Insurance World

Long term care is a major concern of American senior citizens and their families. Studies have shown that Americans rank long term care second, behind saving for retirement, when prioritizing financial needs. Unfortunately, many Americans do not want to think about needing long term care and, therefore, fail to plan for it. Others wrongly assume that Medicare or standard health insurance policies will cover the costs of long term care services. As a result of this failure to plan, tens of thousands of Americans are impoverished each year by the costs of long term care.

The best time to plan for long term care is before it is needed. Start thinking about long term care when you plan for retirement. If you are already retired, it is not too late to begin planning for potential long term care needs.

Private long term care insurance is an excellent way to finance long term care. This brochure will guide you through the important process of selecting the right long term care insurance policy. This booklet provides information on long term care services, what to look for in a long term care insurance policy, and a glossary of terms.

Finding a good policy will take some effort, but the effort will be worthwhile. Here are some steps to take when considering the decision to purchase a long term care insurance policy:

1. Talk to your financial planner or insurance agent about whether long term care insurance makes sense for you.
2. Ask your financial advisor to recommend a company and a policy.
3. Check with insurance rating services to make sure the insurance company you are considering is financially secure.
4. Call your state insurance department and ask about the company and its record in your state.
5. Make sure your insurance agent is licensed to sell long term care insurance in your state.
6. Review all the details and options of the policy. Do not rely just on the marketing materials or outline of coverage.
7. Make sure you understand all the provisions before you purchase any policy.
8. Ask your insurance agent questions. Seek guidance from the state insurance commission office, the Area Agency on Aging, or local senior centers. Discuss policies with friends, family, and others whose opinions you respect. Take time when choosing a policy, and don’t allow yourself to be pressured into making quick decisions. And remember: Never pay cash.

The decision to purchase long term care insurance is not a simple one, but thorough investigation and thoughtful planning now can offer you and your family financial protection for the future, and, most importantly, peace of mind.

Defining Long Term Care

Long term care includes a range of nursing, social, and rehabilitative services for people who need ongoing assistance. Most people in long term care facilities are older, but many young people need long term care during an extended illness or after an accident.

Assistance with routine personal needs such as bathing, dressing, eating, toileting, and taking medicine is the most common long term care service. Long term care facilities also provide skilled nursing and rehabilitative care, which is ordered by a physician and supervised by skilled medical personnel such as a nurse or licensed therapist.

Long Term Care Is Offered In A Variety Of Settings

Nursing facilities are the primary settings for people who require medical care daily or intermittently. You must have a physician specify needed services in a written treatment plan for admission to a nursing facility. Many nursing facility stays are short periods of recuperation from an acute medical episode such as a hip fracture or surgery.

Assisted living facilities or residential care facilities provide general supervision, housekeeping services, medical monitoring, and planned social, recreational, and spiritual activities for people who are still independent and ambulatory. Assisted living facilities do not provide medical care.

Facility care services include skilled nursing care, speech, physical, or occupational therapy, facility health aides, or help from facilitymakers. Sometimes, family members, or caregivers, provide most of the care with the help of facility aides and skilled professionals.

Adult day care services are available in many communities, providing personal care, skilled care, and recreational services.

Financial Issues And Long Term Care

The cost of long term care varies by the level of care needed, the setting where the care is provided, and geographic location. Nursing facilities, assisted living facilities, and facility care services provide different levels of care to different resident populations; therefore, costs are not comparable.

On average, round-the-clock long term care services in a nursing facility cost $40,000 per year, or $112 per day.

Assisted living costs vary dramatically—anywhere from $900 to $3000 per month depending on room size, amenities provided, and services required.

Facility care, if needed daily, also can be quite expensive. In 1996, an average facility care visit from a registered nurse (RN) cost $99. RN visits for facility care typically do not exceed 2-4 hours per day, so care is not round-the-clock.

Eight hours of adult day care can cost an average of $45 per day.

Nursing Facility Care: About one third of the costs of nursing facility care are paid directly by individuals and their families. Two government programs may pay for some of your care.

Medicare, a health insurance program for people age 65 or older, only covers skilled facility care and up to 100 days of skilled care in a nursing facility if you are admitted after a three-day hospitalization (not required if you are an HMO member) and your physician prescribes skilled care in your treatment plan. Many people think that Medicare is the primary payor of nursing facility stays, but Medicare accounts for only 9 percent of nursing facility expenditures.

