Tuesday, December 23, 2008

Comment on Congressional Budget Office Long-Term Care Proposals

Received several notes from people regarding the information posted from the Congressional Budget Office's report on Long-Term Care proposals.

I thought I would share comments (below) from one leading expert whom I respect as one of the more knowledgable LTCi industry pros. On a personal note, I completely concur that the proposals will cost taxpayers and will do nothing to keep Medicaid solvent to meet the future needs of consumers. The American Association for Long-Term Care Insurance is not chartered as a lobbying entity but we'll do our best to keep everyone apprised and if the time comes to raise our voices ... we will. My goal for this blog is to be information (not an ongoing rant) ... but I'm personally glad to see some folks have signed-up. You can post comments to the blog.

Let's keep building ... we have some wonderfully bright and passionate minds (on our side!)

Jesse Slome


One Expert Comments to the CBO Proposals for Long-Term Care

"I won't go into the problems the Medicaid suggestions raise: How does a minimally trained case worker in a county get info about expenditures made 7 years ago from anyone much less from a cognitively impaired 85 year old! But the LTC insurance piece does concern me. I'm surprised you were not more critical of the CBO report proposal.

As I look at it, it would severely impact LTCi sales opportunities and harm the public.
1. Even where a person made $100K over 40 years, a savings account of 1.2% of income would only accumulate about $53K. Scarcely adequate to buy LTCi for a 65 year old 40 yrs from now. If the client had used the 1.2% right along to pay premiums rather than put money into the Treasury account it would work, but not the way this concept is set up.

2. Second, I couldn't find anything in the report about treasury bills. Nothing in the report that says any interest would be paid which makes affordability of decent LTCi at 65 even more unlikely.

3. Why buy LTCi at all until 65 when the windfall occurs. We've fought the "Medicare covers LTC" myth for years. This would be a million times worse especially since the feds will be touting the plan. Windfall is also an appropriate word. The concept implies a single premium. There is no other way to explain the report's provision that allows funds remaining after the "best" policy is purchased to go back to the accountholder (after taxes). If the CBO authors had envisioned annual premiums, this would never come up because remaining funds would be premised on death or LTC eligibility .

4. The report says insurers would have huge opportunities to sell new products. I agree, but not the products we do today nor products that actually help our clients. CBO optimism is premised on the idea that the cost of LTCi is driven primarily by negative selection. Not so. If everyone had to buy coverage, the cost of policies would go down (maybe 15%), but not enough to make even modestly adequate coverage affordable under this plan. So, at age 65, people would find that unless they were willing to kick in a lot, their promised coverage would be next to nothing. As to insurers, our sales outside the 65 mandated group would be even less than they are today.

On the bright side, we'd have the opportunity to sell new products that matched the limited account funds. On the downside, those products are likely to be standardized (whatever that means to the CBO) products (like Medigap) but dominated by NTQ minimal indemnity coverage akin the old hospital indemnity policies."

Friday, December 19, 2008

Congressional Budget Office Recommends New Savings Program To Fund Purchase Of Long-Term Care Insurance

Congressional Budget Office Recommends Savings Program To Enable Americans To Purchase Long-Term Care Insurance

To aid the incoming 111th Congress and the Obama Administration, the Congressional Budget Office (CBO) has just released a 235-page report outlining 115 budget options for health care reform. The report expands on one the CBO's regular reports to the House and Senate Committees on the Budget. The authors claim the report presents ideas for reducing "and in some cases, increasing" federal spending on health care, altering federal health care programs and making (in again their words) "substantive changes to the nation's health insurance system.

When it comes to the long-term care section according to Jesse Slome, Executive Director of the American Association for Long-Term Care Insurance, most of the changes will increase spending adding costs to an already strained federal program.

One proposal would require workers to contribute a percentage of their pretax wages to an individual account reserved specifically to pay for long-term care insurance. In the Congressional Budget Office’s estimation, a contribution of 1.2 percent of income subject to the Social Security payroll tax would meet the option’s funding requirements. Non-wage earners, such as stay-at-home spouses, would not be covered under this option.

