Are You Healthy Enough To Get Long Term Care Insurance?

August 29, 2017

My job is helping you plan for the day you will need long term care services (assistance with getting through the day).  It is easier to plan when you don’t have major medical issues, but you do not need to be in perfect health to qualify.

Long term care insurance is the planning tool of choice because it is so good at protecting families.  People say that I often get long term care insurance approved for them…in spite of medical history problems.

What exactly does “Healthy Enough” mean?  If you are not healthy enough, can an insurance company turn you down?  Even with or without the existence of Obama Care?  Absolutely!  Obama Care (the Affordable Care Act), unlike for medical insurance, does not impact long term care insurance at all.  Insurance companies can & do decline (turn down) people for long term care insurance when their risk is thought to be too high.


Let’s start with a few examples from a typical long term care insurance company height/weight chart.  The following applies to both women & men: If you are 5′ 0″ tall & weigh between 92-205 lbs…Good!  You are 5′ 6″ tall & weigh between 118-263 lbs…Good!  You are 6′ 0″ tall & weigh between 133-295 lbs…Good again!  At the high end, these are pretty generous allowances compared to those for life insurance.

What source does an insurance company use for determining your height & weight?  Answer: They use whatever is in your medical records from your most recent doctor’s office visit…sometimes further verified by an abbreviated exam.

On the flip side (meaning you cannot get long term care insurance if you have these conditions) a few “knock-outs” are: AIDS, Alzheimer’s disease, arthritis requiring narcotic pain medication, back pain that is disabling or requires narcotic pain medication (see a pattern here?), dementia, organ transplant, Medicaid recipient (receiving heath care through Medicare, the government health insurance for people age 65 & better, is OK), oxygen use, Parkinson’s disease, physical or occupational therapy within the past 3 months, pregnancy, surgery (requiring general anesthesia) that is planned or has been scheduled, use of a walker or wheelchair.

What about a history of cancer?  Answer: It depends.  Breast Cancer: Stages I-III, no metastasis, at least two years since last treatment.  Not a long term care insurance problem.  Basal Cell or Squamous Cell Skin Cancer: Not a long term care insurance problem.  Prostate Cancer: Stages I-III, no metastasis, at least two years since last treatment, and PSA zero or near-zero.  Not a long term care insurance problem.

Any cancers that have metastasized (spread), or recurred: Problem.

Diabetes Type II: Present for less than 20 years, well-controlled & stable with diet & exercise & oral medications, no injected insulin, no diabetic complications, & tobacco free for at least 12 months: Not a long term care insurance problem. Insulin less than 50 units per day, everything else is good: May be able to obtain long term care insurance…everything else really has to be good.

Women taking hormone replacement therapy medications: Not a long term care insurance problem.

Tobacco use within two years: Assuming everything else to be good, you will not have a problem obtaining long term care insurance.  However, you will not qualify for the very best rate class if you are a smoker.

THANK YOU FOR READING TO THE END. None of the above medical conditions apply to your ability to keep long term care insurance after it is effective.  Once you have been through the underwriting process & a policy has been issued & accepted by you, it is yours for as long as you like…provided you pay the premiums when due & have been truthful on the application.

AND MOST IMPORTANT: If you are younger than age 80, fall within the height & weight tables, & have no significant health issues, THEN I CAN FIND: GOOD, AFFORDABLE, LONG TERM CARE INSURANCE, FROM A GOOD COMPANY for you.

ONE OTHER THING: Please do not hurt yourself by assuming that you cannot qualify. Talk to me first.  Insurance is not the only tool I have available for long term care planning.

My intent in writing this article was not to scare you into thinking you had no options. Rather it was to point out that all of us are but one doctor’s visit away from becoming unable to purchase insurance at any price. Each of us will cross that uninsurable threshold at some point in our lives.  Do your planning before it happens.


