Long Term Care


Q. What is long term health care? How does it differ from other kinds of health care?

A. Long term health care is the variety of services necessary for someone who requires some form of daily, ongoing assistance.

This may include such things as housekeeping, financial management, bathing, dressing, transferring from a bed or chair, as well as assistance with meal preparation, feeding and toileting.

While people often think of this as care for elders, there are many physical and mental conditions that require long term care at younger ages as well.

Q. Why might I need long term health care?

A. Studies published in the New England Journal of Medicine and other publications, indicate that for individuals over 65, there is a 43% chance of needing some form of long term care.

For married couples this means a risk of more than 80 percent that one spouse will need such care at some point.

For most retirees this is the largest threat to the income and assets they have accumulated over a lifetime.

Compare this risk to that of a house fire (1 in1200) or an auto accident (1in 240).

Q. Won't Medicare, Medicare Supplement Policies such as Medex, or my retiree health benefits, pay for most of my long term care costs?

A. NO! These programs pay only for hospitalization and a brief period of post hospital recovery, usually less than 60 days.

According to the most optimistic estimates, Medicare paid for less than 9% of the total long term care bill last year.

Congress is expected to further curtail such benefits as home health care paid for by the Medicare program.

Unless you have already purchased a private long term policy, less than 3% of nursing home care and a minimum amount of home care is paid for by your current health care insurance.

Q. What are the costs associated with Long Term Care?

A. Last year, the average cost of a semi-private room in the North-eastern US was between $165.00 and $185 per day.

A private room is likely to run more than $200.00 per day.

The Massachusetts Rate Setting Commission recently approved hourly rates for a home health aide at $18.00 to $22.00 per hour.

Q. How much should I expect to pay for a Long Term Care insurance policy?

A. The cost of obtaining insurance coverage of long term care will depend on several things; your age on the date you applied for coverage; your health, the amount of long term care you want to insure; and the optional benefits you select such as inflation protection.

The typical policy for someone 60 years of age, including inflation protection, is $100 per month.

Rates and benefits can vary significantly depending upon the company you obtain your coverage from. (For this and other reasons, it is important to compare policies from several companies before you decide.)

The same policy would be nearly twice as expensive for a 70 year old and only half as much for a fifty year old.

If you want this protection, the longer you wait, the greater the risk that you'll need it and the more expensive it becomes.

Q. How do I decide whether this coverage is appropriate for me? If I do need Long Term Care insurance, how do I select the policy that is best suited for my needs?

A. Contact an Independent Long Term Care insurance specialist. An independent broker can focus on your needs-not the insurance company's. Insist that your first meeting with a broker be an informational meeting. Don't succumb to sales pressure to make a hasty decision. You may want to have another family member present-or perhaps an attorney or accountant- to ask questions and to help you in the decision making process.

Q. Does my health affect my ability to obtain Long Term Care insurance?

A. YES! You must be in good health "for your age". Insurance companies frequently insure applicants that have had previous health problems including cancer, and heart disease.

Generally the insurance company will obtain a report on your medical history. Chronic conditions such as Alzheimer's, Parkinson's, Lou Gherig's disease and severe rheumatoid arthritis will make it unlikely that you will be approved for Long Term Care insurance.