Under the proposed plan, the accounts themselves would be administered by a federal entity, which would invest them in Treasury securities. The money in the account would be the property of the individual and would be part of the individual’s estate if he or she died before turning 65. At age 65, the balance of the account would be required to be used to purchase the most generous long-term care insurance policy available given that balance.

Here is a summary of the other proposals and some preliminary estimated costs:

1. Increase States' Flexibility to Offer Home- and Community-Based Services Through Medicaid State Plan Amendments. This option would increase Medicaid’s spending by an estimated $2.7 billion over the 2010–2014 period and by $8.1 billion over the 2010–2019 period.

2. Make Home and Community-Based Services a Mandatory Benefit Under Medicaid. This option would increase Medicaid spending by approximately $20 billion over the 2010–2014 period and by about $90 billion over the 2010–2019 period. That estimate incorporates a reduction in nursing home spending as a result of a modest decline—compared with current law—in the number of Medicaid beneficiaries who receive care in nursing homes and a subsequent increase in the number of individuals receiving home or community-based services.

3. Increase the Federal Matching Rate for Home and Community-Based Services and Decrease the Federal Matching Rate for Nursing Home Services. This option would increase Medicaid spending by about $8 billion over the 2010–2014 period and by about $13 billion over the 2010–2019 period.

4. Clarify Medicaid's Definition of Permissible Asset Transfers. This option would explicitly define which types of transfers are permissible. Because the rules are ambiguous, states tend to interpret them narrowly. This option would clarify that the following types of transfers are permissible:
Providing financial assistance to a family member for educational expenses;
Assisting a family member with medical expenses;
Assisting a family member facing a financial crisis, including a failing business or family farm;
Assisting an individual who is a caregiver for a family member or person with whom he or she lives; or
Donating funds to a church, religious organization, or charity.
Implementing this change would increase mandatory federal spending by about $2.6 billion over the 2010–2014 period and by $6 billion over the 2010–2019 period.

5. Increase the "Look-Back" Period for Transfers of Assets in Medicaid. This option would further extend that period from 60 months to 84 months for transfers made on or after October 1, 2009. Transfers made prior to that date would be subject to the 60-month look-back period. The look-back period would increase to 84 months over time, with the option generating its first budgetary effects in year six of the 10-year period from 2010 to 2019—that is, after 60 months had passed. Therefore, this change would have no effect on federal spending until 2015; over the period from 2015 through 2019, it would reduce spending by approximately $220 million.

6. Implement Policies That Encourage the Use of Advance Directives. Provided that appropriated funds were available, implementing those activities would increase federal discretionary spending by about $60 million over the 2010–2014 period and by $110 million over the 2010–2019 period. There would be a savings to Medicare of about $30 million over the 2010–2014 period and $100 million over the 2010–2019 period resulting from the portability of advance directives.

Here is the link to access the full report click on this link or paste the following address into your Web browser. The long-term care provisions are contained in Chapter 10 that actually begins on page 193. http://www.cbo.gov/ftpdocs/99xx/doc9925/12-18-HealthOptions.pdf

Wednesday, December 17, 2008

2009 Medicaid Impoverishment Limits Impact Long-Term Care Planning

Consumers as well as agents and brokers who market long-term care insurance should have a current knowledge and understanding of Medicaid's Spousal Impoverishment rules that come into play when an individual or a spouse enters a nursing home.It is important to understand that far too many people fail to properly plan for the potential risk of needing long-term care. At a point in time when they finally anticipate the need, they are generally in too poor health to qualify. Counting on government programs such as Medicaid is certainly not going to be a viable answer going forward as Federal and State programs become more severely strapped for cash.

The expense of nursing home care, which according to the 2008 LTC Insurance Sourcebook, published by the American Association for Long-Term Care Insurance ranges from $4,000 to $7,000 a month or more, can rapidly deplete the lifetime savings of elderly couples. The cost of home care as well as assisted living can be costly as well. Generally government programs such as Medicaid do not pay for this care and, as a result, as personal savings were depleted many people were (and are) forced into nursing homes.

