US Healthcare Business Stinks Thread II (2 Viewers)

[The Longtime Lurker]

Anyone in here up on what's happening with medicaid? Especially in relation to long term care facilities. It would appear to me that the federal funding for such places are going to be cut, or greatly reduced, but clear information on this specifically and it's ramifications seems hard to gather. Maybe at this point it's still unclear what's going on here?

The bill is out there. Not sure if we're allowed to link such things here or not. Probably depends on the person doing the linking, but it's not going to be good. At a 10,000 foot level, lots of rural areas are going to have their hospitals and/or urgent care groups go away. Lots of people are probably going to have to forgo standard trips to the doctor and rely more heavily on emergency rooms etc.

My wife is in administration at a state run skilled nursing facility and she seems a bit in the dark still as there's no official word as to how this is going to directly affect their funding. We've seen and heard some numbers thrown around, but nothing concrete which is why i was hoping someone here might have a more direct knowledge of how those particular facilities will fair. Perhaps we're a ways off still and state funding will still need to be worked out when federal funding changes.

Every state will be different. Take my comments from the 80/20 perspective. It will all depend on how well the state can fill the gaps, if they can. My dad lives in Florida and they've had several rural areas impacted when hospitals close. FL chose not to increase their medicaid funding the last time they were afforded the opportunity, so these current closings are because of that, but this is a pretty good indicator of what happens when outside support/funding goes away in areas like those. It makes complete sense to assume the same sorts of things are going to happen with this new bill too.

Michigan looks to be losing 325mm from federal funding for skilled nursing. Back of the napkin math puts that at a loss of 65k a month in federal aid with the numbers we currently have. Not ideal, but not end of the world if this really is the case. I suppose we're in a wait and see for awhile. Just trying to stay a step ahead of we can.

 

[massraider]

Once drug prices are pushed lower in the US, these same companies will be screaming that the US markup is what drives innovation and research... which is a stretch

The only reason we pay these drug prices is because our politicians are bought and paid for by the pharma industry.

Here's how I know: buying power.

I sell drugs for a living-- cannabis products. I sell to someone with one store, they get one price. Someone with 4 busy stores? They get special price, and more support, and on and on. They get what they want.

The US has all the buying power, and anytime the government wants to play hardball, Big Pharma will cave in, ASAP.

Our government has no interest in cheap medicine. I know this, because we don't have cheap medicine.

 

[Sparky Polastri]

Anyone in here up on what's happening with medicaid? Especially in relation to long term care facilities. It would appear to me that the federal funding for such places are going to be cut, or greatly reduced, but clear information on this specifically and it's ramifications seems hard to gather. Maybe at this point it's still unclear what's going on here?

The bill is out there. Not sure if we're allowed to link such things here or not. Probably depends on the person doing the linking, but it's not going to be good. At a 10,000 foot level, lots of rural areas are going to have their hospitals and/or urgent care groups go away. Lots of people are probably going to have to forgo standard trips to the doctor and rely more heavily on emergency rooms etc.

My wife is in administration at a state run skilled nursing facility and she seems a bit in the dark still as there's no official word as to how this is going to directly affect their funding. We've seen and heard some numbers thrown around, but nothing concrete which is why i was hoping someone here might have a more direct knowledge of how those particular facilities will fair. Perhaps we're a ways off still and state funding will still need to be worked out when federal funding changes.

Every state will be different. Take my comments from the 80/20 perspective. It will all depend on how well the state can fill the gaps, if they can. My dad lives in Florida and they've had several rural areas impacted when hospitals close. FL chose not to increase their medicaid funding the last time they were afforded the opportunity, so these current closings are because of that, but this is a pretty good indicator of what happens when outside support/funding goes away in areas like those. It makes complete sense to assume the same sorts of things are going to happen with this new bill too.

Michigan looks to be losing 325mm from federal funding for skilled nursing. Back of the napkin math puts that at a loss of 65k a month in federal aid with the numbers we currently have. Not ideal, but not end of the world if this really is the case. I suppose we're in a wait and see for awhile. Just trying to stay a step ahead of we can.

That stat is good news for your area. There are many other areas that need to be considered when it comes to overall impact.

 

[The Longtime Lurker]

Anyone in here up on what's happening with medicaid? Especially in relation to long term care facilities. It would appear to me that the federal funding for such places are going to be cut, or greatly reduced, but clear information on this specifically and it's ramifications seems hard to gather. Maybe at this point it's still unclear what's going on here?

The bill is out there. Not sure if we're allowed to link such things here or not. Probably depends on the person doing the linking, but it's not going to be good. At a 10,000 foot level, lots of rural areas are going to have their hospitals and/or urgent care groups go away. Lots of people are probably going to have to forgo standard trips to the doctor and rely more heavily on emergency rooms etc.

My wife is in administration at a state run skilled nursing facility and she seems a bit in the dark still as there's no official word as to how this is going to directly affect their funding. We've seen and heard some numbers thrown around, but nothing concrete which is why i was hoping someone here might have a more direct knowledge of how those particular facilities will fair. Perhaps we're a ways off still and state funding will still need to be worked out when federal funding changes.

Every state will be different. Take my comments from the 80/20 perspective. It will all depend on how well the state can fill the gaps, if they can. My dad lives in Florida and they've had several rural areas impacted when hospitals close. FL chose not to increase their medicaid funding the last time they were afforded the opportunity, so these current closings are because of that, but this is a pretty good indicator of what happens when outside support/funding goes away in areas like those. It makes complete sense to assume the same sorts of things are going to happen with this new bill too.

Michigan looks to be losing 325mm from federal funding for skilled nursing. Back of the napkin math puts that at a loss of 65k a month in federal aid with the numbers we currently have. Not ideal, but not end of the world if this really is the case. I suppose we're in a wait and see for awhile. Just trying to stay a step ahead of we can.

That stat is good news for your area. There are many other areas that need to be considered when it comes to overall impact.

Definitely. No doubt the consequences will be far reaching and other states will feel this far worse I'm sure.

 

[The Longtime Lurker]

It was really frustrating to find a good doctor after the doctor i had for years went to a more concierge style practice. And now my current doctor is leaving without any warning whatsoever. Received this email yesterday. AI powererd PCPs can't come fast enough.

"Good afternoon, We wanted to reach out and let you know that xxxxxxx the provider who is currently assigned as your Primary Care Provider has given us their notice that they will be leaving primary care to work out of the area. Obviously, we did not expect their departure. We know how frustrating and unsettling this kind of change can be. Unfortunately, this has become a common struggle across primary care across the US—finding and keeping great providers isn’t easy right now, and we’re feeling the negative effects of it, too. Despite this, there will be no change in the service that you have become accustomed to and you will remain in caring hands at xxxxxxxx as always. That said, we’re actively working on next steps. It would be very helpful for us to know if you have a preference for your Primary Care Provider by completing a quick questionnaire (click the link to complete). In the meantime, if you need anything—whether it’s a refill, follow-up, or you’re not sure who to reach out to—just give us a call. We’re here and happy to help however we can."

 

[FarFromHome]

It would be very helpful for us to know if you have a preference for your Primary Care

Ya, I prefer someone that knows what they are doing. I prefer them to have went to school also. Ha ha. I really think the days of Little House on the Prairie, where Doc Baker was just the doctor forever are over. I've been at my current VA facility for 4 years and have had literally 4 different primary care doctors assigned to me. Crazy. Zero continuity.

 

[The Longtime Lurker]

It would be very helpful for us to know if you have a preference for your Primary Care

Ya, I prefer someone that knows what they are doing. I prefer them to have went to school also. Ha ha. I really think the days of Little House on the Prairie, where Doc Baker was just the doctor forever are over. I've been at my current VA facility for 4 years and have had literally 4 different primary care doctors assigned to me. Crazy. Zero continuity.

