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Thursday, July 02, 2015

Everything You Always Wanted To Know About Long-Term Care Insurance

Everything You Always Wanted To Know About
Long-Term Care Insurance

The policies are getting pricier, harder to find and increasingly difficult to justify as a worthwhile purchase

People used to buy long-term-care insurance because they were scared. Now it is the policies themselves that are keeping buyers awake at night.

The coverage—which pays for some or all of the costs of nursing homes, assisted-living facilities and home health care for people unable to take care of themselves—has been coming under fire. Premiums have been rising, fewer insurers are selling the product, and new research is questioning whether many people even need it.

More than two-thirds of individuals 65 and older will require some kind of long-term care, according to experts. The median annual cost for a private nursing-home room is $91,250, and round-the-clock home care can top $170,000, according to a new study from Genworth Financial, the leading seller of the policies.

Yet sales of policies have been on a decline as consumers have reacted to higher prices for fewer benefits, which have left waves of upset policyholders, many who say they bought on the assumption their premiums would stay level over the years.

Many insurers are charging more and trimming potential payouts on new versions of the coverage, while winning regulatory approval for price increases on policies that in some instances were sold more than three decades ago.

Patrick Lemarchand, a 66-year-old retired senior marketing executive who lives in Greenwich, Conn., saw a 40% increase that boosted his 2013 premium to $3,740 for a Genworth policy he bought in 2004. His wife’s premium also increased 40%.

“I am lucky in that I am not at poverty level,” Mr. Lemarchand says. His biggest fear is that more price increases are ahead.

“The lack of control [over cost is] the most devastating feeling,” Mr. Lemarchand says.

A Genworth spokesman says that the Connecticut insurance regulator reviewed and approved “a 40% rate increase on certain long-term-care insurance policy forms” after a public comment period.


About eight million people have some form of long-term-care coverage, according to Limra, a research firm funded by the insurance industry. Last year, an estimated 131,000 long-term-care policies were sold, down 24% from 2013. Sales peaked at about 750,000 a year in the early 2000s. Only about a dozen companies remain in the market, compared with about 100 just over a decade ago.

Currently, a typical basic policy provides $164,000 of potential proceeds, according to the American Association for Long-Term Care Insurance, a trade group. Premiums for a 60-year-old couple buying such policies for both of them range from a combined $1,685 a year to $2,813, depending on the insurer.

Adding inflation protection of 3% a year—which would boost the benefit to $365,000 per person at age 85—would raise the cost to between $3,549 and $4,746 a year for the couple.

Meanwhile, a new trend is giving consumers more options: Many life insurers now are selling “hybrid” products, making long-term-care benefits available with life insurance and retirement-income annuities.

Here is a closer look at what recent developments mean for prospective purchasers.

Rates Are Rising

In the 1980s and ’90s, long-term-care insurance seemed a perfect product for aging baby boomers less afraid of dying prematurely than outliving their savings and ending up on public assistance in poor-quality nursing homes.

But in launching the business line, which originally offered unlimited lifetime benefits, many insurers underestimated factors such as the number of claims, how long claimants would receive benefits and rising health-care costs, according to industry consultants and executives.

The ultralow interest rates of the past few years have made matters worse. A substantial chunk of insurers’ profit had been expected to come from investment income on premiums paid over the years before policyholders filed claims, but those projected earnings have fallen far short. Over the years, insurers have won regulatory approval for rate increases ranging from the single digits to 45% or even more.

Shares of Genworth, which leads the market with nearly a quarter of annual long-term-care insurance sales to individuals, slid by about half from November, amid $839 million in charges by the company to boost claims and other reserves for long-term-care policies.

The stock-price slide highlights the many problems that insurers have had with the business line, and why so many no longer sell policies. Five of the 10 largest sellers, including MetLife and Prudential Financial, have sharply reduced or discontinued sales entirely since 2010, according to analysts.

Genworth shares jumped this past week as the company reported first-quarter results ahead of expectations and disclosed plans to sell some or all of its life-insurance and annuity operations as part of a strategic review of its operations. Chief Executive Thomas McInerney said the company is sticking with its long-term-care business, though it is “challenging and complicated.”

