LONG TERM CARE INSURANCE: MYTHS AND PITFALLS
The longevity revolution is well underway and long term care (LTC) is a huge personal fear for many as the growing number of Canadians over the age of 65 doubles in the next 25 years. In 20 years, 2 million Canadians will be over age 80!
The following information has the intention of alerting consumers to some of the many factors associated with purchasing an LTC plan and why it is essential to have an LTC Specialist assist you in your selection.
Increased longevity brings a greater need for specialized health care services. LTC is normally identified with chronic illness conditions associated with the elderly. LTC policies typically pay benefits for Cognitive Impairment’ illnesses or if a person is unable to perform any 2 of 6 activities of daily living (ADL’s). These would include Bathing Eating, Dressing, Toileting, and Bladder & Bowel Continence.
Chronic illnesses are a huge threat to our health care system. Interest in LTC plans is growing but it’s extremely important to fully understand such plans before making a purchase. So, here are some myths and pitfalls to be aware of when considering LTC:
Individuals who require LTC:
Myth: One reason often cited for buying LTC insurance while you’re young is because over 40% of individuals requiring LTC are under age 65.
Fact: Less than 1% of LTC patients who receive nursing home or facility care are under age 65.
Facility care vs. Home Care:
Myth: You run an almost 50% risk of requiring 24-hour care in either a Nursing Home or LTC facility after age 65.
Fact: Approximately 80% of LTC services are provided at home and only 20% in Nursing Homes or LTC facilities. The average age of admission to a Nursing Home is age 83.
LTC Premium Adjustability:
Myth: The best time to purchase LTC insurance is when you’re young and premiums are low.
Fact: LTC policies are adjustable and premiums can increase dramatically over 20-30 years. In the U.S. some premiums have increased 700% over the last 35 years.
Smoking Status, Health and Gender:
Myth: A non-smoker might expect to pay less for an LTC policy.
Fact: In Canada smokers and non-smokers pay the same price. As well, some plans charge men and women the same.
A Risky Investment:
Myth: By purchasing an LTC in one’s 60’s you are making a sound investment.
Fact: In order to purchase an LTC plan one must be in good health and therefore could be paying adjustable premiums for many years to come before any likelihood of receiving benefits. Individual plan purchasers can expect and should be financially prepared for significant future premium increases.
Qualifying Period:
Myth: Once an LTC plan has been purchased, there is no wait time for benefit payments to commence.
Fact: LTC plans have a qualifying, waiting or elimination, period that must be satisfied before the benefit is paid. The shorter the qualifying period the higher will your cost be.
Pitfall 1
A Catch 22 Dilemma:
It’s estimated you run a 50% risk of requiring LTC after age 65. But insurance companies screen LTC applicants and only accept healthy ones who will end up paying adjustable premiums for many years. One survey in the USA concluded that, based on a typical purchase age of 60 or older: ‘If you are medically eligible and able to qualify for an LTC plan you probably don’t need it and if you do need it, you probably won’t qualify for it’.
Pitfall 2
Beware the Fine Print:
Before claim benefits are paid out, an insured must satisfy the policy’s definitions, sometimes referred to as the fine print’. A policy’s definitions dictate which type of care the insured is eligible for and where and by whom it can be administered. That may not be as simple as it sounds. For example, Cognitive Impairment is relatively easy to understand as one immediately thinks of Alzheimer’s or some other form of Dementia. However, such a condition wouldn’t be covered if it resulted from a self-inflicted injury, or from alcohol or drug abuse.
Pitfall 3
Benefit Caps and Limits:
Most plans offer both Facility and Home Care; but some only cover Facility or Home Care. Note too that the majority of LTC plans offer a lifetime benefit period, as well as shorter benefit periods. Many LTC Specialists recommend a limited benefit plan rather than a lifetime plan as the average length of an LTC claim is only 2.8 years. A dilemma could occur should you outlive the policy.
In summary, if you are age 65 or under, the decision to purchase an LTC plan is more complicated than if you are older. One alternative to consider is a Critical Illness (CI) insurance policy providing coverage to age 100. In fact, one particular plan starts out as a CI plan and then converts into an enhanced LTC and CI policy after age 70. CI premiums won’t increase and there are no restrictions as to where and by whom care is provided. When the benefit is activated (by condition) the payout is in the form of a life annuity and can be used wherever the patient is and to pay anyone giving patient care.
Discuss your concerns with a Long Term Care Broker.