I thought that was weird too. How about competent and leave it at that. Living in a rural area is going to get real rough from a healthcare standpoint. I mean it already is, but the future isn't looking very promising. Where we settle in retirement will be strongly based on where quality healthcare can be found.

 

[Ron Swanson]

It was really frustrating to find a good doctor after the doctor i had for years went to a more concierge style practice. And now my current doctor is leaving without any warning whatsoever. Received this email yesterday. AI powererd PCPs can't come fast enough.

"Good afternoon, We wanted to reach out and let you know that xxxxxxx the provider who is currently assigned as your Primary Care Provider has given us their notice that they will be leaving primary care to work out of the area. Obviously, we did not expect their departure. We know how frustrating and unsettling this kind of change can be. Unfortunately, this has become a common struggle across primary care across the US—finding and keeping great providers isn’t easy right now, and we’re feeling the negative effects of it, too. Despite this, there will be no change in the service that you have become accustomed to and you will remain in caring hands at xxxxxxxx as always. That said, we’re actively working on next steps. It would be very helpful for us to know if you have a preference for your Primary Care Provider by completing a quick questionnaire (click the link to complete). In the meantime, if you need anything—whether it’s a refill, follow-up, or you’re not sure who to reach out to—just give us a call. We’re here and happy to help however we can."

It's actually a pretty good communication compared to what I get. I walk into the office and 50% of the time it's someone new with no notification, etc. And they can't even take the time to read my history so I have to rehash to get them on the same page. 0 relationship with someone I need to trust. Very frustrating.

 

[bcat01]

It would be very helpful for us to know if you have a preference for your Primary Care

Ya, I prefer someone that knows what they are doing. I prefer them to have went to school also. Ha ha. I really think the days of Little House on the Prairie, where Doc Baker was just the doctor forever are over. I've been at my current VA facility for 4 years and have had literally 4 different primary care doctors assigned to me. Crazy. Zero continuity.

I thought that was weird too. How about competent and leave it at that. Living in a rural area is going to get real rough from a healthcare standpoint. I mean it already is, but the future isn't looking very promising. Where we settle in retirement will be strongly based on where quality healthcare can be found.

Rural hospitals are already strained financially and they will be crushed with pending changes. Even if you move somewhere with quality healthcare they are going to be swamped with more patients due to fewer locations.

 

[The Longtime Lurker]

It would be very helpful for us to know if you have a preference for your Primary Care

Ya, I prefer someone that knows what they are doing. I prefer them to have went to school also. Ha ha. I really think the days of Little House on the Prairie, where Doc Baker was just the doctor forever are over. I've been at my current VA facility for 4 years and have had literally 4 different primary care doctors assigned to me. Crazy. Zero continuity.

I thought that was weird too. How about competent and leave it at that. Living in a rural area is going to get real rough from a healthcare standpoint. I mean it already is, but the future isn't looking very promising. Where we settle in retirement will be strongly based on where quality healthcare can be found.

Rural hospitals are already strained financially and they will be crushed with pending changes. Even if you move somewhere with quality healthcare they are going to be swamped with more patients due to fewer locations.

Yes and yes. It appears to be a real **** sandwich and we're all going to have to take a bite one way or another.

 

[The Z Machine]

It would be very helpful for us to know if you have a preference for your Primary Care

Ya, I prefer someone that knows what they are doing. I prefer them to have went to school also. Ha ha. I really think the days of Little House on the Prairie, where Doc Baker was just the doctor forever are over. I've been at my current VA facility for 4 years and have had literally 4 different primary care doctors assigned to me. Crazy. Zero continuity.

I thought that was weird too. How about competent and leave it at that. Living in a rural area is going to get real rough from a healthcare standpoint. I mean it already is, but the future isn't looking very promising. Where we settle in retirement will be strongly based on where quality healthcare can be found.

Rural hospitals are already strained financially and they will be crushed with pending changes. Even if you move somewhere with quality healthcare they are going to be swamped with more patients due to fewer locations.

Yes and yes. It appears to be a real **** sandwich and we're all going to have to take a bite one way or another.

Who benefits from this system?

 

[The Longtime Lurker]

It would be very helpful for us to know if you have a preference for your Primary Care

Ya, I prefer someone that knows what they are doing. I prefer them to have went to school also. Ha ha. I really think the days of Little House on the Prairie, where Doc Baker was just the doctor forever are over. I've been at my current VA facility for 4 years and have had literally 4 different primary care doctors assigned to me. Crazy. Zero continuity.

I thought that was weird too. How about competent and leave it at that. Living in a rural area is going to get real rough from a healthcare standpoint. I mean it already is, but the future isn't looking very promising. Where we settle in retirement will be strongly based on where quality healthcare can be found.

Rural hospitals are already strained financially and they will be crushed with pending changes. Even if you move somewhere with quality healthcare they are going to be swamped with more patients due to fewer locations.

Yes and yes. It appears to be a real **** sandwich and we're all going to have to take a bite one way or another.

Who benefits from this system?

I'm not sure, but it doesn't feel like it's the patients.

 

[Terminalxylem]

Who benefits from this system?

Hospital admin, and other non-clinical, unnecessary middle people.

Probably advanced practice providers as well.

Definitely not the patients, nor physicians.

 

[The Z Machine]

advanced practice providers as well.

Like specialist physicians? Or like imaging techs?

 

[Terminalxylem]

advanced practice providers as well.

Like specialist physicians? Or like imaging techs?

It's the catch-all for nurse practitioners and physician assistants/associates, as older terms like mid-level provider, non-physician provider, and physician extender are felt to be demeaning. But some groups don't like that moniker either.

Basically, they want to make "provider" a more inclusive concept, describing anyone who makes clinical decisions. This avoids the hierarchy and implicit expertise that goes along with that pesky MD training.

 

[bcat01]

My MIL is in a nursing home memory care unit. She is on Medicaid along with probably 90% of the residents. If the cuts happen like projected there will be no where for these residents to go.

 

[The Longtime Lurker]

My MIL is in a nursing home memory care unit. She is on Medicaid along with probably 90% of the residents. If the cuts happen like projected there will be no where for these residents to go.

My wife is an administrator for a long term care facility. Things aren't looking great. Medicaid rates are proposed to be cut by a lot along with the overall Medicaid payments they receive. It's understood that this will be implemented over the next 10 years, but who can say forsure. Regardless, this could really cripple care for the elderly and put the cost or care burden back on the family.

 

[STEADYMOBBIN 22]

It was really frustrating to find a good doctor after the doctor i had for years went to a more concierge style practice. And now my current doctor is leaving without any warning whatsoever. Received this email yesterday. AI powererd PCPs can't come fast enough.

"Good afternoon, We wanted to reach out and let you know that xxxxxxx the provider who is currently assigned as your Primary Care Provider has given us their notice that they will be leaving primary care to work out of the area. Obviously, we did not expect their departure. We know how frustrating and unsettling this kind of change can be. Unfortunately, this has become a common struggle across primary care across the US—finding and keeping great providers isn’t easy right now, and we’re feeling the negative effects of it, too. Despite this, there will be no change in the service that you have become accustomed to and you will remain in caring hands at xxxxxxxx as always. That said, we’re actively working on next steps. It would be very helpful for us to know if you have a preference for your Primary Care Provider by completing a quick questionnaire (click the link to complete). In the meantime, if you need anything—whether it’s a refill, follow-up, or you’re not sure who to reach out to—just give us a call. We’re here and happy to help however we can."