Disclaimer: Actual policy language, rather than the contents of this eNewsletter always takes precedence.  Long term care insurance policies & underwriting requirements vary widely from company to company & within the same company.  Raymond Smith, The Long Term Care Specialist, does not give legal or tax advice.  Consult your attorney or tax advisor for these matters.

© Raymond Smith, The Long Term Care Specialist, 2017






The Diagnosis

June 27, 2017
In April of this year, my wife & I had an appointment with a neurologist. The complaint was occasional minor tremors. Nothing significant, but we wanted to have it checked out.
Imagine my shock when after completing his evaluation, the doctor said “You have Parkinson’s Disease.”.
I flashed back to (and talked about) my late sister-in-law who 20 years ago, suffered from Parkinson’s. Toward the end, she was wheel-chair bound and could not speak (but did communicate by squeezing my hand whenever we saw her). The doctor quickly corrected me with “Don’t let your memory of a person who had Parkinson’s 20 years ago color your expectations for today. There have been major treatment advances since then, including many new drugs that did not then exist.”.  And he said, “There is a tremendous amount of research being conducted that I know will someday lead to a cure.”.
Since that day in April, we have together gone to a multi-hour Parkinson’s overview presentation at University Hospital, participated in several webinars, heard an excellent talk about the importance of exercise, and spent hours online looking at the fantastic Michael J. Fox Parkinson’s Foundation website. We both continue our twice-weekly personal trainer workouts, and together walk a mile and a half every day, rain or shine. On top of all this we have had a tremendous outpouring of support from friends, family, our rabbis, and my wonderful clients.
I think I have come to grips with the diagnosis. Mostly, I buy into: “If you have to have an illness, Parkinson’s isn’t all that bad.”   “It is an inconvenience, not something that is life-threatening.” “There are no travel restrictions (and we do enjoy travel)…you just become tired more easily.”
The one thing that I have not been able to accept is that it is my wife who has the disease. How I wish it had been me instead. Would have been easier for me to deal with.
Still, both of us have more than our fair share of things to be thankful for:
1. We have had 50 wonderful years of marriage together and, God willing, many more to come.
2. We have two grown children who make us more proud to be their parents each day.  A daughter who is a teacher of children…imagine that!  She teaches 5th graders how to lead happy, productive, successful lives.   A son who works tirelessly to save our planet and to improve social justice for all (We agree on many things, but not everything.) while he defends the Earth.  Did I mention that last week, he presented his documentary film to rave reviews in a sold-out Denver movie theater? Well he did!
3. My wife & I have both made it into our seventies with no illnesses until now. Wow! It could have been something much worse…and it wasn’t!
4. While not wealthy, we are OK financially. No complaints.
5. I enjoy helping my clients.  My “work” is not really work…I’m having too much fun to call it that.
6. The two of us are far more than OK relationship-wise.  The relationship between my wife and myself, while always strong, has become so much stronger.  We often laugh aloud about our good fortune in finding each other. Or was it a blessing? We think the latter.
Those of you who are long-term readers of this eNewsletter know that I seldom share details of my personal life…and you never see anything about my wife (you have not yet read her name).  However, this diagnosis of Parkinson’s is too important to keep secret.
So what can you learn from this?   It can happen to anyone…at any time…no matter how healthy you think you are.  When a diagnosis does hit, you had better have your plan in place for providing long term care services.  My wife is now uninsurable.  Fortunately, we each have good coverage that was purchased years ago…when we were both healthy enough to buy it.  When my wife’s symptoms inevitably progress to the point that we need professional care, our insurance will pay for that care…from the care provider who best meet my wife’s needs.
We will not become dependent upon our children, or upon Medicaid, the endangered government welfare program.
I do not wish to make my wife’s illness into a commercial.  So I will close with this: Contact me if you have questions about Parkinson’s or if you just want to talk.
© 2017 by Raymond Smith, The Long Term Care Specialist

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Stacking: Does It Make Sense To Own More Than One Policy?

