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Your Customized Benefit Selection Process

The following is an abbreviated section from my book The ABC’s of Long-Term Care Insurancekeepin’ it REALLY simple for you, folks!

To simplify the benefit selection process, there are six major choices that impact a premium. Here is each choice and a recommendation.

1a) Daily or Monthly Benefit – Look at the average cost in your area for 8-10 hours of home care (or where you plan to move to when you retire), and decide if you want a plan that provides full coverage or if you are willing to pay part of the cost. If you are planning on self-insuring part of the cost, you can ask for an insurance quote that would pay 2/3 or 80%.

Tip: A monthly benefit is more flexible for home care.

1b) How do you want the benefit paid?

Reimbursement – the actual charge is paid up to the daily or monthly benefit. If you don’t use it all, you don’t lose it. The difference stays in your benefit pool to be used later. To collect benefits, you must provide proof of services from qualified caregivers.

Indemnity – you receive the daily or monthly benefit regardless of what the charge is. You still have to provide proof of services from qualified caregivers to receive benefits.

Cash – you receive a check each month and you can use the money however you need it, which means you can use it to pay informal caregivers like family friends, neighbors or sitters and companions provided by a caregiving agency. You don’t have to account for how you spend it

Pro: Cash can be especially helpful in rural areas when licensed caregivers can be difficult to find. It can also be helpful to pay for new services .

Con: if you hire your own informal caregivers, you will likely be responsible for the employer’s contribution of the caregiver’s Social Security, Medicare and state employment taxes.

Hybrid – For no additional premium, this is a new type of policy that allows you to take 40% of the home care benefit any month you like in cash and use however you need it.

2. Waiting Period (Elimination Period) – Shorter time periods are available, but most people choose a waiting period (deductible) of 90 days for two reasons:

• this is a one-time event in today’s policies no matter how many
times they have a claim;
• they aren’t worried about needing care for three months; they’re
worried about needing care for three years;
• many plans have made this a calendar day waiting period with no
charges required or some have even waived it for home care; or
• they bought the policy at work and 90 days was the only choice

3. Inflation Protection – This is the factor that you choose to make your benefits grow each year.

Tip: BUY IT. Would you buy health insurance that only pays hospital room rates at what they cost today?

Here are common inflation options and how long it takes the benefit to double so you can see how fast they grow:

5% compound 15 years
4% compound 18 years
3% compound 24 years
5% simple 20 years

The cost of nursing home care has grown 5-6% compound in the last 20 years which means it has tripled in that time period.24 Home care and assisted living has grown much slower but the demands of the baby boomers may accelerate the growth rate.

The 5% compound inflation factor that grows until you have used all your benefits is the most desirable of course. Premiums for this benefit have increased dramatically in the last three years. There are still a few solid carriers that haven’t made this type of inflation extremely costly, so if you want it, now is an excellent time to get it.

If you use the lower compound benefits or an inflation benefit based on the Consumer Price Index which will grow also around 3%, just start at a higher monthly benefit since it takes them longer to double.

Important: To get the asset protection equal to benefits paid by your long-term care insurance policy in those states that offer Partnership policies, you have to buy a compound inflation benefit if you are under age 61 when you apply for coverage.

4. Home Health and Community Coverage
This will be difficult for some people to hear but you must have a primary caregiver before this becomes a viable option. If you are younger (30s-50s) and you don’t know if you will have a primary caregiver, include the home care benefit if affordable to provide maximum choice when care is needed.

Note: If you live alone and your state allows it, you may be better off buying a “Facilities-Only” policy with “Cadillac” benefit levels; i.e. a monthly benefit high enough to get into the nicest assisted living facility in the area, 5% compound inflation for life, a longer benefit period, and the like. Not everyone is a candidate for home health benefits. Think about it. Most people can’t afford coverage that will pay 24 hours a day of home care, which would require a daily benefit of $400 a day or more. Someone living alone has to manage medications as well as personal care, plus cook meals and maintain a home.