This kept happening to me. Ended up signing up with One Medical and just use them for my primary and luckily I don’t need referrals so I just go to specialists on my own.

 

[The Z Machine]

This avoids the hierarchy and implicit expertise that goes along with that pesky MD training.

I get that physicians are needed. But I really don't think that the medical school system we have in the US is serving the interests of a healthy population. We need more and cheaper clinicians. And there really is no reason for a physician to attend a 4 year undergraduate university followed by all the medical school training. 2 years of that post-secondary education could be cut out. That's what many other countries do.

 

[Terminalxylem]

My MIL is in a nursing home memory care unit. She is on Medicaid along with probably 90% of the residents. If the cuts happen like projected there will be no where for these residents to go.

Many people in nursing facilities end up on Medicaid, after all their assets are quickly depleted. Since we already have a bed shortage, the cuts certainly won't help.

 

[The Longtime Lurker]

It was really frustrating to find a good doctor after the doctor i had for years went to a more concierge style practice. And now my current doctor is leaving without any warning whatsoever. Received this email yesterday. AI powererd PCPs can't come fast enough.

"Good afternoon, We wanted to reach out and let you know that xxxxxxx the provider who is currently assigned as your Primary Care Provider has given us their notice that they will be leaving primary care to work out of the area. Obviously, we did not expect their departure. We know how frustrating and unsettling this kind of change can be. Unfortunately, this has become a common struggle across primary care across the US—finding and keeping great providers isn’t easy right now, and we’re feeling the negative effects of it, too. Despite this, there will be no change in the service that you have become accustomed to and you will remain in caring hands at xxxxxxxx as always. That said, we’re actively working on next steps. It would be very helpful for us to know if you have a preference for your Primary Care Provider by completing a quick questionnaire (click the link to complete). In the meantime, if you need anything—whether it’s a refill, follow-up, or you’re not sure who to reach out to—just give us a call. We’re here and happy to help however we can."

This kept happening to me. Ended up signing up with One Medical and just use them for my primary and luckily I don’t need referrals so I just go to specialists on my own.

How does this work? Is there a physical office with this, or primarily telehealth?

 

[Terminalxylem]

This avoids the hierarchy and implicit expertise that goes along with that pesky MD training.

I get that physicians are needed. But I really don't think that the medical school system we have in the US is serving the interests of a healthy population. We need more and cheaper clinicians. And there really is no reason for a physician to attend a 4 year undergraduate university followed by all the medical school training. 2 years of that post-secondary education could be cut out. That's what many other countries do.

The AMA has certainly not worked to increase our physician pool, as med school and residency positions are capped way below the number of qualified applicants. That said, you may be right about the training being excessive anyway.

I've long said ~90% of what physicians do could be replicated by a chimp (or certainly AI). It's the other 10% that requires critical thinking skills. But any reasonably intelligent individual could probably learn that in a couple years.

As far as APPs, the best ones are every bit as good as doctors. But the quality and experience is far more variable than MDs imo.

 

[The Z Machine]

As far as APPs, the best ones are every bit as good as doctors. But the quality and experience is far more variable than MDs imo.

I can see that, and tracks with my own experiences. I don't have an issue seeing a PA or NP, or even having one as my primary. If they are knowledgeable, we have a good rapport, and they are willing to seek assistance when it's outside of their wheelhouse, I think they are great.

 

[STEADYMOBBIN 22]

It was really frustrating to find a good doctor after the doctor i had for years went to a more concierge style practice. And now my current doctor is leaving without any warning whatsoever. Received this email yesterday. AI powererd PCPs can't come fast enough.

"Good afternoon, We wanted to reach out and let you know that xxxxxxx the provider who is currently assigned as your Primary Care Provider has given us their notice that they will be leaving primary care to work out of the area. Obviously, we did not expect their departure. We know how frustrating and unsettling this kind of change can be. Unfortunately, this has become a common struggle across primary care across the US—finding and keeping great providers isn’t easy right now, and we’re feeling the negative effects of it, too. Despite this, there will be no change in the service that you have become accustomed to and you will remain in caring hands at xxxxxxxx as always. That said, we’re actively working on next steps. It would be very helpful for us to know if you have a preference for your Primary Care Provider by completing a quick questionnaire (click the link to complete). In the meantime, if you need anything—whether it’s a refill, follow-up, or you’re not sure who to reach out to—just give us a call. We’re here and happy to help however we can."

This kept happening to me. Ended up signing up with One Medical and just use them for my primary and luckily I don’t need referrals so I just go to specialists on my own.

How does this work? Is there a physical office with this, or primarily telehealth?

Both. Although I try not to use Amazon, we went through Amazon and the whole family got covered for like 250 bucks for four of us.

The physical spaces I visited, have been immaculate but you can just do remote visits for little stuff that they don’t need to see you for.

It’s a good replacement for a primary, keeping up with your prescriptions and getting a fast appointment.

ETA - I was with them before Amazon partnered with them so only when through Amazon to save a hundred bucks and further fuel the economic monopoly that Amazon already is. I just admit- the upgrade to the spacious penthouse physical offices have been a nice addition.

 

[The Longtime Lurker]

My MIL is in a nursing home memory care unit. She is on Medicaid along with probably 90% of the residents. If the cuts happen like projected there will be no where for these residents to go.

Many people in nursing facilities end up on Medicaid, after all their assets are quickly depleted. Since we already have a bed shortage, the cuts certainly won't help.

It's 85% the last census on medicaid here. Certainly they get their non homestead assets eaten up rather quickly (to the tune of $450 a day. Medicaid currently pays a rate of around $415 per resident per day) unless you start moving assets 5 years prior as anything still in your name will get used up before Medicaid kicks in. It's a lot more complicated than that, but that's the gist. The current model can't survive a whole lot of cutting.

 

[The Longtime Lurker]

It was really frustrating to find a good doctor after the doctor i had for years went to a more concierge style practice. And now my current doctor is leaving without any warning whatsoever. Received this email yesterday. AI powererd PCPs can't come fast enough.

"Good afternoon, We wanted to reach out and let you know that xxxxxxx the provider who is currently assigned as your Primary Care Provider has given us their notice that they will be leaving primary care to work out of the area. Obviously, we did not expect their departure. We know how frustrating and unsettling this kind of change can be. Unfortunately, this has become a common struggle across primary care across the US—finding and keeping great providers isn’t easy right now, and we’re feeling the negative effects of it, too. Despite this, there will be no change in the service that you have become accustomed to and you will remain in caring hands at xxxxxxxx as always. That said, we’re actively working on next steps. It would be very helpful for us to know if you have a preference for your Primary Care Provider by completing a quick questionnaire (click the link to complete). In the meantime, if you need anything—whether it’s a refill, follow-up, or you’re not sure who to reach out to—just give us a call. We’re here and happy to help however we can."

This kept happening to me. Ended up signing up with One Medical and just use them for my primary and luckily I don’t need referrals so I just go to specialists on my own.

How does this work? Is there a physical office with this, or primarily telehealth?

Both. Although I try not to use Amazon, we went through Amazon and the whole family got covered for like 250 bucks for four of us.

The physical spaces I visited, have been immaculate but you can just do remote visits for little stuff that they don’t need to see you for.

It’s a good replacement for a primary, keeping up with your prescriptions and getting a fast appointment.

ETA - I was with them before Amazon partnered with them so only when through Amazon to save a hundred bucks and further fuel the economic monopoly that Amazon already is. I just admit- the upgrade to the spacious penthouse physical offices have been a nice addition.

I need to look into something like this. I think telehealth and the walk in will be good enough for now since my screenings are all up to date, but something like that sounds pretty good, though i doubt it's an option here just yet.

