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LONG TERM CARE (is it worth considering)

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Posted 4/30/2012 4:36 AM (GMT 0)
I have posted in prior posts that I had Radical Robotic Prostatectomy surgery in 2009, and am getting ready to have Hormone and Radiation (due to rising PSA, currently at 0.16). Hopefully, the treatments will be successful, and that will be the end of it. (you can look at my prior posts for details, if you are interested).

My question for this new thread is: for discussion sake, if things don't go well, and i end up with Cancer spread to the bones, or Lymph, or elsewhere, is Long Term Care Insurance something that could be useful?

I realize that i have months and months to go before i would be in dire conditions. My urgency in my post tonight, is that my Company is terminating enrollment for "Long Term Care Insurance" this month. I can sign up now, and pay, and hopefully never need it. (costs range from 40/month --> up to 120/month, based on my age (56). The difference between 40/month, and 120/month is if i want 115.00, 175.00, 230.00, or 290.00 Daily Maximum Benefit, and if I want a "2 year Plan" or the "5 year plan".

So, what am i really asking in this thread? Does/can advanced Prostate Cancer put someone in a condition where they may need (1) Nursing Room home and board, (2) Alternative Care Facility r&b, (3) Home Health Agency Services, (4) Adult Day Care, or other related (Long Term Care).

I *do*, yes I *do* realize that i am not there now, or yet. However, i have to decide this month, if i want enroll.

If i say "no" , then i will be unable to enroll in the future (or at least not through my employer). The Long Term Care would be via John Hancock Insurance.

Thanks for your thoughts.
Posted 4/30/2012 5:24 AM (GMT 0)
I think you need to look at your total health and not just the PC. I have a long term care policy that for years because of my concerns about having stroke and/or other heart related illnesses. Also my family has a history of other cancers so I like to have the insurance around.

but that is just me.
Posted 4/30/2012 11:28 AM (GMT 0)
I asked this very question of my life insurance agent and what he told me made sense to me. If and when you get to the point of needing these services, it really is not going to be required 'long term'.
Posted 4/30/2012 11:47 AM (GMT 0)
I have been lookjng into LTC for a while. It's a bit of a gamble, but since I had a recurrence of PCa after surgery I stopped considering it for myself.
Posted 4/30/2012 12:24 PM (GMT 0)
Just before I retired my wife and I decided that we would get long term care insuracne. We have only 1 son and did not want to give him that burdon if that time came. At the time I did not have a Dx of prostate cancer. My company got us good rates and we figure it gave us a bit of peace of mind.

Just our thought. This is a very personal thing and ever situation is different. I would not have enrolled in the program just because of PCa.

Cajun Jeff
Posted 4/30/2012 12:33 PM (GMT 0)

The bogleheads.org forum has had numerous threads on LTC.  Here is a link to a recent one:  http://www.bogleheads.org/forum/viewtopic.php?f=2&t=92448&newpost=1333383.  Use their search function to see the many other threads.  I looked at it many years ago and found it to be very expensive with a lot of catches with regard to admission, amount of coverage and duration of coverage.  On the other hand, a decent nursing home in my area starts at $5,000/mo.  From the linked article above, it appears that many companies have quit the business.  What happened to the folks that paid in for many years?

Posted 4/30/2012 1:00 PM (GMT 0)
ABSOLUTELY GET IT.

There is no way you would be accepted if you applied other than thru a group plan, due to your situation.

about 10 years ago, we bought a LTC policy. We pay about $860 per year and it is a joint policy. This means they willpay for my wife and/or myself, up to $3000 per month total for up to 3 years. I think there might be an inflation rider, so they may pay more.

My analysis was this: what threats are there in terms of our financial well being? The only real possibility is medical. We have decent health insurance, but a long nursing home stint could wreck us financially. Hence, the LTC insurance.

Obviously other things could happen and you can't anticipate everything, but LTC helps. (It also covers hospice).