Medicaid, a program for the poor, pays for approximately 52 percent of the nation’s nursing facility care, but only for people who have spent almost all their assets and become impoverished. Due to lack of planning for long term care, Medicaid is the source of payment for nearly 70 percent of people in nursing facilities!

Unless you have long term care insurance, qualify under limited conditions for Medicare coverage, or become poor, you will pay out of your savings for nursing facility services.

Assisted Living: About 90 percent of the nation’s assisted living services are paid for with private funds. The Supplemental Security Income, Older Americans Act, and Social Services Block Grant programs pay for some assisted living services, while about one-fifth of the states allow the federal Medicaid program to pay for some service components.

Facility Care: Private funds pay for about 46 percent of facility care costs; Medicare covers 32 percent; Medicaid, 22 percent.

Adult Day Care: There are some out-of-pocket expenses for adult day care; however, the majority of funding comes from public sources either the state exclusively, or, in some states, Medicare and Medicaid. Private donations from corporations and charitable groups such as the United Way also supplement the costs of adult day care.

When To Buy Long Term Care Insurance

Because long term care insurance premiums are based on age at the time of purchase, the younger you are when you purchase a policy, the less expensive the annual premium. These premiums for most policies stay level each year as you age. If you buy at age 55 a policy that cost $800 per year, you will continue to pay the same premium. However, if you wait until you are 65, the same policy will cost you $1,700 per year.

What To Look For In A Policy

The best policy for you depends on several factors, including your family arrangement, your financial situation, your preferences regarding long term care choices, and the level of risk you are willing to accept. There is no one best company or one best policy for everyone. You should select a policy that meets your needs.

Before you buy a policy, make sure you know the product you are buying and from whom you are buying it. Be sure your agent is licensed to sell insurance in your state and has received specific training on long term care insurance. Consult friends, consumer guides, and information from your state’s insurance counseling program or local agency on aging.

Health Savings Accounts are an excellent way to build a second retirement account. These tax-favored accounts, which have only been available since January of 2004, can be opened by anyone with a qualifying high-deductible health insurance plan. Once you open an HSA account, you can place tax-deductible contributions into it, which grow tax-deferred like an IRA. You may withdraw money tax-free to pay for medical expenses at any time.

The biggest reason more people don’t retire before age 65 is lack of health insurance, and many Americans reach age 65 woefully unprepared for the medical expenses they’ll face once they do retire. One of the most important long-term reasons for establishing an HSA is to build up some money for medical expenses incurred during retirement.

Fidelity Investments reports that the average couple retiring in 2006 will need $190,000 to cover medical expenses during retirement. This assumes life expectancies of 15 years for the husband and 20 years for the wife.

HSAs are, without exception, the best way to build up money to pay for medical expenses during retirement. You should not contribute any money to your traditional IRA, 401 (k), or any other savings account until you have maximized your contribution to your HSA. This is because only health savings accounts allow you to make withdrawals tax-free to pay for medical expenses. You can take these distributions anytime before or after age 65.

Your HSA contributions won’t affect your IRA limits — $3,000 per year or $3,600 for those over 55. It’s just another tax-deferred way to save for retirement, with the added advantage being that you can withdraw funds tax-free if they are used to pay for medical expenses.

For early retirees who are healthy, a health savings account can also be a smart option to help lower their health insurance costs while they wait for their Medicare coverage. The older someone is, the more they can save with an HSA plan. For many people in their 50’s and 60’s who are not yet eligible for Medicare, HSAs are by far the most affordable option.

Any money you deposit in your health savings account is 100% tax-deductible, and the money in the account grows tax-deferred like an IRA. For 2006, the maximum contribution for a single person is the lesser amount of your deductible or $2,700. In other words, if your deductible is $3,000, you can contribute a maximum of $2,700; if your deductible is $2,000, then that is the maximum. For families, maximum is the lesser of $5,450 or the deductible.

If you’re 55 and older, you can put in an extra $700 catch-up contribution in 2006, $800 in 2007, $900 in 2008, and an additional $1,000 from 2009 onward. The contribution limit is indexed to the Consumer Price Index (CPI), so it will increase at the rate of inflation each year.

How much you accumulate in your HSA will depend on how much you contribute each year, the number of years you contribute, the investment return you get, and how long you go before withdrawing money from the account. If you regularly fund your HSA, and are fortunate enough to be healthy and not use a lot of medical care, a substantial amount of wealth can build up in your account.