 

[matttyl]

There are no easy answers when it comes to LTC coverage or options. The baby boomer generation will roughly double the LTC demand side over the next ~10-20 years, and they had fewer children than their parents did, meaning fewer potential informal caregivers (and what gen Xer or millennial wants or can afford to take on that responsibility/burden?).

The LTC insurance landscape has changed drastically over the past 10-15 years with many large carriers simply leaving the market completely.

 

[The Longtime Lurker]

There are no easy answers when it comes to LTC coverage or options. The baby boomer generation will roughly double the LTC demand side over the next ~10-20 years, and they had fewer children than their parents did, meaning fewer potential informal caregivers (and what gen Xer or millennial wants or can afford to take on that responsibility/burden?).

The LTC insurance landscape has changed drastically over the past 10-15 years with many large carriers simply leaving the market completely.

Seems they're going to have to fill the void. Out of pocket isn't an option for close to 90% of those requiring long term care. It's about the only option other than taking care of elderly relatives at home. It's messy and there's not many good options on the horizon.

 

[matttyl]

There are no easy answers when it comes to LTC coverage or options. The baby boomer generation will roughly double the LTC demand side over the next ~10-20 years, and they had fewer children than their parents did, meaning fewer potential informal caregivers (and what gen Xer or millennial wants or can afford to take on that responsibility/burden?).

The LTC insurance landscape has changed drastically over the past 10-15 years with many large carriers simply leaving the market completely.

Seems they're going to have to fill the void. Out of pocket isn't an option for close to 90% of those requiring long term care. It's about the only option other than taking care of elderly relatives at home. It's messy and there's not many good options on the horizon.

Oh, there are still options out there, and I wish more people would look into them (I’m an insurance agent after all), but currently most of those options are still pretty expensive (from a premium perspective) that most simply can’t afford.

But even if insurance companies did, let’s be honest here - they’d simply be another middle man in the big picture taking their cut. They wouldn’t be there if they weren’t making money. And they were the best option, or looked to be the best, 10-20 years ago for folks aged 55-70, and those folks are now 70-90 and the ones in these nursing homes where 85% of folks are relying on Medicaid.

 

[The Longtime Lurker]

There are no easy answers when it comes to LTC coverage or options. The baby boomer generation will roughly double the LTC demand side over the next ~10-20 years, and they had fewer children than their parents did, meaning fewer potential informal caregivers (and what gen Xer or millennial wants or can afford to take on that responsibility/burden?).

The LTC insurance landscape has changed drastically over the past 10-15 years with many large carriers simply leaving the market completely.

Seems they're going to have to fill the void. Out of pocket isn't an option for close to 90% of those requiring long term care. It's about the only option other than taking care of elderly relatives at home. It's messy and there's not many good options on the horizon.

Oh, there are still options out there, and I wish more people would look into them (I’m an insurance agent after all), but currently most of those options are still pretty expensive (from a premium perspective) that most simply can’t afford.

But even if insurance companies did, let’s be honest here - they’d simply be another middle man in the big picture taking their cut. They wouldn’t be there if they weren’t making money. And they were the best option, or looked to be the best, 10-20 years ago for folks aged 55-70, and those folks are now 70-90 and the ones in these nursing homes where 85% of folks are relying on Medicaid.

Yup, seems another way the insurance companies win while everyone else loses.

Edit. Posed this question to my wife and she says almost nobody has LTC insurance in her building and never really have. The assumption is the cost, which without medicaid will become the cheaper option.

 

[matttyl]

There are no easy answers when it comes to LTC coverage or options. The baby boomer generation will roughly double the LTC demand side over the next ~10-20 years, and they had fewer children than their parents did, meaning fewer potential informal caregivers (and what gen Xer or millennial wants or can afford to take on that responsibility/burden?).

The LTC insurance landscape has changed drastically over the past 10-15 years with many large carriers simply leaving the market completely.

Seems they're going to have to fill the void. Out of pocket isn't an option for close to 90% of those requiring long term care. It's about the only option other than taking care of elderly relatives at home. It's messy and there's not many good options on the horizon.

Oh, there are still options out there, and I wish more people would look into them (I’m an insurance agent after all), but currently most of those options are still pretty expensive (from a premium perspective) that most simply can’t afford.

But even if insurance companies did, let’s be honest here - they’d simply be another middle man in the big picture taking their cut. They wouldn’t be there if they weren’t making money. And they were the best option, or looked to be the best, 10-20 years ago for folks aged 55-70, and those folks are now 70-90 and the ones in these nursing homes where 85% of folks are relying on Medicaid.

Yup, seems another way the insurance companies win while everyone else loses.

How does everyone else lose? I have multiple people on LTC policy claims right now, getting paid thousands of dollars each month as reimbursement for their care that without they’d be bankrupt.

 

[The Longtime Lurker]

There are no easy answers when it comes to LTC coverage or options. The baby boomer generation will roughly double the LTC demand side over the next ~10-20 years, and they had fewer children than their parents did, meaning fewer potential informal caregivers (and what gen Xer or millennial wants or can afford to take on that responsibility/burden?).

The LTC insurance landscape has changed drastically over the past 10-15 years with many large carriers simply leaving the market completely.

Seems they're going to have to fill the void. Out of pocket isn't an option for close to 90% of those requiring long term care. It's about the only option other than taking care of elderly relatives at home. It's messy and there's not many good options on the horizon.

Oh, there are still options out there, and I wish more people would look into them (I’m an insurance agent after all), but currently most of those options are still pretty expensive (from a premium perspective) that most simply can’t afford.

But even if insurance companies did, let’s be honest here - they’d simply be another middle man in the big picture taking their cut. They wouldn’t be there if they weren’t making money. And they were the best option, or looked to be the best, 10-20 years ago for folks aged 55-70, and those folks are now 70-90 and the ones in these nursing homes where 85% of folks are relying on Medicaid.

Yup, seems another way the insurance companies win while everyone else loses.

How does everyone else lose? I have multiple people on LTC policy claims right now, getting paid thousands of dollars each month as reimbursement for their care that without they’d be bankrupt.

I guess I'm looking at it from a cost perspective. Currently medicaid covers 85% of the resident population here and none have LTC insurance. Maybe insurance is a better option than personal pay then medicaid when that's exhausted. I'm not familiar with LTC insurance so i can't say one way or the other. I'm sour on health insurance in general, so maybe I'm biased in that comment.

If you have resources on this i would appreciate that. I'll forward it along and maybe it'll help prepare for life after medicaid if that is indeed on the horizon.

Edit. I should say very few have it. None might be inaccurate

 

[The Z Machine]

prepare for life after medicaid

Woof. That is gonna be real terrible for a lot of folks. Boomers are gonna run down their assets, transferring none to their kids, while impoverishing their kids to pay for their care. Not to mention the detrimental impact on the boomer's grandkids, who should be seeing the benefits of wealth transfer but instead will just inherit a planet with rising sea levels, AI taking jobs, and no personal privacy.

 

[matttyl]

prepare for life after medicaid

Woof. That is gonna be real terrible for a lot of folks. Boomers are gonna run down their assets, transferring none to their kids, while impoverishing their kids to pay for their care. Not to mention the detrimental impact on the boomer's grandkids, who should be seeing the benefits of wealth transfer but instead will just inherit a planet with rising sea levels, AI taking jobs, and no personal privacy.

So they should buy a LTC policy to transfer that risk. I’m not saying it’s easy (or cheap), but neither is the alternative you describe.

LTC is pretty simple in concept, it’s just insurance like any other. If you own a house (even without a mortgage), you have insurance on it, or should. The ACA, even with its faults, mandated Americans have something we all should have had anyway (health insurance). Most states now mandate if you operate a vehicle you have insurance on it to mitigate that risk.