In calls with analysts and investors earlier this year, Genworth said it is having success persuading state insurance departments to approve rate increases—many in the double digits—on older long-term-care policies. It also has assured shareholders that new policies will turn a respectable profit because they offer fewer benefits than the older versions and have been priced to assume persistently low interest rates, among other conservative assumptions.

The company has said in those calls that it works with regulators to come up with ways to minimize the pain to the policyholders, such as spreading increases over a number of years and providing options for trading back some of their original benefits—future inflation adjustments, say—to hold the premium level.

“The odds of significant rate increases on what we’re selling today are greatly reduced,” Mr. McInerney said, but he isn’t ruling out potential price increases for unexpected developments.

All this is hardly what existing and prospective customers want to hear.

Who Needs It?

In November, Boston College’s Center for Retirement Research published a study that further complicates the buying decision. It concluded that previous research by other academics understates the risk of going into nursing-home care—but overstates the average length, and thus cost, of those stays.

The researchers also found that Medicare, the government health-insurance program for Americans 65 and older, has paid as much as a quarter of nursing-home costs in recent years—a finding that lessens the value of long-term-care insurance for many Americans.

Previously, experts have minimized Medicare’s role in paying for long-term care, with the focus on Medicaid, the state and federal health-care program for low-income people.

“What the research shows is that long-term-care costs are more common and less catastrophic than previously thought,” says Anthony Webb, a senior research economist at the center and a co-author of the paper.

Before the Boston College study, leading academic research put the lifetime risk of needing nursing-home care at 27% for men 65 or older and 44% for such women. The new study puts the risk at 44% and 58%, respectively. Yet the study concluded that nursing-home stays are shorter than previously believed: 10 months for the typical single man and 16 months for a woman, down from 1.3 years and two years, respectively.

The center’s researchers also found that nearly half of men’s nursing-home stays, and 36% of women’s, don’t exceed three months—within Medicare’s 100-day maximum for stays that follow hospitalizations.

All this makes the decision to buy a long-term-care policy trickier, financial advisers say.

People with low incomes and few financial resources have no real option but to rely on Medicaid. At the other end of the wealth spectrum, people can pay for extended care out of their savings.

The dilemma is hardest for the large number of people in the middle. Many do have homes with equity that can be tapped in a variety of ways, advisers say.

If staying at home is the goal, remember that round-the-clock home-based professional care can be costlier than a high-quality assisted-living facility or nursing home. A major factor in a purchase decision is whether you will have family or friends to provide at least some unpaid help.

Surveys show many people are counting on such free help, but studies have documented a shrinking number of family caregivers, thanks to smaller families and other demographic shifts.

For the majority of people, buying a long-term-care policy “is all about care at home,” says Jesse Slome, executive director of the American Association for Long-Term Care Insurance. In 2012, the latest year for which data are available, roughly half of newly opened claims were for home-based care, according to the trade group. Nursing homes represented 31% of such new claims, and assisted-living facilities represented 19%.

People aiming to stay in their homes also can take out a reverse mortgage to help cover costs. In these transactions, homeowners borrow against a home’s equity and continue to live in the house. The loan—and any accumulated interest—is paid off when the house is sold, or the borrowers move out or die.

Fees can run high for reverse mortgages, and a trusted adviser is essential when going this route.

Other choices
A frequent criticism of the high cost of long-term-care policies is that they must be used, or the premiums are for naught. Insurance agents say this is often true of insurance—and that few homeowners regret not making a claim because their house didn’t burn down.

Such concerns help explain the popularity of hybrid or “combo” policies, which combine long-term-care benefits with either life insurance or retirement-income annuities—tax-advantaged savings vehicles that often provide a lifetime stream of income.

“Consumers are opting for these types of products rather than making the tougher decision about purchasing long-term-care insurance,” says Brian T. Horn, a financial adviser at Somerset Wealth Strategies, an advisory firm in Portland, Ore.

Costs vary, and the products tend to be complicated, contain restrictions and have potential drawbacks, so they need to be bought through a trusted adviser. Most hybrid policies pay for care at home or in a facility, but benefits can vary depending upon the contract.

