Understanding long-term care insurance

11/17/17

By Brad Breeding

If you or a loved one own long-term care insurance (LTCI) it is important to understand how the policy works and what it covers so you will be better equipped to incorporate it into your overall retirement plan. Here is a description of the key components of LTCI:

Type(s) of Care Covered

If you own long-term care insurance (LTCI) or are thinking about purchasing coverage it is important to understand how the policy works and what it covers. Adult children should also be familiar with the details of their parents’ coverage because they will likely be involved with coordinating LTCI benefits when the time comes. By understanding the details of the policy you will be better equipped to get the most out of your coverage when it is needed.

What type of care is covered?

The earliest forms of LTCI (issued more than two decades ago) were considered “nursing home” policies, which covered skilled nursing services received in a nursing facility. Long-term care delivered at home or in an assisted living facility were not covered expenses.

Eventually policies began covering care in assisted living facilities and sometimes at-home care, but often at a discounted amount. For example, the policy might cover care in an assisted living facility at 50 percent of the benefit amount that would be paid for care received in a skilled nursing facility.

Most policies issued within the last five to 10 years are more comprehensive, providing the same amount of coverage regardless of where care is received. These policies may also cover expenses like adult day care and respite care.

LTCI Benefit Amount

The benefit amount is usually a daily or monthly amount, and the total lifetime benefit amount is expressed in years. For example, a policy might provide a daily benefit of $200 for three years. This amounts to a total lifetime benefit of $219,000 ($200 x 365 x 3). This does not mean that the policy must be used within three years, but rather that the policyholder has the equivalent of three years of coverage over their lifetime. However, a policy will not pay more than the stated benefit amount in any given day or month. Therefore, using the example above, the policy would not, for instance, pay out $300 for any one day of coverage.

Inflation Rider

Many policies include an “inflation rider” which increases the benefit amount annually to help ensure that the coverage amount reflects the increased cost of care over time. The formula used to determine the increase can vary from one policy to another. If your policy includes an inflation rider, you should know the current coverage amount, as opposed to the originally stated coverage amount. If this information is not clear, contact the insurance company and ask about the current benefit.

Coverage Elimination Period

Most LTCI policies have an elimination period. This is similar to a deductible, but is measured in days, not dollars. A policyholder chooses the elimination period (from zero to 180+ days) at the time of application. A longer elimination period lowers the premium, and vice versa. A policy’s elimination period can be based on days of care or calendar days. For example, a policy with a 90-day elimination period would specify if that means 90 calendar days (beginning with the first day of care), or 90 days of care. In some cases there could be a substantial difference in time between the two if there is a break in care within the 90-day period. Additionally, a policy could have different elimination periods for different care settings.

If you are thinking about buying coverage and want to keep your premiums lower, or if you want to lower premiums on your existing coverage, consider extending the elimination period. You may decide that you are willing, and able, to pay out of pocket for a certain amount of time but want to cap your exposure for all care beyond that.

Benefit Triggers

Before LTCI coverage will pay benefits, the policyholder must be unable to perform at least two of the six activities of daily living (ADLs): feeding, toileting, dressing, bathing, walking/transferring (i.e., moving from bed to wheelchair), and continence. Some policies may require that the policyholder be unable to perform three ADLs instead of two. Policies may also specify what is required before the policyholder is declared “unable” to perform a certain ADL. Additionally, some policies may include cognitive impairments, such as dementia or Alzheimer’s, as a benefit trigger. In some cases, a policy will not pay benefits unless a doctor certifies that the care is medically necessary.

Benefit Payment Methods

LTCI policies are generally categorized as either expense-incurred (reimbursement) or indemnity (set dollar amount). Under an expense-incurred policy, a policyholder only receives benefits when care is received. The policyholder, or a representative for the policyholder, must submit receipts for services. If it is an approved service, the insurance company will pay the insured or the care provider for the cost of services up to the daily (or monthly) benefit amount.

The less common indemnity plan pays the daily or monthly benefit amount stated in the policy, regardless of the actual cost of services. Once the claim is approved the benefit is paid directly to the policyholder, up to the stated benefit amount, and continues as long as eligible services are being received. The premium for an indemnity policy is typically higher than it would be for comparable coverage under an expense-incurred policy.

Hybrid Policies

An increasingly popular type of long-term care plan is actually a hybrid that combines life insurance (or a deferred annuity) and long-term care insurance. If you meet the benefit triggers, which are typically similar to those described above, then you can tap into the long-term care benefit. If, however, you never require long-term care insurance then your heirs will receive the death benefit. Additionally, if you cancel the policy anytime in between you will receive the cash surrender value at that time.