 

[The Z Machine]

prepare for life after medicaid

Woof. That is gonna be real terrible for a lot of folks. Boomers are gonna run down their assets, transferring none to their kids, while impoverishing their kids to pay for their care. Not to mention the detrimental impact on the boomer's grandkids, who should be seeing the benefits of wealth transfer but instead will just inherit a planet with rising sea levels, AI taking jobs, and no personal privacy.

So they should buy a LTC policy to transfer that risk. I’m not saying it’s easy (or cheap), but neither is the alternative you describe.

LTC is pretty simple in concept, it’s just insurance like any other. If you own a house (even without a mortgage), you have insurance on it, or should. The ACA, even with its faults, mandated Americans have something we all should have had anyway (health insurance). Most states now mandate if you operate a vehicle you have insurance on it to mitigate that risk.

I would imagine that LTC insurance is prohibitively expensive for those in their 60s and 70s. What are the prices / coverage we're talking about?

 

[matttyl]

prepare for life after medicaid

Woof. That is gonna be real terrible for a lot of folks. Boomers are gonna run down their assets, transferring none to their kids, while impoverishing their kids to pay for their care. Not to mention the detrimental impact on the boomer's grandkids, who should be seeing the benefits of wealth transfer but instead will just inherit a planet with rising sea levels, AI taking jobs, and no personal privacy.

So they should buy a LTC policy to transfer that risk. I’m not saying it’s easy (or cheap), but neither is the alternative you describe.

LTC is pretty simple in concept, it’s just insurance like any other. If you own a house (even without a mortgage), you have insurance on it, or should. The ACA, even with its faults, mandated Americans have something we all should have had anyway (health insurance). Most states now mandate if you operate a vehicle you have insurance on it to mitigate that risk.

I would imagine that LTC insurance is prohibitively expensive for those in their 60s and 70s. What are the prices / coverage we're talking about?

Huge range in what we’re talking about here. Back in the day I could sell a “stand alone” LTC policy to a fairly healthy couple in that age range for $4-9k a year which would cover $150-200 per day, and that 150-200 would grow each year (compounded or simple inflation) of 3 or 5%.

Today the big thing in LTCi is via a life policy. You buy a $500k whole life policy with an LTC rider - if you never need LTC your beneficiary gets the $500k. If you do need it, it’s paid for out of the future death bed it, reducing it dollar for dollar. So you’ll get your money back one way or another, or your heirs will. But then folks will say that permanent life insurance is a rip off and we’re back to square one.

 

[The Z Machine]

prepare for life after medicaid

Woof. That is gonna be real terrible for a lot of folks. Boomers are gonna run down their assets, transferring none to their kids, while impoverishing their kids to pay for their care. Not to mention the detrimental impact on the boomer's grandkids, who should be seeing the benefits of wealth transfer but instead will just inherit a planet with rising sea levels, AI taking jobs, and no personal privacy.

So they should buy a LTC policy to transfer that risk. I’m not saying it’s easy (or cheap), but neither is the alternative you describe.

LTC is pretty simple in concept, it’s just insurance like any other. If you own a house (even without a mortgage), you have insurance on it, or should. The ACA, even with its faults, mandated Americans have something we all should have had anyway (health insurance). Most states now mandate if you operate a vehicle you have insurance on it to mitigate that risk.

I would imagine that LTC insurance is prohibitively expensive for those in their 60s and 70s. What are the prices / coverage we're talking about?

Huge range in what we’re talking about here. Back in the day I could sell a “stand alone” LTC policy to a fairly healthy couple in that age range for $4-9k a year which would cover $150-200 per day, and that 150-200 would grow each year (compounded or simple inflation) of 3 or 5%.

Today the big thing in LTCi is via a life policy. You buy a $500k whole life policy with an LTC rider - if you never need LTC your beneficiary gets the $500k. If you do need it, it’s paid for out of the future death bed it, reducing it dollar for dollar. So you’ll get your money back one way or another, or your heirs will. But then folks will say that permanent life insurance is a rip off and we’re back to square one.

OK, got it. I've had a Term 80 life policy for 12 years now. It's obviously gone up in premiums since then, but I have been hesitant to revisit the life insurance situation as my wife and I have higher BMI now than we did 12 years ago... and my wife is on Lipitor now too.

 

[The Longtime Lurker]

@matttyl what percentage of the population has LTC insurance, or a rough estimate? My concern is before people convert to private insurance from medicaid that many LTC facilities will have closed their doors. As it stands without medicaid these facilities aren't going to get paid. 85-90% of residents relying on Medicaid won't be able to pay their bill in the short to medium term.

$450 is the daily rate for self pay and $420 for medicaid assistance (self pay rate is required to be higher than medicaid)

Edit. The requirement for higher self pay rate may be a state thing and vary from place to place, but that's what it looks like in Michigan.

 

[matttyl]

@matttyl what percentage of the population has LTC insurance, or a rough estimate? My concern is before people convert to private insurance from medicaid that many LTC facilities will have closed their doors. As it stands without medicaid these facilities aren't going to get paid. 85-90% of residents relying on Medicaid won't be able to pay their bill in the short to medium term.

$450 is the daily rate for self pay and $420 for medicaid assistance (self pay rate is required to be higher than medicaid)

First off, the places will be fine. The demand is there, and growing. All the LTC places where I am, at least the semi over ones and up, all have long waiting lists. If residents don’t (can’t) pay, I’d imagine they’d have to leave and make a room available for someone who can.

As for the number of people who have LTCi, a quick google search tells me about 7.5 million folks have some type of LTC, which is about 3-4% of those 50 and older. It’s a very small piece, but I’m extremely grateful that my parents do, as does my MIL. Just like with retirement, it takes planning. And for many, perhaps that plan is social security followed by Medicaid.

ETA - another article mentioned 14% of those 65 and up, which seems a bit high to be, even though that’s only 1 and 7 in that age group.

 

[The Longtime Lurker]

$450 a day (and rising, Oct 1 they go to 475 and medicaid 453.69, how it works is rates determined by 2024 costs. The state then takes that and determines the medicaid rate. A lot of factors go into that, plant costs, fixed assets, wages and benefits. Its a big complex formula. Then in a year or so medicaid will audit everything and a final rate will be set and theres either a settlement or owe the state money back) out of pocket is a big ask for most people, so I'm not sure i agree they'll be fine. Things have a way of working out, so you're probably right, but this going to be messy and will be a pretty big change to the way business is currently done.

There's also quota penalties for failing to meet occupancy, so a reduction in residents (under 85% occupancy) will hurt too in the form of reduced medicaid rate (which i guess won't be a problem if there's no medicaid and CMS to enforce things like regulations, staffing, occupancy, ect).

Edit. Sorry, this was meant be a reply

Edit 2. Quota penalties are enforced with a significantly reduced medicaid rate based on the census. CMS civil money penalties are based off the state survey. Just to clear up my error which I've edited.

 

[Terminalxylem]

It’s a ticking time bomb, as most people can’t afford LTC, or insurance coverage. Meanwhile, families are getting smaller, so there are less able bodies to help at home.

 

[Joe Bryant]

There are no easy answers when it comes to LTC coverage or options. The baby boomer generation will roughly double the LTC demand side over the next ~10-20 years, and they had fewer children than their parents did, meaning fewer potential informal caregivers (and what gen Xer or millennial wants or can afford to take on that responsibility/burden?).

The LTC insurance landscape has changed drastically over the past 10-15 years with many large carriers simply leaving the market completely.

Thanks @matttyl - Sorry I'm late to the game on this. I'm a little gunshy of posting in another medical thread.