If you considering an option for little or no home care benefits either for affordability or because you live alone, remember that the policy will still make nursing home care the last resort by providing coverage for the beautiful assisted living facilities that are going up everywhere.

5. Benefit Period/Benefit Maximum – This choice should be made after all of the above choices have been made. This is not how long you can be covered, by the way. You can be covered until you’re 104 if you live that long. It’s how long the policy will pay benefits when you become impaired enough to qualify for benefits. Choices are two, three, four, five, six, ten years and a few companies still offer an unlimited benefit period. Some companies offer a benefit maximum of $100,000, $200,000, $300,000, $400,000, $500,000 or $1,000,000. The length of time is determined by the monthly benefit you choose; e.g. $300,000 ÷ $4500 = 66 months (5.5 years). All will grow with inflation coverage, of course.

The important point here is that you should never sacrifice inflation coverage for a longer benefit period or a larger benefit account. Why? Because if you can’t make up the difference at claim time, you may have to apply for Medicaid and lose your private pay choices sooner rather than later. Even if you bought a Partnership policy, it won’t help you because the asset protection feature is based on how much the policy has paid out when you apply for Medicaid.

To help you with this decision, a major claims study by the Society of Actuaries showed that less than 15% of claimants are using more than four years of benefits. The average duration for all claims is 1.9 years but the average duration for claims that last longer than a year is 3.5 years.*  So buy as many years as you can afford and if it’s only two years, that’s two years of private pay choices that you might not otherwise have. If the benefits aren’t enough, you can apply for Medicaid and a Long-Term Care Partnership policy will protect your assets equal to the benefits paid out.

If you are on the other end of the spectrum economically and want a long or unlimited benefit period, my advice to you is don’t wait. The insurance companies are pricing the longer periods higher so now is the best time to buy the longer periods.

6. Non-Forfeiture – This benefit is something you can do without.

Summary: You can give up the home care as long as assisted living is covered. Do not eliminate inflation coverage. If the benefit is too small at claim time and you can’t make up the difference, you could wind up on Medicaid quickly (or whatever type of public assistance/welfare benefit is available at the time).

*Society of Actuaries LTC Experience Intercompany Study, 1984-2007, Table E-1


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  1. Lynn Andrews says:

    I have the option of buying ForeCare Individual Annuity with Long-Term Care Insurance. What are your thoughts about this type of LTCI? Thank you.

    1. Phyllis Shelton says:

      I think it’s a great option if you make sure the coverage is as meaningful in the future as it is today. You should do these things:

      1) Determine the monthly cost of a “country club” assisted living facility in your area or in the area you plan to live in retirement.
      2) Project that cost at 5% compound for 20 or 30 years, depending on your life expectancy.
      3) Ask yourself how much of that cost you want your insurance policy to pay…half, 2/3, 80%, all of it?
      4) Check the Forethought illustration and be sure it is going to provide that amount at that time.

      For example, if a really nice assisted living facility costs $4500 a month today, that would grow to about $12,000 a month in 20 years and about $20,000 a month in 30 years. So if you wanted the policy to pay half, you would make sure it will pay at least $6000 a month in 20 years and at least $10,000 a month in 30 years. A good compound calculator is

      I am using the cost of an assisted living facility because home care is growing much slower…maybe 2% a year, so the future cost of a “country club” assisted living facility should provide you with significant home care benefits as well. If you need me to review the illustration more, please email it to or fax it to him at 615-590-0307.

  2. Judy Barrow says:

    Hi Phyllis, I am torn between buying LTC where if I don’t use it, I lose the premiums paid and buying a Whole life insurance policy with a LTC rider. Which is better?
    Thanks, Judy

    1. Phyllis Shelton says:

      Combos can work great if you design the plan correctly. Most people don’t. It’s so important to build any plan by looking at the future cost in the area in which you see yourself retiring and build the monthly benefit so you can make up the difference between what it pays and the charge at the time.