Insurers sold 100,000 combination life-insurance/long-term-care policies last year, Limra estimates, up from 16,000 in 2008. One popular type is known as “LTC acceleration,” in which the policy provides an advance payment for long-term-care needs, typically close to the full death benefit.

Another option is known as “LTC extension of benefits/linked benefits,” under which the long-term-care benefit can be greater than the death benefit.

With annuities, the amount of the future long-term-care benefit can grow over time based on the contract’s particular terms.

Still, annuities and universal-life policies have potential drawbacks that need to be understood before purchase. Consumers should be aware that universal-life policies often are promoted by agents on the basis that interest will build up inside the policy in a tax-advantaged “cash value” account, to become ample enough to pay some, or all, of the annual insurance charges as the policyholder ages.

If the buildup isn’t so robust over time, the owner may have to increase his or her payments into the policy to keep it in force at the original face-value amount.

With “indexed” annuities, which are often used in combination with long-term-care benefits, the insurer pays interest tied to a stock-market benchmark such as the S And P 500. Insurers typically cap the percentage of the index’s gain they will pay annually, and other limitations also can apply.

Anyone who buys the product expecting great returns could be sorely disappointed. That said, insurers guarantee that the annuity’s value doesn’t go down when the index does.

Why People Don’t Buy Long-Term-Care Insurance

Study offers new insights on what keeps people from buying policies—and what insurers can do about it

When it comes to long-term care, two facts stand out. First, an estimated 70% of people will need such care, which will be costly. And second, most of them refuse to buy insurance to cover it.

The question is, why?

Part of the explanation, no doubt, is that long-term-care insurance is expensive. Some people also may be assuming, incorrectly, that they will qualify for government assistance to help them pay for nursing-home care. Rules are in place to disqualify many who won’t meet the strict conditions required.

But our research suggests that a deeper problem may be that consumers are looking at long-term-care policies in the wrong way; and, just as important, that insurers may be missing opportunities to tweak their products in ways that might address and overcome some of the root causes of those 

For instance, in a study we conducted recently, we found that many people regard long-term-care insurance as having no real value if ultimately the payouts aren’t needed. That is, instead of looking at long-term-care insurance primarily as financial protection, many people think of it as an investment—and a bad one at that. They see the premiums as money that would be wasted if the policy owner ultimately doesn’t need long-term care. They don’t think about the catastrophic losses a policy could help them avoid.

Moreover, our research suggests that some consumers’ rejection of long-term-care insurance is based on what psychologists call “narrow framing,” or people’s tendency to exclude key factors when making decisions. Narrow framing has been found to be common when individuals face complicated decisions—and shopping for long-term-care insurance is certainly one of those instances.


In our study, we looked at a subset of 1,900 respondents in the Health and Retirement Study, a nationally representative survey of Americans over the age of 50. Based on their answers, we classified respondents according to how likely they were to be narrow framers. We then looked at whether narrow framers had different amounts of long-term-care insurance.

We found that narrow framers were much less likely to have long-term-care insurance, compared with the average person. Specifically, narrow framers were only half as likely to buy such insurance—a gap that persists regardless of respondents’ health status, risk tolerance, marital status and wealth.

Wireless Camera Finder

While our findings suggest that long-term-care-insurance providers are up against some deep-seated consumer attitudes, we believe that insurers could better position their products in the marketplace by providing more information to consumers regarding the high probability of needing care, and the high costs of such care.

Insurers also could focus more marketing toward adult children whose parents will likely require nursing-home care, since the children are often aware of (and concerned about) the costs and benefits that insurance can provide.

Another approach would be for insurers to emphasize policies that provide benefits in addition to protection for long-term-care costs. For example, more policies could include retirement income payouts or life insurance—as some insurers already do offer.


While adding such features does make long-term-care policies more expensive, they help alleviate concerns about policies being worthless if long-term care were not needed. In fact, many life-insurance companies already take this tack by including a savings component that pays out should the policy owner outlive the policy.

Your questions and comments are greatly appreciated.

Monty Henry, Owner


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