I'm assuming you're in this area of insurance with Long Term Care? Thanks for sharing your expertise.

I don't doubt there aren't easy answers. But what advice would you give to a friend in their 60's on what to do?

 

[matttyl]

There are no easy answers when it comes to LTC coverage or options. The baby boomer generation will roughly double the LTC demand side over the next ~10-20 years, and they had fewer children than their parents did, meaning fewer potential informal caregivers (and what gen Xer or millennial wants or can afford to take on that responsibility/burden?).

The LTC insurance landscape has changed drastically over the past 10-15 years with many large carriers simply leaving the market completely.

Thanks @matttyl - Sorry I'm late to the game on this. I'm a little gunshy of posting in another medical thread.

I'm assuming you're in this area of insurance with Long Term Care? Thanks for sharing your expertise.

I don't doubt there aren't easy answers. But what advice would you give to a friend in their 60's on what to do?

Yes, I’m a life and health insurance agent. Have been for 20+ years now. When I first got into the industry, right out of school in fact, LTCi was the hottest thing and I sold quite a bit of it. Back then they were “stand alone” plans - means all they did was provide LTC in the future if you needed it. They didn’t build any “value”, so if you never needed LTC (or as is often the case you didn’t need it for longer than the policy’s waiting period), it didn’t provide any benefit other than peace of mind.

Fast forward 10-15 years when those insurance pools starting making claims, and those claims were not only far more frequent than insurance companies had predicted, but also larger on average and the carriers were paying more money out in claims than they were taking in from premiums. In fact, I’ve seen stats showing that carriers had a loss ratio of over 150% on average - meaning for every dollar they took in from premiums, they were paying out $1.50 in claims. It doesn’t take a math whiz to know that wasn’t sustainable, so carriers did the only things they could. Raise rates. Drastically so. This created a “death spiral” for some insurance pools where those healthy, and perhaps young enough, to find alternate coverage with another carrier did so, leaving the remaining pool on average older and sicker. Many carriers stopped selling those policies completely, including the ones I sold most often.

Anyway, the market has changed, and the LTC policies I sell now are very different - mostly built off either a life insurance or even annuity chassis - I described one above but can get into more detail if you like. Those are very interesting, and have the advantage of not having to worry about an increasing premium down the road.

I recently saw an annuity product out there where you put $X into it as a one time premium, it grows at a pretty low interest rate, like 2% - but if you ever need LTC it could provide up to 4X back to you for it. So $100k in could provide up to $400k out - and if you never needed LTC you or your heirs get the $100k (plus 2% compounding interest) back, tax advantaged.

Anyway, I’m rambling now. My advice would be to have a plan, and share that plan. It’s no different than retirement planning, or estate planning. In fact, it’s a part of retirement/estate planning in my eyes as it’s the largest threat to that retirement/estate. Once you have that plan - either via some insurance product, self pay, or for many Medicaid, share that plan with family. Make sure they know your thoughts and wishes, and if you’re lucky, obtain their blessing. You don’t want to go into it with the thought of - if it ever comes to that, “I’ll just go outside and sit on a stump until my time comes” as one prospect of mine said years ago in front of his wife, to her utter disbelief.

If folks (55+ with assets to protect and a family they’d like to pass some legacy onto) are looking specifically into obtaining a LTCi product - in today’s market I’d have them look at a life policy with LTC rider. Either they’ll die in the future without having needed LTC, and the life policy pays a death benefit to heirs - or they’ll need LTC in which case the policies death benefit would pay for it (and lower that death benefit dollar for dollar).

As one last bit of a sales pitch, but very informative to those in their 60s - here’s a stat that’s a few years old, but still pretty accurate. An American turning 65 today has a 50/50 shot of ever needing LTC in their remaining lifetime. Of those that do need it, half need it less than 90 days and half need it for longer than that. So you have a 25% shot of needing LTC for longer than 3 months. Of those that do - half need it for 2+ years. So 12.5%, roughly. Would 2+ years at $300-500 per day for that care ruin your retirement/estate plan?

 

[Uruk-Hai]

My parents bought LTC insurance in the early 1960s when both were basically teenagers (my dad had just turned 20). Their monthly premium was something silly like $10.

Thank goodness they did. My father grew into dementia in his late 60s and there came a time when my mother couldn't care for him anymore. Because of that long-term policy, she was able to get him into a very good assisted living facility that specialized in his disease. She had to pay (I think) 10% out-of-pocket and their policy paid the rest. We figured it up after dad passed and the total cost (not counting a couple of hospitalizations) was way (I mean, WAY) over a million bucks for 16 months of care. It wouldn't have completely ruined her (or my brother and myself) financially if she had to pay out of pocket, but she'd be living with either my brother or me for the last 11 years. Hell, we'd all three probably be living together.

Anyway, idiot that I am, I never looked into long-term until this stuff happened with my dad. Holy crap. It was about double my mortgage payment.

@matttyl you're still in my area? I'd like to meet up in maybe September if it's cool with you. I need a pro to help me roadmap my way forward.

 

[Max Power]

There are no easy answers when it comes to LTC coverage or options. The baby boomer generation will roughly double the LTC demand side over the next ~10-20 years, and they had fewer children than their parents did, meaning fewer potential informal caregivers (and what gen Xer or millennial wants or can afford to take on that responsibility/burden?).

The LTC insurance landscape has changed drastically over the past 10-15 years with many large carriers simply leaving the market completely.

Thanks @matttyl - Sorry I'm late to the game on this. I'm a little gunshy of posting in another medical thread.

I'm assuming you're in this area of insurance with Long Term Care? Thanks for sharing your expertise.

I don't doubt there aren't easy answers. But what advice would you give to a friend in their 60's on what to do?

Yes, I’m a life and health insurance agent. Have been for 20+ years now. When I first got into the industry, right out of school in fact, LTCi was the hottest thing and I sold quite a bit of it. Back then they were “stand alone” plans - means all they did was provide LTC in the future if you needed it. They didn’t build any “value”, so if you never needed LTC (or as is often the case you didn’t need it for longer than the policy’s waiting period), it didn’t provide any benefit other than peace of mind.

Fast forward 10-15 years when those insurance pools starting making claims, and those claims were not only far more frequent than insurance companies had predicted, but also larger on average and the carriers were paying more money out in claims than they were taking in from premiums. In fact, I’ve seen stats showing that carriers had a loss ratio of over 150% on average - meaning for every dollar they took in from premiums, they were paying out $1.50 in claims. It doesn’t take a math whiz to know that wasn’t sustainable, so carriers did the only things they could. Raise rates. Drastically so. This created a “death spiral” for some insurance pools where those healthy, and perhaps young enough, to find alternate coverage with another carrier did so, leaving the remaining pool on average older and sicker. Many carriers stopped selling those policies completely, including the ones I sold most often.

Anyway, the market has changed, and the LTC policies I sell now are very different - mostly built off either a life insurance or even annuity chassis - I described one above but can get into more detail if you like. Those are very interesting, and have the advantage of not having to worry about an increasing premium down the road.

I recently saw an annuity product out there where you put $X into it as a one time premium, it grows at a pretty low interest rate, like 2% - but if you ever need LTC it could provide up to 4X back to you for it. So $100k in could provide up to $400k out - and if you never needed LTC you or your heirs get the $100k (plus 2% compounding interest) back, tax advantaged.