In 1988, Congress enacted provisions to prevent what has come to be called "spousal impoverishment" that can leave the spouse who is still living at home in the community (as they refer to it) with little or no income or resources. These provisions are designed to help ensure that this situation will not occur and that community spouses are able to live out their lives with independence and dignity.

2009 Resource Eligibility (According to CMS)

The spousal impoverishment provisions apply when one member of a couple enters a nursing facility or other medical institution and is expected to remain there for at least 30 days. When the couple applies for Medicaid, an assessment of their resources is made. The couple's resources, regardless of ownership, are combined. The couple's home, household goods, an automobile, and burial funds are not included in the couple's combined resources. The result is the couple's combined countable resources. This amount is then used to determine the Spousal Share, which is one-half of the couple's combined resources.

To determine whether the spouse residing in a medical facility meets the state's resource standard for Medicaid, the following procedure is used: From the couple's combined countable resources, a Protected Resource Amount (PRA) is subtracted.

The PRA is the greatest of:
The Spousal Share, up to a maximum of $109,560 in 2009;
The state spousal resource standard, which a state can set at any amount between $21,912 and $109,560 in 2009;
An amount transferred to the community spouse for her/his support as directed by a court order; or
An amount designated by a state hearing officer to raise the community spouse's protected resources up to the minimum monthly maintenance needs standard.

After the PRA is subtracted from the couple's combined countable resources, the remainder is considered available to the spouse residing in the medical institution as countable resources. If the amount of countable resources is below the State's resource standard, the individual is eligible for Medicaid. Once resource eligibility is determined, any resources belonging to the community spouse are no longer considered available to the spouse in the medical facility.

Income Eligibility
The community spouse's income is not considered available to the spouse who is in the medical facility, and the two individuals are not considered a couple for income eligibility purposes. The state uses the income eligibility standard for one person rather than two, and the standard income eligibility process for Medicaid is used.

Post-Eligibility Treatment of Income
This process is followed after an individual in a nursing facility/medical institution is determined to be eligible for Medicaid. The post-eligibility process is used to determine how much the spouse in the medical facility must contribute toward his/her cost of nursing facility/institutional care. This process also determines how much of the income of the spouse who is in the medical facility is actually protected for use by the community spouse.

The process starts by determining the total income of the spouse in the medical facility. From that spouse's total income, the following items are deducted:
A personal needs allowance of at least $30;
A community spouse's monthly income allowance (between $1,750 and $2,739 for 2009), as long as the income is actually made available to her/him;
A family monthly income allowance, if there are other family members living in the household;
An amount for medical expenses incurred by the spouse who is in the medical facility.
The community spouse's monthly income allowance is the amount of the institutionalized spouse's income that is actually made available to the community spouse. If the community spouse has income of his or her own, the amount of that income is deducted from the community spouse's monthly income allowance. Similarly, any income of family members, such as dependent children, is deducted from the family monthly income allowance.

Once the above items are deducted from the institutionalized spouse's income, any remaining income is contributed toward the cost of his or her care in the institution.

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Tuesday, December 16, 2008

Long-Term Care Insurance Tax Planning Idea For Business Owners

Long-term care insurance is one of the greatly overlooked tax deductions with special advantaged best suited for small business owners. The American Association for Long-Term Care Insurance maintains helpful information about deductibility levels and rules on it's website. Click here to read more.

But here is a tip summarized from the just published edition of Long-Term Care Insurance Sales Strategies magazine. The idea was shared by David Hillelsohn of the Haslett Management Group.

The firm worked with an employer who desired offering an employer-paid long-term care insurance plan to employees, but only wanted to selectively provide the coverage to those nearing retirement age.

To accomplish this,, the firm created their own eligible classification for the insurance benefit by creating a point system - giving a point for years of service and a point for the employees age. Any employee with 50 or more points was eligible for the employer paid plan.

