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Health and Long Term Care Insurance

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Well it's that time of year again where we fulltimers who are below age 65 have to deal with health care insurance again. I use the Escapees South Dakota address as my full time address. I have very little options on health insurance. I am 64 so have one more year to go till I am elligable for Medicare. I know I will still have to purchase a supplement policy.  My parents both who are in their 80s just went into assisted living. They have a Medicare Supplement policy but still are experiencing high out of pocket costs for their care. So I began to look into a Long Term Care policy for myself. I am finding out that these too are state specific. But I am full time. I don't know what state I may be in if and when I would have a claim for long term care. I know that Medicare is statewide and does not have a network but was Wondering what other full timers do for Medicare supplement and long term care insurance. I've got a year yet but just thinking of it at this time while I'm looking into health insurance again. 

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Medicare supplement policies are sold for residents of specific states, but are applicable to expenses that occur in any state.  We are SD residents and have Humana supplemental policies sold there.  We both have Plan F supplements and have used them all over the US without any issues.  Plan F is the most expensive of the supplements but it covers virtually anything Medicare doesn't pay.  Specific claims have to be for services that Medicare covers, but if a claim is paid, in part by Medicare, then Plan F usually pays anything left over.

Of course, there are physicians who don't accept Medicare reimbursements as payment of their fees.  In those cases I believe Plan F pays up to something like 110% of the Medicare limit and beyond that you may still owe the physician or other provider.  However, in 5 years of being covered by Medicare we have yet to have this occur.  So far this year our out-of-pocket expenses for anything other than prescription drugs has been zero, as it has been for the past 5 years.

As for long term care insurance, we have policies purchased in Maryland more than 15 years ago.  From what I have read, it's my understanding that long term care "partnership" policies are state specific because they tie Medicaid eligibility thresholds to payments received from long term care policies.  But there is little reason for policies that aren't of the partnership type to be restricted to specific states.  We had no problem with our Mutual of Omaha long term care policies changing our domicile to SD.

Unfortunately, buying a long term care policy at age ~65 will be a lot more costly than buying it at a younger age.  Ours were bought when we were ~55 and have had 5% inflation riders since then.  Since inflation has been lower than 5% for quite a few years, this means that our policies pay a significantly higher percentage of expected cost than they would have when we first purchased them.

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Thanks docj. I know my health insurance is only good for SD in network providers except for emergency treatment. I also know that Medicare when I am eligible next year will cover me in any state not just SD as Medicare does not have a network. I'm not sure if the long term policy will require me to be in a long term care facility in SD only. Being full time I probably won't be in SD if and when I need long term care. 

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My mother had a long term care policy and they were a pain to deal with to get the money when she needed it.  They required multiple faxes each month from the assisted living place before they would cut a check.  I asked the assisted living place if there were any companies that were better and they said they were all bad and most were worse than my mother's, since many found ways to pay less through loopholes.  My mother's policy cost her $230 a month and they paid a maximum of $2100 a month for up to two years.    They did pay the full amount for 8 months, and she paid in for over 20 years, so they made money on her.  Made me not believe in long term care policies.  

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Mr. Joyce: That has also been my experience and I don't think I will buy one. When my mother, 83, was in a nursing home in 2001 the cost was $7,000 per month and somehow my father didn't have to pay? She was only there for less then a month before she died. I remember that my father was upset because he didn't make $7,000 per month so that he could pay. By this time, my father, 90, was slowing down so his plan: sell the home in the northeast and the condo in South Florida and give all of the money to his four children. The rest of his money he put into CDs with me as the beneficiary with the understanding that I divide it between the four children. He lived off of his $6,500 per month income which was more then enough at 90. He never spent one day in a nursing home.

 

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From out experience with our mothers (if you want the government to take care of you) the government will leave you with 1 home, 1 car and about $2K in savings.  They will take the rest and THEY will tell you the assisted or nursing home you will live in.  It will no doubt be the least expensive and who knows where it will be located.  If you plan to give your assets to the kids to hide them the government will go back 5 or 10 years to get your assets.  We consulted an attorney in MI several years ago when estate planning our mothers. 

We have been paying for long term care for many years (less expensive when payments start in your 50s) but we can determine the place we'll be or stay in our home and have care come to us.  There is a limit on what they pay and how long which allows us some control over the cost.     Greg  

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The government didn't look to see if or when my father gave us the money. Not all of us will end up is a nursing home of assisted living facility. My mother spent less then one month and my father no at all. I would think that as I lay there dying it will not matter were I am.

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My mother in law spent almost two years in assisted and then dementia living centers, she (the family also) was fully aware of the level and quality of service she was getting.  During the first time hospice was brought in she and us were well aware of the service she was getting.  The second time I will agree that she wasn't aware of what was going on.  Don't assume your time in a living center will be short and your level of service will not matter. 

In MI we were assured the government would check your finances and history.       Greg   

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5 hours ago, whj469 said:

The government didn't look to see if or when my father gave us the money. Not all of us will end up is a nursing home of assisted living facility. My mother spent less then one month and my father no at all. I would think that as I lay there dying it will not matter were I am.

Did your father start receiving Medicaid for long-term care?  That is when the 'claw-back' would occur.  Since you stated your father never was in a care facility there wouldn't have been a reason for them to scrutinize his finances.   It is only when you have drawn down all assets and ask for Medicaid to help with the care that they look at historical finance records.

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Look back at the time our parents were getting old and unable to manage their affairs was 3 years in PA.   We took  legal actions perfectly legal to protect their assets and to provide them with the best quality care we could. Their  home for example was "purchased" by myself and rented "on paper" to them .By the time they were  unable to manage their affairs  we that is my sisters and myself managed all their affairs. We had no problems with Medicaid or the choice of nursing home facilities. They passed with dignity  and well cared for.

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According to the U.S. Bureau of the Census, slightly over 5 percent of the 65+ population occupy nursing homes, congregate care, assisted living, and board-and-care homes, and about 4.2 percent are in nursing homes at any given time. The rate of nursing home use increases with age from 1.4 percent of the young-old to 24.5 percent of the oldest-old. Almost 50 percent of those 95 and older live in nursing homes.

Today, a senior citizen (65+) has about a one-in-four chance of spending time in a nursing home (skilled care facility).
Currently 5 percent of the older population lives in nursing homes (skilled care facilities), with an average life-expectancy of approximately six months upon entrance into the nursing home.

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Just thinking about some friends, a father-daughter-grand-daughter. I think he is now 92/93.  They have been together for more than 20 years but I wonder if he might have been better to have gone into some group type home when he was still mobile and able to develop friendships there to supplement  his other family. They live in a rural area and the daughter still needs to work and the grand daughter is in a nearby Med. school.  Even though he mostly has his faculties he has limited mobility and has to rest a good bit during the day.   I don't know if I am explaining my thoughts well but maybe you will understand.  It has me rethinkng some of my strategy. 

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Bigjim,   I do understand.  My mother is a very active 95 yr old, but she developed vertigo a few years ago and became afraid of being alone in case she fell.  So 5 yrs ago she moved in with my sister,  just so there would be someone around.   She frequents the senior citizens center in their town, joined their writers group,  and since my sister has retired, they do a lot of things together, but she often mentions that maybe she should have gone to assisted living instead because she is the only elderly (unlike us who are still young) person in the neighborhood.   

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