Anyway, I’m rambling now. My advice would be to have a plan, and share that plan. It’s no different than retirement planning, or estate planning. In fact, it’s a part of retirement/estate planning in my eyes as it’s the largest threat to that retirement/estate. Once you have that plan - either via some insurance product, self pay, or for many Medicaid, share that plan with family. Make sure they know your thoughts and wishes, and if you’re lucky, obtain their blessing. You don’t want to go into it with the thought of - if it ever comes to that, “I’ll just go outside and sit on a stump until my time comes” as one prospect of mine said years ago in front of his wife, to her utter disbelief.

If folks (55+ with assets to protect and a family they’d like to pass some legacy onto) are looking specifically into obtaining a LTCi product - in today’s market I’d have them look at a life policy with LTC rider. Either they’ll die in the future without having needed LTC, and the life policy pays a death benefit to heirs - or they’ll need LTC in which case the policies death benefit would pay for it (and lower that death benefit dollar for dollar).

As one last bit of a sales pitch, but very informative to those in their 60s - here’s a stat that’s a few years old, but still pretty accurate. An American turning 65 today has a 50/50 shot of ever needing LTC in their remaining lifetime. Of those that do need it, half need it less than 90 days and half need it for longer than that. So you have a 25% shot of needing LTC for longer than 3 months. Of those that do - half need it for 2+ years. So 12.5%, roughly. Would 2+ years at $300-500 per day for that care ruin your retirement/estate plan?

Good post. I was just reading about the Centene stock decline due to the company pulling its yearly guidance.

The company cited a significantly higher morbidity rate than projected. Not good for the state of Healthcare or this style of insurance provider going forward.

Sounds like the only option left is to raise rates.

 

[Joe Bryant]

There are no easy answers when it comes to LTC coverage or options. The baby boomer generation will roughly double the LTC demand side over the next ~10-20 years, and they had fewer children than their parents did, meaning fewer potential informal caregivers (and what gen Xer or millennial wants or can afford to take on that responsibility/burden?).

The LTC insurance landscape has changed drastically over the past 10-15 years with many large carriers simply leaving the market completely.

Thanks @matttyl - Sorry I'm late to the game on this. I'm a little gunshy of posting in another medical thread.

I'm assuming you're in this area of insurance with Long Term Care? Thanks for sharing your expertise.

I don't doubt there aren't easy answers. But what advice would you give to a friend in their 60's on what to do?

Yes, I’m a life and health insurance agent. Have been for 20+ years now. When I first got into the industry, right out of school in fact, LTCi was the hottest thing and I sold quite a bit of it. Back then they were “stand alone” plans - means all they did was provide LTC in the future if you needed it. They didn’t build any “value”, so if you never needed LTC (or as is often the case you didn’t need it for longer than the policy’s waiting period), it didn’t provide any benefit other than peace of mind.

Fast forward 10-15 years when those insurance pools starting making claims, and those claims were not only far more frequent than insurance companies had predicted, but also larger on average and the carriers were paying more money out in claims than they were taking in from premiums. In fact, I’ve seen stats showing that carriers had a loss ratio of over 150% on average - meaning for every dollar they took in from premiums, they were paying out $1.50 in claims. It doesn’t take a math whiz to know that wasn’t sustainable, so carriers did the only things they could. Raise rates. Drastically so. This created a “death spiral” for some insurance pools where those healthy, and perhaps young enough, to find alternate coverage with another carrier did so, leaving the remaining pool on average older and sicker. Many carriers stopped selling those policies completely, including the ones I sold most often.

Anyway, the market has changed, and the LTC policies I sell now are very different - mostly built off either a life insurance or even annuity chassis - I described one above but can get into more detail if you like. Those are very interesting, and have the advantage of not having to worry about an increasing premium down the road.

I recently saw an annuity product out there where you put $X into it as a one time premium, it grows at a pretty low interest rate, like 2% - but if you ever need LTC it could provide up to 4X back to you for it. So $100k in could provide up to $400k out - and if you never needed LTC you or your heirs get the $100k (plus 2% compounding interest) back, tax advantaged.

Anyway, I’m rambling now. My advice would be to have a plan, and share that plan. It’s no different than retirement planning, or estate planning. In fact, it’s a part of retirement/estate planning in my eyes as it’s the largest threat to that retirement/estate. Once you have that plan - either via some insurance product, self pay, or for many Medicaid, share that plan with family. Make sure they know your thoughts and wishes, and if you’re lucky, obtain their blessing. You don’t want to go into it with the thought of - if it ever comes to that, “I’ll just go outside and sit on a stump until my time comes” as one prospect of mine said years ago in front of his wife, to her utter disbelief.

If folks (55+ with assets to protect and a family they’d like to pass some legacy onto) are looking specifically into obtaining a LTCi product - in today’s market I’d have them look at a life policy with LTC rider. Either they’ll die in the future without having needed LTC, and the life policy pays a death benefit to heirs - or they’ll need LTC in which case the policies death benefit would pay for it (and lower that death benefit dollar for dollar).

As one last bit of a sales pitch, but very informative to those in their 60s - here’s a stat that’s a few years old, but still pretty accurate. An American turning 65 today has a 50/50 shot of ever needing LTC in their remaining lifetime. Of those that do need it, half need it less than 90 days and half need it for longer than that. So you have a 25% shot of needing LTC for longer than 3 months. Of those that do - half need it for 2+ years. So 12.5%, roughly. Would 2+ years at $300-500 per day for that care ruin your retirement/estate plan?

Aweseome. Thank you so much for the insights and expertise. Super helpful.

 

[Joe Bryant]

As one last bit of a sales pitch, but very informative to those in their 60s - here’s a stat that’s a few years old, but still pretty accurate. An American turning 65 today has a 50/50 shot of ever needing LTC in their remaining lifetime. Of those that do need it, half need it less than 90 days and half need it for longer than that. So you have a 25% shot of needing LTC for longer than 3 months. Of those that do - half need it for 2+ years. So 12.5%, roughly. Would 2+ years at $300-500 per day for that care ruin your retirement/estate plan?

Thank you. That's exactly the kind of "weigh it out" information that helps people make a decision. Super helpful.

 

[matttyl]

There are no easy answers when it comes to LTC coverage or options. The baby boomer generation will roughly double the LTC demand side over the next ~10-20 years, and they had fewer children than their parents did, meaning fewer potential informal caregivers (and what gen Xer or millennial wants or can afford to take on that responsibility/burden?).

The LTC insurance landscape has changed drastically over the past 10-15 years with many large carriers simply leaving the market completely.

Thanks @matttyl - Sorry I'm late to the game on this. I'm a little gunshy of posting in another medical thread.

I'm assuming you're in this area of insurance with Long Term Care? Thanks for sharing your expertise.

I don't doubt there aren't easy answers. But what advice would you give to a friend in their 60's on what to do?

Yes, I’m a life and health insurance agent. Have been for 20+ years now. When I first got into the industry, right out of school in fact, LTCi was the hottest thing and I sold quite a bit of it. Back then they were “stand alone” plans - means all they did was provide LTC in the future if you needed it. They didn’t build any “value”, so if you never needed LTC (or as is often the case you didn’t need it for longer than the policy’s waiting period), it didn’t provide any benefit other than peace of mind.

Fast forward 10-15 years when those insurance pools starting making claims, and those claims were not only far more frequent than insurance companies had predicted, but also larger on average and the carriers were paying more money out in claims than they were taking in from premiums. In fact, I’ve seen stats showing that carriers had a loss ratio of over 150% on average - meaning for every dollar they took in from premiums, they were paying out $1.50 in claims. It doesn’t take a math whiz to know that wasn’t sustainable, so carriers did the only things they could. Raise rates. Drastically so. This created a “death spiral” for some insurance pools where those healthy, and perhaps young enough, to find alternate coverage with another carrier did so, leaving the remaining pool on average older and sicker. Many carriers stopped selling those policies completely, including the ones I sold most often.

