year and after 10 years....only one more to go....it is paid off. I hope to never have to use it, but I am glad that my financial planner suggested it after my husband was diagnosed.
We have LTC with Transamerica and my LO already qualifies for nursing home pay after she spends 90 days there under Medicare. But I have not choosen to lhave her committed yet. They have a clause for "Alternate" services but we can not negotitate until she first goes into the nursing home. Seems like a catch 22 to me but it does excallate every year and will pay for the more expensive Nursing Home care and maybe I can then negotiate some kind of Home Care after we meet the first requirements. I have not choosen to pursue it any further since we have found out that DW is qualified by enough of the list of can't do's!!!!!