May 28, 2017

Maybe.  Let’s say you want long term care insurance that will reimburse you for $6,000 per month.  But you can only afford (for now) coverage for $3,000 per month.  You expect your available income to grow during the next few years.  Buying the $3,000 per month policy today & then another, larger, policy later could be a good strategy provided:

  1. You remain insurable.
  2. You understand that the same policy will cost more per $100 of coverage just because you will be a few years older.
  3. A comparable policy, with a comparable cost structure, may not be offered a few years from now.
  4. Neither of the two policies have a coordination of benefits clause that would prevent you from receiving benefits from both…more on that later.

Here is another situation where “Stacking” policies could work.  Perhaps you have a small, older policy with a very low premium…and you want more coverage.  Should you apply for a single new policy that provides all the protection you are looking for, & discard the old policy?  Or should you keep the old policy & add a new one that makes up the difference?

As your insurance broker, I would conduct an analysis comparing the total cost of both approaches AND the comparative benefits of the old & new policies.  Even if there is a cost savings one way or the other, I (& you) would have to consider any differences in benefits.  For example:

  1. Older policies tend to express the maximum periodic benefit in dollars per day, while current policies almost always use maximum dollars per month.  $200 per day & $6,000 per month may seem like the same thing, but they are not.  $6,000 per month lets you get reimbursed $800 for a twice-monthly speech therapist visit following a stroke (assuming you don’t spend more than $5,200 for other long term care during the month).  If your policy benefit was $200 per day, your reimbursement for the same two $400 visits would only be $400.
  2. Elimination Periods for older policies tend to be expressed as the number of required “service days”.  Newer polices most often use “calendar days”.  The difference?  Service Days only count those days in which you actually incur a charge for care.  Calendar Days count all days (whether or not you actually have paid “service”) starting with the first day you are otherwise eligible (other than having satisfied the Elimination Period).  There is no pocketbook difference if you are in a facility, but it may matter greatly if you are receiving Home Care, for less than seven days per week.  For example: If you were receiving covered Home Care four days per week, starting on January 1st, it would take until about June 7th to satisfy your Elimination Period.  With Calendar Days in the same situation, it would only take until March 31st.
  3. Inflation Protection: Older policies often had “5% compound” inflation protection.  While 5% compound may still be offered in a few cases, it has become so expensive that only 3% compound is usually presented.

My recommendation would be based upon a combination of total (combined) cost & the difference (and there always is a difference) in policy benefits.  You would always be told the pros & cons of either keeping your old policy and adding a new one to it, or applying for a single new policy that would provide all the wanted benefits.  Of course, the decision would always be yours to make.

When would it NOT make sense to stack policies?

  1. If keeping the old policy & adding a new one would be more expensive than a single new policy AND the old policy does not have better benefits.
  2. If there is a “coordination of benefits” clause in either the old or new policies that permits the relevant insurance company to only pay benefits provided by one policy for the same long term care event.  For this reason, I would always recommend that if you do buy two or more polices, they be from different insurance companies.  Then, in the absence of a coordination of benefits clause, each insurance company would be contractually obligated to pay the stated policy benefits.  Note: I have never seen an individual policy with the kind of coordination of benefits clause I have just described.  Perhaps they do exist with some group policies.
  3. Your health has deteriorated to the point you are no longer insurable…here you have no choice but to keep the old policy.  You cannot buy a new policy.

None of the above discussion applies to a situation when someone wants to replace an older (more than about 5 years old) policy with a new one to save money.  You simply cannot get here from there.  Any policy more than a few years old will always be more expensive than a comparable policy available today.  I know, because I have checked this out for many of my clients.


Disclaimer: Actual policy language, rather than the contents of this eNewsletter always takes precedence.  Long term care insurance policies vary widely from company to company & often within the same company.  Raymond Smith, The Long Term Care Specialist, does not give legal or tax advice.  Consult your tax advisor or attorney for these matters.


© Raymond Smith, The Long Term Care Specialist, 2017