Anyway, the market has changed, and the LTC policies I sell now are very different - mostly built off either a life insurance or even annuity chassis - I described one above but can get into more detail if you like. Those are very interesting, and have the advantage of not having to worry about an increasing premium down the road.

I recently saw an annuity product out there where you put $X into it as a one time premium, it grows at a pretty low interest rate, like 2% - but if you ever need LTC it could provide up to 4X back to you for it. So $100k in could provide up to $400k out - and if you never needed LTC you or your heirs get the $100k (plus 2% compounding interest) back, tax advantaged.

Anyway, I’m rambling now. My advice would be to have a plan, and share that plan. It’s no different than retirement planning, or estate planning. In fact, it’s a part of retirement/estate planning in my eyes as it’s the largest threat to that retirement/estate. Once you have that plan - either via some insurance product, self pay, or for many Medicaid, share that plan with family. Make sure they know your thoughts and wishes, and if you’re lucky, obtain their blessing. You don’t want to go into it with the thought of - if it ever comes to that, “I’ll just go outside and sit on a stump until my time comes” as one prospect of mine said years ago in front of his wife, to her utter disbelief.

If folks (55+ with assets to protect and a family they’d like to pass some legacy onto) are looking specifically into obtaining a LTCi product - in today’s market I’d have them look at a life policy with LTC rider. Either they’ll die in the future without having needed LTC, and the life policy pays a death benefit to heirs - or they’ll need LTC in which case the policies death benefit would pay for it (and lower that death benefit dollar for dollar).

As one last bit of a sales pitch, but very informative to those in their 60s - here’s a stat that’s a few years old, but still pretty accurate. An American turning 65 today has a 50/50 shot of ever needing LTC in their remaining lifetime. Of those that do need it, half need it less than 90 days and half need it for longer than that. So you have a 25% shot of needing LTC for longer than 3 months. Of those that do - half need it for 2+ years. So 12.5%, roughly. Would 2+ years at $300-500 per day for that care ruin your retirement/estate plan?

Good post. I was just reading about the Centene stock decline due to the company pulling its yearly guidance.

The company cited a significantly higher morbidity rate than projected. Not good for the state of Healthcare or this style of insurance provider going forward.

Sounds like the only option left is to raise rates.

Unfortunately that last sentence is true. For the carriers it’s either that or go under completely, which obviously is the last resort.

 

[matttyl]

My parents bought LTC insurance in the early 1960s when both were basically teenagers (my dad had just turned 20). Their monthly premium was something silly like $10.

Thank goodness they did. My father grew into dementia in his late 60s and there came a time when my mother couldn't care for him anymore. Because of that long-term policy, she was able to get him into a very good assisted living facility that specialized in his disease. She had to pay (I think) 10% out-of-pocket and their policy paid the rest. We figured it up after dad passed and the total cost (not counting a couple of hospitalizations) was way (I mean, WAY) over a million bucks for 16 months of care. It wouldn't have completely ruined her (or my brother and myself) financially if she had to pay out of pocket, but she'd be living with either my brother or me for the last 11 years. Hell, we'd all three probably be living together.

Anyway, idiot that I am, I never looked into long-term until this stuff happened with my dad. Holy crap. It was about double my mortgage payment.

@matttyl you're still in my area? I'd like to meet up in maybe September if it's cool with you. I need a pro to help me roadmap my way forward.

I am, let’s chat sometime soon and go from there.

 

[Joe Bryant]

There are no easy answers when it comes to LTC coverage or options. The baby boomer generation will roughly double the LTC demand side over the next ~10-20 years, and they had fewer children than their parents did, meaning fewer potential informal caregivers (and what gen Xer or millennial wants or can afford to take on that responsibility/burden?).

The LTC insurance landscape has changed drastically over the past 10-15 years with many large carriers simply leaving the market completely.

Thanks @matttyl - Sorry I'm late to the game on this. I'm a little gunshy of posting in another medical thread.

I'm assuming you're in this area of insurance with Long Term Care? Thanks for sharing your expertise.

I don't doubt there aren't easy answers. But what advice would you give to a friend in their 60's on what to do?

Yes, I’m a life and health insurance agent. Have been for 20+ years now. When I first got into the industry, right out of school in fact, LTCi was the hottest thing and I sold quite a bit of it. Back then they were “stand alone” plans - means all they did was provide LTC in the future if you needed it. They didn’t build any “value”, so if you never needed LTC (or as is often the case you didn’t need it for longer than the policy’s waiting period), it didn’t provide any benefit other than peace of mind.

Fast forward 10-15 years when those insurance pools starting making claims, and those claims were not only far more frequent than insurance companies had predicted, but also larger on average and the carriers were paying more money out in claims than they were taking in from premiums. In fact, I’ve seen stats showing that carriers had a loss ratio of over 150% on average - meaning for every dollar they took in from premiums, they were paying out $1.50 in claims. It doesn’t take a math whiz to know that wasn’t sustainable, so carriers did the only things they could. Raise rates. Drastically so. This created a “death spiral” for some insurance pools where those healthy, and perhaps young enough, to find alternate coverage with another carrier did so, leaving the remaining pool on average older and sicker. Many carriers stopped selling those policies completely, including the ones I sold most often.

Anyway, the market has changed, and the LTC policies I sell now are very different - mostly built off either a life insurance or even annuity chassis - I described one above but can get into more detail if you like. Those are very interesting, and have the advantage of not having to worry about an increasing premium down the road.

I recently saw an annuity product out there where you put $X into it as a one time premium, it grows at a pretty low interest rate, like 2% - but if you ever need LTC it could provide up to 4X back to you for it. So $100k in could provide up to $400k out - and if you never needed LTC you or your heirs get the $100k (plus 2% compounding interest) back, tax advantaged.

Anyway, I’m rambling now. My advice would be to have a plan, and share that plan. It’s no different than retirement planning, or estate planning. In fact, it’s a part of retirement/estate planning in my eyes as it’s the largest threat to that retirement/estate. Once you have that plan - either via some insurance product, self pay, or for many Medicaid, share that plan with family. Make sure they know your thoughts and wishes, and if you’re lucky, obtain their blessing. You don’t want to go into it with the thought of - if it ever comes to that, “I’ll just go outside and sit on a stump until my time comes” as one prospect of mine said years ago in front of his wife, to her utter disbelief.

If folks (55+ with assets to protect and a family they’d like to pass some legacy onto) are looking specifically into obtaining a LTCi product - in today’s market I’d have them look at a life policy with LTC rider. Either they’ll die in the future without having needed LTC, and the life policy pays a death benefit to heirs - or they’ll need LTC in which case the policies death benefit would pay for it (and lower that death benefit dollar for dollar).

As one last bit of a sales pitch, but very informative to those in their 60s - here’s a stat that’s a few years old, but still pretty accurate. An American turning 65 today has a 50/50 shot of ever needing LTC in their remaining lifetime. Of those that do need it, half need it less than 90 days and half need it for longer than that. So you have a 25% shot of needing LTC for longer than 3 months. Of those that do - half need it for 2+ years. So 12.5%, roughly. Would 2+ years at $300-500 per day for that care ruin your retirement/estate plan?

Good post. I was just reading about the Centene stock decline due to the company pulling its yearly guidance.

The company cited a significantly higher morbidity rate than projected. Not good for the state of Healthcare or this style of insurance provider going forward.

Sounds like the only option left is to raise rates.

Unfortunately that last sentence is true. For the carriers it’s either that or go under completely, which obviously is the last resort.

Really dumb insurance question. If an insurance company does go under, are you just out of luck after paying in all the premiums?

I assume so, but never had really heard much on it.