Health savings accounts are self-directed, meaning that you have almost total control over where you invest your funds. There are numerous banks that can act as your HSA administrator. Some offer only savings accounts, while others offer mutual funds or access to a full-service brokerage where you may place your money in stocks, bonds, mutual funds, or any number of investment vehicles.

One of the biggest advantages of retirement accounts like HSAs are that the funds are allowed to grow without being taxed each year. This can dramatically increase your return. For example, if you are in the 33% tax bracket, you would need a 15% return on a taxable investment to match a tax-deferred yield of only 10%.

As another example, if you are in a 33% tax bracket and were to invest $5,450 each year in a taxable investment that yielded a 15% return, you would have $312,149 after 20 years. If you put that same money in a tax-deferred investment vehicle like an HSA, you would have $558,317 - over $240,000 more.

Because catch-up contributions are allowed only for people age 55 and older, if one or both of you are under age 55 you should establish your HSA in the older spouse’s name. This will allow you to capitalize on the expanded HSA contribution limits for people in this age range and maximize your HSA contributions. Once that person turns 65 and is no longer eligible to contribute to their HSA, you can open another health savings account in the younger spouse’s name.

Strategies to Maximize your HSA Account Growth

If your objective is to maximize the growth of your HSA in order to build up additional funds for your retirement, there are three important strategies you should implement.

Strategy #1: place your money in mutual funds or other investments that have growth potential. Though this is riskier than placing your money in an FDIC-insured savings account, it is the only way to really take advantage of the tax-deferred growth opportunity that an HSA provides.

Strategy #2: delay withdrawals from your account as long as possible. Though you may withdraw money from your HSA tax-free at any time to pay for qualified medical expenses, you do have the option of leaving the money in the HSA so that it continues to grow tax-free. As long as you save your receipts, you can make medical withdrawals from your account tax-free at any future date to reimburse yourself for medical expenses incurred today.

As an example, let’s say a 45 year old couple places $5,450 per year in their HSA over a period of 20 years, they have $2,000 per year in qualified medical expenses, and they get a 12% return on their investments. If they withdraw the $2,000 from their HSA each year, they’ll have a net contribution of $3,450 per year into their account, and they’ll have $248,581 in their account when they begin their retirement years.

If on the other hand they delay withdrawing that money, they will have $392,686 in their account at age 65. If they choose they can withdraw the $40,000 to reimburse themselves tax-free for the medical expenses incurred during that 20 year period, and still have $352,686 in their account - over $100,000 more than if they had withdrawn the money each year.

Strategy #3: make the maximum allowable deposit to your HSA at the beginning of each year. Even though you are allowed until April 15 of the following year to make deposits to your HSA, you should take advantage of the tax-free growth in your account by funding it as soon as possible. The extra interest you can earn by contributing to your account on January 1 of each year rather than the next April 15 can amount to over $40,000 in a 20 year period, and over $100,000 in 30 years.

Using Your HSA to Pay for Medical Expenses during Retirement

When you enroll in Medicare, you can use your account to pay Medicare premiums, deductibles, copays, and coinsurance under any part of Medicare. If you have retiree health benefits through your former employer, you can also use your account to pay for your share of retiree medical insurance premiums. The one expense you cannot use your account for is to purchase a Medicare supplemental insurance or “Medigap” policy.

Though Medicare will pay for the majority of health expenses during retirement, there many be expenses that Medicare will not cover. Nursing home expenses, un-conventional treatments for terminal illnesses, and proactive health screenings are all examples of medical expenses that will not be paid for by Medicare, but that you can pay for from your HSA.

Long-term care is assistance with the activities of daily living, such as dressing, bathing, or feeding yourself. It can be provided in your home, a retirement community, or a nursing home. Long-term care expenses can be paid for using funds from your HSA, and long-term care insurance can even be paid for from the HSA up to the following maximum annual amounts:

- Age 40 or under: $260
- Age 41 to 50: $490
- Age 51 to 60: $980
- Age 61 to 70: $2,600
- Age 71 or over: $3,250

To establish a health savings account, you must first own an HSA-qualified high deductible health insurance plan. Compare HSA plans side by side to determine the best value to meet your needs. Once you have your high deductible health insurance plan in place, you can open your Health Savings Account with the financial institution of your choice.