Mel

Posted 4/30/2012 1:43 PM (GMT 0)
The question, in my opinion, isn't judging the value of LTC in general. The writer of this thread was asking in regards to LTC and PC. In that context, I would think the answer would be "no". There are always exceptions of course, but generally, even with advanced PC, it would not be the norm to need LTC as the result of the cancer's progression. More typically, at some point, near the end of the person's life, hospice would be required, either outpatient or as they often do now, at home hospice. Most, if not all, health insuranes will pay for hospice care. I know that Medicare does as well.

I wouldn't base a decision for LTC based on having PC, and what happens if it gets worse. There are are, however, plenty of good sound reasons to have LTC in general, as nursing home and even home care, can be very expensive. But you have to really read closely, any LTC policy, because they can be laced with limitations, stipulations, time limits, etc. In that sense, you have to look at it as if it were an "Extended Warranty" policy - sometimes they are a good thing, others - not.

david in sc
Posted 4/30/2012 1:48 PM (GMT 0)
As a financial planner, I discuss Long Term Care with every client as an element of their long-term risk management. If you are currently being treated for PCa I know of no companies that will consider you for coverage, so do look into the employer sponsored plan. Be advised that many employer sponsored plans require medical underwriting.

As to the consolidation in the insurance industry, many notable companies have either ceased writing LTC or raised premiums to make it nearly unaffordable. Many companies have simply long underpriced coverage and this is exacerbated by the low interest rates and increased longevity that makes more people more likely to go on claim. Thus, it is currently not profitable. As for policyholders of companies that have stopped writing new business, they will continue their policies as if nothing happened. The current carrier will either continue to serve them or they will sell the block of business to another company. In either case the original contract will continue in force as originally written with no change in the benefits, however the premiums can be increased.

A caveat for all, Medicare does not cover nursing home costs or the costs of hiring people to provide care in one's home. Medicare only provides a limited 20 day nursing home coverage under certain circumstance following a hospitalization. Medicaid will only cover nursing home confinement for people of very modest means. They require assignment of income benefits such as pension and social security and evidence that essentially all assets except for the home have been consumed before providing benefits. Then, after death, the state will claim against whatever property is left and the claim is in front of the heirs. Relying on Medicaid is not prudent planning.
Posted 4/30/2012 2:07 PM (GMT 0)
JNF,

Your last paragraph is a good summary of what happened to a cousin who had a stroke, and required constant care. It was very ugly, and a brutal example of where a lot of people wind up if they live long enough.

I purchased a policy, but as David mentions, it had nothing to do with PCa. For me, it was based on the extreme amount of time I spent on the road, and the combination of coverages I had at the time, none of which would have covered this sort of care for any extended term. Given what I know now about PCa, I still would fear a partial or complete paralysis from a car accident more than the impact of PCa.

 

Posted 4/30/2012 2:24 PM (GMT 0)
Thanks for the replies. I appreciate the input.
Posted 4/30/2012 3:27 PM (GMT 0)
David et, al:

Yes, my answer was more generalized. However, in my personal case, with possibly a virulent form of PC, it is also relevent on that issue alone.

MY LTC policy also covers hospice, but as you said I guess Medicare also covers it.

When I did my analysis 10 or so years ago (well before PC), I just looked at my coverages/safety net and asked the question, "is there any real major hole in my safety net?" I actually dropped a term life policy and bought the LTC policy. I felt we were in good enough financial shape so that my demise would not result in a destitute situation for my wife. That is still true (and I do have a life insurance policy at work provided by my employer good for 2-3 times my annual salary -- but I don't even consider that since I hope to be around to retire when I choose).

Also, my LTC is with Genworth. Their history was one of steady premiums and they did indicated that my premium will not rise unless they raised it for everyone. That has been the case. I've paid in $850 (approx.) per year. However, after reading some recent articles, I have a hunch my next premium will be significantly higher. I'll know in June. I do intend to keep the policy. Although I am unlikely to need it, a nursing home stay can bankrupt one.