The use of Executive Carve Out plans for long-term care insurance remains one of the best ways small businesses can use pre-tax dollars to pay for this important benefit. For more information, contact your long-term care insurance professional or click here for no-obligation information.

Monday, December 15, 2008

Response To Conseco Situation

I received a request for commentary on the Conseco Trust situation by Mark Miller who authors an excellent Website and blog: Retirement Revised.

Here is the response from the American Association for Long-Term Care Insurance:

When it comes to Conseco and the issue of long-term care insurance, it is very important for people considering buying protection to understand that the past does not equal the present nor the future. Conditions and state regulations mandated and approved in most states are designed to prevent just this type of situation. It is also important for consumers to know that insurers fund state guarantee funds. These guaranty funds guaranty policyholders in the case of an insurer insolvency. The limits range from $100,000 to as much as $500,000 in some states.But, let's look back. The Conseco situation was very unfortunate but other than lawyers attempting to create much ado by crying foul, the resulting agreement provides what many reasonable experts deemed the best of a lousy situation.

Why have insurers who issued policies in the late 1980s and 1990 found themselves facing unanticipated financial strains. One of the primary reasons has been declining interest rates. Insurers collect small amounts of premiums each year, invest the money in anticipation of paying future claims. When many of these policies were priced, interest rates were say 8-9 percent. As we've all seen, they've declined steadily to the point where last week the U.S. government sold treasuries at zero percent interest.

Falling interest rates are wonderfully advantageous to those financing a home or car purchase. The exact opposite is true for long-term care insurers. For every one percent drop in interest rates, an insurer would need a 10 percent premium increase (back to the issue date) to maintain targeted profitability.

Some of the larger, better capitalized insurers raised premiums on policies (these increases ranged from 8 to 18 percent). Others found themselves in a worse situation.

Bad news makes headlines and lawyers create profit for themselves by scaring people. Let's balance that with some positive news; in 2007 long-term care insurers paid $3.5 billion to 180,000 Americans who purchased this valuable protection and got exactly what they needed.

Friday, December 12, 2008

Long Term Care Insurance Videos - Featured Claims Stories

Five videos discussing the importance of purchasing long-term care insurance have been posted by the American Association for Long-Term Care Insurance on the new YouTube page established by the organization.

The first video features a three-minute television appearance by Jesse Slome, the Association's executive director. Slome recently appeared on the noon news in St. Louis, MO to discuss key facts consumers need to know about long-term care planning and insurance protection options.

Two additional videos feature Association members Harry Crosby and Fred Frauhiger who appeared on their local television news shows during 2008's Long Term Care Awareness Month. Both experts share relevant information for consumers.

The final two videos feature interviews with real claimaints who were featured in the 2008 Long-Term Care Insurance industry advertisement that appeared in the December 2008 edition of Kiplinger's personal Finance magazine. The ad was supported by eleven leading long-term care insurers. Click here to link to the page where the ad can be viewed.

All five videos can be viewed online. Click on this link or paste the following text into your web browser's address box: http://www.youtube.com/LongTermCareInfo . The Association plans to add additional long-term care insurance claims stories throughout 2009.

Thursday, December 11, 2008

Finding Security In Guaranty Associations

Guaranty associations were created by states to product insureds in case of a company insolvency. All insurance companies licensed in a state are required, as a condition of doing business in that state, to be a member of the guaranty association.

The guarantee varies but generally ranges from a minimum of $100,000 to $500,000 in some states (Connecticut, New York and Washington).

Insurers are forbidden to talk about this guarantee (unlike banks that are encouraged to promote the FDIC guarantee).

I plan to interview Peter Gallanis, the national director for the national organization representing each of the state guaranty associations and look forward to posting meaningful information as part of our Ask The LTC Guy Q&A featured on the Association's Consumer Information Center.

I have a list of questions that I plan to ask Mr. Gallanis but if you have suggestions, please E-mail me at mailto:jslome@aaltci.org .

Thanks. Looking forward to sharing some of the findings here as well.