  3. debra acocella says:

    I have Genworth which I purchased at age 55 yrs old, and now I am 58 yrs old., want to keep it , I have NY partnership, I got this when AARP endorsed them, I see their stock is plummeting and hope they will be in business when I need them, can I fax you my policy page so you can review it and advise me. I am paying $2750 which has not increased as of yet. I truly would appreciate your input. please fax me your number . much appreciated , I am single with no kids.

    1. Phyllis Shelton says:

      Hello Debra – yes of course I will review your policy. Genworth is by far the largest carrier offering LTC insurance and they are taking a number of steps to ensure that claims will be paid. My fax number is 615-590-0307. Thanks,

      Phyllis Shelton

  4. Chris says:

    You actually make it seem really easy along with your presentation but I to find this matter to be actually something that I believe I’d never understand. It sort of feels too complex and very broad for me. I’m taking a look ahead on your subsequent submit, I’ll attempt to get the cling of it!

    1. Phyllis Shelton says:

      My goal in life is to make planning for long-term care easy Chris. If you want to proceed, just to to the contact us page on my site and complete the short questionnaire. Thanks!

      Phyllis Shelton

  5. Elizabeth says:

    I am 49 years old and my financial advisor has quoted me some rates on long term care insurance. he advised that the rates are going up next year and now would be a good time to buy it. I am in a quandry trying to figure out whether it is worth paying around 3000/year now for a policy. I live alone and may have enough money to pay this out based on my savings. I have 700,000 dollars that is for my retirement right now and will inherit about 400,000 (in today’s value) at some point. This is a Genworth plan and I live in California. I also don’t know whether I will retire and die here. I am considering moving to Europe. So much to consider… Is now the right time to buy given all my questions? Thanks, Elizabeth

    1. Phyllis Shelton says:

      Your financial advisor is 100% correct, Elizabeth. Now is the time to buy it as it will get more expensive sooner rather than later. Also, gender rating is going to start next year which means women will have to pay more and single women will have to pay the most. In my opinion, you don’t have enough money to self-insure. Some plans have international benefits and there is one plan (MedAmerica Insurance Company) that is all cash and provides world-wide coverage. All cash means you get a check each month after qualifying for benefits and you can spend it however you need it. It is owned by the Blue Cross plan in Rochester, New York and is available in California. Several plans have a partial international benefit. Please don’t wait. You also have your insurability to consider. I see way too many people in their 40s who have developed a progressive health condition and can’t qualify for long-term care insurance.

  6. Maureen says:

    I am 62yrs old and my employer has decided to offer LTC with 90days elimination period with buy more coverage over time and3%and 5% increase for life compound.The daily benefit starts at $150 and ends at .$300. The monthly payments start at $100 and $171 at this time.Can you advise me on the best action to take. Thank you Maureen

    1. Phyllis Shelton says:

      The 5% compound is the best, Maureen. The “Buy more coverage over time” option is the most expensive as your premium will continue to increase each time you buy more. The 5% will make your benefits double every 15 years. The 3% takes 24 years for them to double. The daily benefit choice is influenced by the cost of care in your area and how much of that cost you are willing to pay out of your own savings. You can see some cost of care surveys under “Cost of Care” on this website. My advice is to buy as much as you can afford at your current age. It will only cost more as you get older and you may have a health problem that doesn’t allow you to buy later. Finally, thank your employer for offering this essential benefit!

  7. Phyllis Shelton says:

    Thanks for stopping by Maryanne. Most people need long-term care insurance and the younger you buy it, the more affordable it is. Plus, you have a much greater chance of being able to qualify with good health. Some plans have preferred health discounts of 5%-15% and it’s really nice when you can get one of those.

  8. Maryanne says:

    Hi and thanks for finding the time to explain the terminlogy towards the newbies!

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