When I took it out, it would cover $3000/month. That seemed like plenty at the time. I suspect these days a stay at a quality place might be triple that amount.

Mel

Posted 4/30/2012 3:43 PM (GMT 0)
I would like to provide some input on this from another perspective.

My wife and I have had an LTC policy for years. As most of you know both my wife and I are dealing with cancer. Lynn's has become debilitating. The policy provides for In-Home as well as facility care.

A lot of the brothers here are married, so what about your spouses. If the wife becomes disabled and needs care, are you going to be up for it from an energy standpoint. Our LTC policy is paying us a flat rate monthly for Lynn's in-home care. At present I provide that care, but the funds are there if I need to bring in professionals. For instance, Lynn needs blood tests every 2 weeks. She is not up for the travel to the hospital, so we have a private nurse that comes in and draws the blood for the tests.

What about a day off for you once in a while from the care-giver activities.

LTC provides for this, it is called respite care. I can bring in professionals or family members to stay with my wife and the funds are there to take care of it. Without this coverage I may not be able to make the trips to NIH for the clinical trial, trips to GFMPH and just generally days off to take care of myself.

There is much more involved in making this decision than just whether of not you will need it because of PCa. And if PCa does bring the need for care at home, this insurance provides for the mental health breaks your spouse will need while caring for you.

Just another look at this from my own experiences.

FWIW,

Sonny
Posted 4/30/2012 5:27 PM (GMT 0)
The irony of my situation is that I was getting my personal health house in order, to apply for LTC, when I discovered my PSA was over 50.

So, here is my thought-question: I am still thinking of getting a LTC policy for my wife. There is a history of Alzheimer's in her family. I assume no one will underwrite me, even if they exclude PCa?? I guess the next best personal option is to set aside a portion of my retirement savings for LTC, just in case.

Posted 4/30/2012 6:15 PM (GMT 0)
I can't say what the disqualifying factors might be, as I got mine as part of a group (not employer) "blanket acceptance" window.

Interesting thought, though. If I had been required to get a PSA test as part of an application, I might have known about my PCa 5 years sooner.

I have a different case from most here, being single, no ex, no kids. I'll have to have something that covers paying someone to take care of me.

Posted 4/30/2012 6:23 PM (GMT 0)
To be clear, a PSA was not required, I had not got that far in the process .. I was just getting a routine physical in preparation, plus I needed some blood work results for my work insurance ... thinking I would get some decent results and move on to the next step. Surprise!
Posted 4/30/2012 9:28 PM (GMT 0)
On the form that i have filled out, the "exclusion" list includes "Metastatic Cancer" but does not just list Prostate, Breast, or other specific cancers. I am assuming that I can qualify, until such time as they turn me down. There are many other exclusions (AIDS, Alzheimers, Dementia, Cystic Fibrosis, Muscular Dystrophy, and many others, but not Prostate Cancer).
Posted 4/30/2012 9:35 PM (GMT 0)
You would have to be very careful there. Ask your uro how he would respond if asked based on current data (you do have to allow the ins. co. to verify information if they choose to do so). My uro considers me to have metastatic cancer, because my PSA is now over 0.2.

 

Posted 4/30/2012 10:17 PM (GMT 0)
Bottom line is if you want the LTC, file for it. The worst that can happen is to be turned down. If you don't apply you will never know.

Sonny
Posted 4/30/2012 10:30 PM (GMT 0)
That is the position that i am taking. I filed today. My surgeon/urologist, and my oncology/radiation doctor, both advised me that my 0.16 is not yet considered Recurrence, and the Radiation that I will be receiving is not officially considered "SRT" (since it is below 0.2, or some look for 0.3, or even 0.4). They consider my next treatment as "Adjunct Treatment". But you are correct, the Ins Company can definitely choose to say "no" if they want to.
Posted 5/8/2012 1:20 PM (GMT 0)
Pat:

As I said in my previous response, we did get a joint policy.

I wonder if our rates will go up -- the rates have not risen since we bought the policy about 10 years ago.

Mel

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