Wednesday, December 10, 2008

Free Marketing Tool For Agents

Yesterday we announced the 2009 National Long-Term Care Sales Achievement Award which recognizes producers (even those who make minimal sales). If you are not familiar with the award, click on this link.

I'm glad to say some 75 producers entered during the first day. But that's not what prompted this message. Our system tabulates the entries and it also keeps track of lots of meaningful info.

One thing it records is the number of people who use the free E-card we placed on our Members Only Page. We don't see any names ... just a counter of how many people used in the past 30 days.

I was shocked to see the number was 13. It's free! It's private. You can personalize it. Replies go back directly to you the agent who sent this.

And, in fact, we are going to be adding a second E-card that agents can use to target business owners.

The ability to use free E-mail marketing to generate interest is a powerful, most powerful marketing tool. And, if you are not collecting E-mail addresses for every person you come in contact with, you are missing the boat.

More important, you need to be segmenting your E-mail lists so that you can selectively target people. Lists I would consider are: clients, non-buyers (who you met with), women living alone, business owners and self-employed.

For now, go to the Association's website. Click here. Go into the Producer's Resource Center and there you will find the Members Only tab. That's your access to free marketing tools, including the E-card. The first one targets women. Try sending the card to yourself ... and then start using these free E-cards to market. We'll have more cards added ... as more people use them.

Let me know what you think. I'll share more tips on the topic.

Tuesday, December 9, 2008

New LTC Insurance Guide For Accountants Published


One of the best ways to generate referrals of long-term care insurance prospects is by working with accountants and CPAs. They know which clients own businesses (and are looking for tax deductions). They know which individuals have assets they'd like to protect.

The American Association for Long-Term Care Insurance has updated this guide with 2008 and 2009 tax deductible rules and limits. Copies are available in packs of 50.

If you are an Association member, you can order individual copies. The cost is $4.50 for 5 copies and $7.50 for 9 copies. This includes postage costs. At over 9 pieces, we would need to mail Priority Mail at $4.80.

For more information, call the Association at (818) 597-3205. If you are a member and wish to order individual copies, just mail a check to AALTCI, 3835 E. Thousand Oaks Blvd., Ste 336, Westlake Village, CA 91362.

All our brochures are viewable online. See All AALTCI tools. Click here now.


Monday, December 8, 2008

Ages When People Buy Long-Term Care Insurance

I've talked a bit about how there's no "best" age to buy long-term care insurance. And, that it's really a matter of when you can still health qualify.

But, today's consumer caller wanted actual numbers. So, there will undoubtedly be others who are interested.

In 2007, the last year for which data was gathered by the American Association for Long-Term Care Insurance, here's the age of new buyers. The data was based on about 200,000 new insureds.
Under age 35 ... 1%
Age 35-44 ........ 6%
Age 45-54 ........ 26%
Age 55-64 ........ 50%
Age 65-74 ........ 15%
Age 75+ ............ 2%

My personal advice to folks is that your mid-50s is the best time to start the process. As I've seen myself, no one who is 50+ leaves the doctor's office without some presecription in hand. That may not cause you to lose good health discounts (or be ineligible at any cost) but why risk it.

For more information, visit the Association's Consumer Information Center where you'll find a wealth of helpful info.

Friday, December 5, 2008

Long-Term Care Producer Sales Contest Open

This message is for insurance agents and financial professionals who market long-term care insurance policies as well as asset-based products. Each year, the American Association for Long-Term Care Insurance conducts the National LTCi Sales Achievement Awards which recognizes the nation's leading producers.

All entrants are ranked on a national as well as a state-by-state basis. Names of awardees are published in the 2009 edition of the Association's Long-Term Care Insurance Sourcebook.

There are multiple categories and there is no cost to enter. For complete information and our online entry form, click this link now. The final date for entering is January 23, 2009.

The awards are a benefit of Association membership. For more details, visit our website or click on this link now to see the many benefits of belonging.

Thursday, December 4, 2008

What Options Must Insurers Give When Raising Rates

Today's consumer inquiry raises a point that will be of interest to both consumers and those marketing long-term care insurance.

