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Every Day, It's a Gettin' Closer

By Nancy Castleman & Marc Eisenson

Unfortunately, the odds are pretty good -- over 40% -- that if we make it past 65, we'll spend at least some time in a nursing home. Over ten percent of us will stay for at least five years. Yet Medicare and Medigap programs generally offer limited help, if any. Oy!

If you ever need a nursing home, you'd better be very rich or very poor. In between, and your assets go bye-bye -- fast. Some estimates now put the average cost for a year in a nursing home at over $61,000. In some states, it's even higher, and wherever you live, the tab just keeps going up and up.

If you have modest assets and income, you'll eventually be eligible for nursing home coverage through Medicaid, although you'd have to endure the difficult process of "spending down" your life savings first. On the other hand, if you can afford to pay for several years in a nursing home, even with the stock market's current downturn, you probably don't have to worry.

Unfortunately, chances are you're in the middle, with enough assets so you won't qualify for Medicaid, although given the performance of your mutual fund lately, you're wondering ... and worrying. Several years in a nursing home could rob you and your mate of your nest egg.

And even if you might eventually qualify for Medicaid ... after all but depleting your life savings or cleverly moving them around ... would you want to go on public assistance, deprive your spouse, or be forced into a nursing home that accepts Medicaid?

What about home care? Could your partner take care of you -- assuming you're the first one who needs care? And vice versa? Will your kids help?

What Should You Do? And When Should You Do It?

The first question is easy to answer: Although it certainly isn't for every senior, you should at least consider long-term care (aka LTC or nursing home) insurance.

With other insurance, the "when" question is pretty straightforward, as in you get car insurance when you buy the car. It's a much tougher call here.

Most experts will tell you (or your folks) to start thinking about LTC between the ages of 55 and 65. If you buy when you're younger, you'll lock in lower rates -- and you'll be less likely to have a medical condition that could disqualify you or significantly raise the price tag.

While it's natural to think you'll save money by waiting until you're older to get coverage, it ain't necessarily so! What you pay in premiums may be so much lower if you start early, that even after many, many years, it could still be your best bet.

On the other hand, long-term care insurance is incredibly complex, and changing all the time, especially now that so many Boomers are fiftysomething. The benefits might improve as time goes by, even though the premiums might also increase. A policy you buy today at age 55 might be obsolete when you turn 85. And even then, you might never need the care the policy would cover.

Bottom line? Buy very carefully, if at all, or you'll invest a fortune in premiums and still not be covered when and if you need nursing home care.

What to Look for in an LTC Policy

All insurance is a gamble, and this axiom is nowhere better illustrated than with long-term care. What you buy and when you buy should depend on your risk tolerance -- not the "advice" of a salesperson. If you decide to invest the $500 to $5,000 a year LTC will cost, here's what you'll want:

     1. A daily benefit that's in line with the average daily nursing home cost in your state (or where you expect to retire), including medications and extras you're likely to need.

     2. An annual inflation rider, preferably one that increases the benefits by 5%, compounded annually.

     3. A coverage period of at least four years. (The average nursing home stay is 2 1/2 years.)

     4. Liberal benefit "triggers," so the checks start rolling in when you're unable to perform two out of six "daily living activities" (for example, bathing and dressing), or when you show evidence of Alzheimer's or something like it.

     5. Coverage for assisted living facilities and home health care, as well as for the more traditional custodial, skilled, and intermediate nursing homes.

     6. A policy that's guaranteed renewable for life, with the premiums waived if you do become institutionalized.

     7. A "qualified" policy, one that makes it possible for you to take tax deductions for the premiums.

How Do You Decide?

Learn As Much As You Can

Fortunately, there's a lot of useful, free info on the Web. A good place to start is with the "Shopper's Guide to Long-Term Care Insurance" from the National Association of Insurance Commissioners. Individual copies are free -- online at: www.quotesmith.com, by phone: 816-842-3600, or via email: pubdist@naic.org.

Also read the booklet, "Guide to Long-Term Care Insurance," put out by the Health Insurance Association of America (www.hiaa.org/consumer/guideltc.cfm).

Choose the Right Long-Term Care: Home Care, Assisted Living & Nursing Homes, written by attorney Joseph L. Matthews, explains how to get the most from Medicare and Medicaid, as well as how to choose the right facility, if any, and pay the bills. Excellent.

Compare LTC Policies Online

At both Quotesmith.com and Long-Term Care Quote (www.ltcq.net), you can get a sense of what policies would cost you based on different assumptions.

Go for a Financially Stable Company

Be sure to check the rating of an insurance company before you sign up. You want one that's been in this business for a number of years, and has earned high scores from the following three free rating services:

Standard & Poor's -- www.standardandpoors.com, 212-438-2400

A.M. Best -- www.ambest.com, 908-439-2200

Moody's -- www.moodys.com, 212-553-0377

Important: An "A" rating from one company may mean "Good," while at another company, it may mean "Excellent." Be sure you know what the ratings mean.

Be Forewarned

Many of the people selling long-term care are ... well ... here's how consumer advocate Mark Green, author of The Consumer Bible, puts it: "Do not trust insurance agents selling long-term care insurance. Even if the agent is honest, the policies are ... riddled with problems." Green reports that "no policy is guaranteed to pay 100% of your long-term care costs, and some policies that don't keep pace with inflation can pay as little as 30%." In other words, after those policy premiums, you still might have to pay a hefty price for nursing home care.Yikes!

To up the odds you'll make the right decision, check these out:

Do's and Don'ts

      Don't speak to only one seller.

      Don't assume that all policies are alike.

      Don't make a quick decision.

      Don't forget that celebrities are paid for their endorsements, and probably don't need the LTC coverage they're hawking.

      Don't buy a policy you can't afford. You'll stop paying the premiums long before you might need the benefits.

      Do make sure you understand the pros and cons of each company and each benefit option you're considering.

      Do consider family history. If your clan is full of centenarians, LTC may be more important than if your relations tend not to be long livers.

      Do read the policy before you agree to it.

      Do discuss LTC with the lawyer or financial planner who helps you plan your estate. (You do have a will and a plan, right?)

How to Save Money on Long-Term Care

     Comparison shop, as always. Prices for LTC can vary considerably ... even for identical coverage.

     Married? It might mean a discount of 10% to 20% on LTC. But there may be some strings: For example, both of you may be required to get the same policies, which may or may not be a good idea.

     In excellent health? There might be a 10% to 20% discount. Ask!

     Think about a longer "elimination period." Policies offer waiting periods of anywhere from zero to 365 days before kicking in, and the savings for a longer wait may be worth it, even though every uninsured day in a nursing home will cost you $167 in today's dollars.

     Live alone? Consider eliminating home care benefits. Why? Because LTC home care is generally a part-time benefit. You'd have to pay for additional home care. Also, someone would have to manage multiple caregivers.

     Belong to any groups? You might find a great buy via your employer, for example. Chances are, even though you're eligible for a discounted group rate, you'll have to foot the bill, so make sure the policy being offered will meet your needs. (A group plan may be especially beneficial to someone whose pre-existing condition would lead to a much costlier individual policy.)

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Reprinted from The Pocket Change Investor© 1996, Marc Eisenson & Nancy Castleman

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