The appeal of a hybrid policy is that the policyholder (or the heirs) is assured to receive cash back whether he or she uses the long-term care insurance or not. The trade-offs are that a traditional policy will buy more coverage per dollar and a hybrid policy requires premiums to be paid in a lump sum — usually $50,000 or more, or at least within 10 years. When premiums are spread out over 10 years the amount per year will be higher than for a traditional plan since traditional plans spread payments over lifetime.

Those who own a cash value life insurance and are interested in getting long-term care insurance may be able change their existing policy into a hybrid plan without having to pay any additional premiums. This can be particularly beneficial for those who, due to health issues, may not be able to qualify for traditional long-term care insurance because hybrid plans sometimes have more flexible underwriting guidelines. This is particularly true of annuity-based hybrid plans.

For a more detailed explanation of LTCI, request a Long-Term Care Insurance Buyers Guide from your state’s insurance department. To understand how long-term insurance can be applied to living at The Culpeper, contact Helen Burnett, Director of Marketing, at hburnett@theglebe.org or call 540-591-2100.

Brad Breeding is co-founder and president of myLifeSite, a website designed to provide objective information about continuing care retirement communities. A certified financial planner, Brad’s extensive knowledge of the senior living industry, combined with his financial planning background, allows him to provide valuable insights about lifestyle, healthcare, and financial planning considerations for seniors. This article is legally licensed for use.  

 

 


NOW HIRING: Executive Director of The Glebe

08/17/18


RICHMOND, Virginia—LifeSpire of Virginia is seeking to hire an executive director for The Glebe, a not-for-profit life plan community in Daleville, Virginia. The Glebe is one of four communities owned and operated by LifeSpire of Virginia, based in Richmond, Virginia.

The Glebe currently consists of 154 independent living apartments/cottages, 32 assisted living beds, and 32 skilled nursing beds.  Master Planning is underway to consider growth opportunities for additional independent living apartments and/or a memory care neighborhood.

The community has an outstanding reputation in the Roanoke market and currently provides service to 256 residents and currently employs 192 staff members. The health center provides excellent care and has a 5-star rating with the Centers for Medicare and Medicaid Services.

Reporting to the Chief Operating Officer, the Executive Director is responsible for continuing and enhancing the reputation of the community by providing strategic leadership consistent with the LifeSpire mission, vision, and values. The Executive Director shall provide leadership in the development of policies, procedures and plans which result in the accomplishment of both the organization’s long- and short-range goals. The Executive Director is responsible for ensuring the development and delivery of appropriate services to residents, clients, and their families.

Key qualifications, duties, and personal characteristics for this position are:

QUALIFICATIONS:

  • Minimum 5 years’ experience as an Executive Director of a life plan community
  • Bachelor’s degree in a relevant field
  • NHA license is a plus, but not required
  • Thorough understanding of the senior housing industry
  • Financial management skills; ability to develop and manage the budget for the entire community; identify areas for expense savings or revenue generating opportunities
  • Ability to maintain and strengthen positive working relationships with staff, residents, and leadership across communities
  • With support of the leadership team, develop and implement a strategic plan that aligns with the LifeSpire mission, vision, and values
  • Provide quality programming and services that meet the needs of today’s and tomorrow’s consumer
  • Develop and sustain a community culture of teamwork, professionalism, mutual respect, continuous quality improvement, and accountability
  • Develop a strong team of competent and committed professionals who are committed to service excellence
  • Articulate a vision, create consensus, and motivate people to build a sense of community

KEY DUTIES AND RESPONSIBILITIES:

  • Support the strategic plan and direction of LifeSpire of Virginia.
  • Direct the overall operations of the facility while complying with state and federal regulations as well as the company’s policies and procedures
  • Ensure compliance and licensure with all licensing agencies
  • Manage occupancy development.
  • Plan, develop, and manage facility’s operating and capital budgets
  • Develop and monitor all contracted provider services.
  • Foster effective communications and teamwork among the facility’s management group
  • Maintain current knowledge about changes in federal, state, and local regulations
  • Focus on achieving and maintaining 5-star status in the community

PERSONAL CHARACTERISTICS:

The ideal candidate will be a competent, compassionate, and committed professional who is willing to enter into a long-term commitment of service to the organization and do so within a team-oriented, collaborative, servant-leadership environment.  He/she will be a person of high integrity and ethical standards and have a personal reputation that will reflect well on the organization.  Of equal importance will be a high standard of care and concern for current and future residents.  He/she will evidence a commitment to establishing community collaborations. As a relationship-oriented person, the Executive Director will be an excellent communicator and will maintain a visible presence among staff, residents, clients, and within the surrounding community.

This job offers a competitive base salary with a bonus incentive structure, as well as an excellent benefits package. The full-time benefits package includes options for health, dental, and life insurance, retirement plan, generous paid time off, and relocation assistance.  EOE.

Qualified applicants may apply by e-mailing a resume to:

jobs@lifespireliving.org