Q: "If an insurer decides it needs to increase rates on an existing class of business (meaning all policies that are in that "class') must they offer consumer alternative options? Or, is this something the insurer has discretion over?"

I thank Dawn Helwig, Principal with Milliman, Inc., and a long-time supporter of the American Association for Long-Term Care Insurance for helping with the following answer.

Effective with the rate stability regulation, all policies have to give policyholders the right to reduce their premium at any time, by reducing their maximum benefit or their daily benefit. So, this isn't just tied in to a rate increase. For policies issued before rate stability, I don't think a carrier has to give that option anytime - even at rate increase time - but most do.

Wednesday, December 3, 2008

Today's Wall Street Journal Article

Today's Wall Street Journal contains an article by M.P. McQueen that looks at the trust established to handle the Conseco policyholders. Kudos to MP for doing a thorough and balanced job.

To see the article, while available, here is the link:
http://online.wsj.com/article/SB122826822305174269.html?mod=googlenews_wsj

There are two things I believe it is vital to keep in mind. It doesn't matter if you are a consumer ... or an insurance professional ... these are important points.

First: The past doesn't equal the future (I'll write another blog on that one day soon).

Second: States have guarentee funds that protect consumers ... similar to the FDIC protects bank depositors. No one writes about these (MP McQueen did ... and kudos to her).

Expect attornies such as Frank Darras to use the media to gain notoriety and clients. The law firm he worked for took out a 2-page ad spread in this past Sunday's LA Times Magazine. These don't come cheap ... and while they may believe they protect and serve consumers ... let's be honest ... they are not "legal aide".

The American Association for Long-Term Care Insurance always believes an educated consumer is the best customer. We welcome healthy and balanced discourse that protects consumers while educating them so they can make good sound decisions.

We'll definitely do our part.

Tuesday, December 2, 2008

Don't Overlook Tax Deductibility of LTC Insurance

Today's call came from an insurance agent who was (yes, still) unfamiliar with the tax deductibility rules pertaining to long-term care insurance. While the American Association for Long-Term Care Insurance does not provide tax advice, our website has very complete information including the new 2009 tax deductible levels for long-term care insurance.

Long-term care insurance is one of the few products that has all of the considerable tax advantages offered by both the Federal government and many states. Few individuals are aware of the rules ... and business owners in particular are not aware that costs for this valuable protection can be 100 percent tax deductible.

Click this link now here to go to the information on the Association's Consumer's website or copy and paste this rather long link into your browser. http://www.aaltci.org/long-term-care-insurance/learning-center/tax-for-business.php

Insurance agents should consider using the Association's most-popular guide to Tax Advantaged Long-Term Care Insurance for Business Owners and Self-Employed Individuals. It spells out all the rules and has the updated 2009 tax deductibility rules. They come in packages of 50.

Click this link now to see the information or copy and then paste this link intio your web browser Address box. http://www.aaltci.org/subpages/resources/marketing_bizowner.html.

Monday, December 1, 2008

This Really Should Be Called Long-Term Home Care

Received a call from a consumer today that's reflective of many questions we've received over the past 10 years; "what if I never go into a nursing home," he asked.

My glib response was, "consider yourself lucky. But that's not a reason not to consider long-term care insurance." I explained that in 2007 (the most recent year for which the American Association for Long-Term Care Insurance gathered data) some 43.0% of long-term care insurance claim benefits went toward home care expenses.

The fact is that most people today ... and most who'll likely need care in the future ... want to receive care in their own home. And, long-term care insurance provides you with the ability to do just that. By the way, I explained, some 32.9% of individual claim benefits in 2007 went for assisted living care. Only 24.1% went for nursing home.

But don't take my word for it ... watch a brief video of Rosemary talking about how their long-term care insurance policy allowed her husband to recover at home. Her words are more powerful than mine could ever be. Click on this link http://www.aaltci.org/claims ... the whole video is 5 or 6 minutes and extremely moving.

A Failure To Plan ... Is A Plan For Failure.