In the Middle of the Credit Down Grade: Long Term Care

There’s an excellent article on the web site “Helping You Care” (which is a quasi non-profit organization based in Florida) that points to the fact that within in the S&P downgrade was a strong reference to the issues around long term care.

The article notes, “In all the political finger pointing and hot rhetoric, few have noticed that in its Rationale for its current rating action, S&P specifically cites its previous report, “Global Aging 2011: In The U.S., Going Gray Will Likely Cost Even More Green, Now,” issued on June 21, 2011. In that report, S&P warned that a “looming U.S. fiscal bill is growing as the population gets older,” and that “the challenges facing the U.S. are more severe than those facing many of the other major industrial societies … because of its rapidly escalating health care costs.”

S&P’s June, 2011 report introduced the subject by stating:

“As the baby boomers start to reach retirement age, the percentage of the U.S. … population eligible for government support will begin to mount. Babies born in 1946 turn 65 this year and will become eligible for Medicare. They will also be entitled to start collecting full Social Security retirement benefits next year, under the current system. The U.S. government, however, is not currently collecting enough money to pay its Medicare, Social Security, and other long-term bills.”

In that June report, S&P pointed out, “In 2010, there were 26 retirees for every 100 members of the U.S. labor force. By 2050, however, we expect that there will be 50 retirees per 100 workers. In other words, the U.S. will go from four workers to support every retiree to only two.” [End of Quote]

The June S&P report, along with comments today from leaders in Washington, point to the fact that the future of long term health care as covered by Medicare and Medicaid are far from set in stone. In many cases, this were already a myth since they required dilution of retirement and other assets before being able to access.

As the debt ceiling discussion becomes more and more about health and long term care costs, those planning for their retirement will want to take every measure to protect themselves for the future, and that includes considering long term care insurance.

You can see the detailed article here.

Long Term Care Takes Toll on Employees

A report from Genworth Financial finds that providing long term care, without the benefit of long term care insurance, can take a toll on employees.

The report called “Beyond Dollars”, finds that the average care provider is in their early 50’s (peak earning years) and is taking care of an immediate family member for a period of about three years.

Nearly half reported a significant increase stress at home. Part of this stress may be from having to dip into family savings or retirement to help pay for care related expenses. Contributions to savings accounts were reduced by an average of 73%, and retirement contributions were reduced by an average of 80%.

Employees also reported having repeated absences from work (33%) or working less hours (29%) to meet care commitments.

Long term care insurance reduces these stresses by providing the funds to support various types of care, including at home and/or day care (including trips to and from doctors).

You see the full report here.

New Data on Long Term Care Costs

A new study from John Hancock Insurance places the average cost of nursing home care in the U.S. at $85,775 annually for a private room and $75,555 for a semi-private room.

The cost is $39,240 annually on average for an assisted living facility. And the average cost of home care is approximately $20 per hour.

The study finds that nursing home care costs nationally have risen an average 3.2 – 3.5 percent per year over the last nine years. The average cost for a home health aide has risen 1.3 percent per year.

John Hancock surveyed more than 11,000 providers in cities across the country. The study then calculated a 9-year average using data from past reports.

About 40% of the people needing long term care are under the age of 65.

You can see more about the study here.

CLASS Act Myth #4: Coverage Will be the Same as Private Long-Term Care Insurance

Remember when you were young and you learned what happens when people assume things? You make an a_ _ out of you and me. Well, if people assume CLASS Act coverage is the same as private long-term care insurance, making an a_ _ of themselves could be the least of their problems. Coverage with CLASS is much different than private insurance and it’s in everybody’s interest to understand those differences.

Regulation differences
Private insurance carriers are required to withhold significant reserves based on the amount of insurance sold. Those reserves must be invested and set aside to pay future claims to protect policyholders. Another difference is the process of increasing premiums on existing policyholders in the event it becomes necessary. For insurance companies to increase premiums, they must receive approval separately from each state Department of Insurance individually and premiums must be increased the same for every person that ever purchased that policy series regardless of age, how long they owned the policy or health.

With CLASS Act on the other hand, the power to increase premiums rests completely with the Department of Health and Human Services and reserves are not held to pay claims. Premiums paid into CLASS are credited to a trust account and accrue interest, but the funds are used to pay current bills. In effect, the government holds IOU’s from itself to pay future claims.

The trigger to collect benefits under CLASS Act can be changed
There is more than one way to increase premiums to policyholders. Only the Federal Government allows itself to change the rules of the contract after customers purchase the policy. If you read the CLASS Act where the definition of how you become benefit eligible, it says that “an individual must either require help to perform either 2 or 3 Activities of Daily Living or have a cognitive impairment”. Private insurance requires people to require help with 2 ADL’s. There is no opportunity to change the trigger to 3 ADL’s which would obviously limit the number and size of claims paid.

Five year waiting period
Private insurance is purchased with a waiting period that can be between zero and 365 days depending on the carrier. CLASS Act does not have an elimination period but requires you to pay premiums for 5 years before becoming benefit eligible and you must work for three of those years. What happens if you have an accident within a couple of purchasing coverage?

Flexibility
Planning for long-term care is not a one-size fits all proposition and that’s what CLASS Act offers. Private insurance coverage has a lot of flexibility and options to tailor coverage that fits each persons specific circumstances. And according to current estimates, private coverage will be less expensive for the 85% of people healthy enough to be medically underwritten when they apply at a young age through an employer sponsored program.

Education for employees
It can be argued that education is the most important benefit when companies implement long-term care insurance benefits. People tend to tune out when the discussion of long-term care arises. Some think it’s only for seniors and others choose to ignore the topic because of more pressing financial obligations. CLASS Act limits the amount of money that can be spent on administrative, marketing and administrative costs. Not providing education limits participation and ultimately increases adverse selection as less healthy people will be more inclined to participate.

CLASS Act Myth #3: Government Provided Coverage is Less Likely to Have Premium Increases

The U.S.A. seal of approval is as good as the Good Housekeeping seal of approval for many citizens. After all, the Federal government has never reduced Social Security benefits or Medicare and the country has not shown the political will to curb spending on these politically popular programs. Everything has limits though and if the Federal deficit is not approaching its limit, it be getting close.

Besides that, CLASS Act is fundamentally different from Social Security and Medicare because most every American participates in both these programs. CLASS Act on the other hand is voluntary; each person, young, old, healthy and sick will make an individual decision to participate or not. And that’s the problem. As discussed previously, a voluntary program violates the fundamental underpinnings of all insurance; spreading a risk over an entire population.

According the Allen Schmitz, FSA, MAAA from Milliman, and independent and highly respected actuarial firm, CLASS Act premiums are actually more likely to increase than private insurance. He says “there is probably greater risk that CLASS Act will need rate increases than the private market”. There are many reasons for this and several have been discussed in previous posts. Adverse selection, premium subsidies for certain groups, limitations on increasing premiums for certain groups.

Another issue understood by few people without an insurance or actuarial background is the methodology of determining the rates that will be sustainable over a 75 year window. By statute CLASS must set rates to ensure financial viability for 75 years, and after 10 years the Department of Health and Human Services will review pricing to ensure the program enough premiums collected to cover benefits projected for the next ___ years.

The problem with using a 75 year window is that it does not take the “tail” of long-term care into consideration. What I mean by that is at the end of 75 years you have many healthy people who have contributed premiums for 20, 30 and even 50 years. Well when they figure solvency at the end of 75 years, the claims that will come due for all those people who have paid in to the program are not considered.

Empower helps employers of all sizes implement long-term care insurance benefit programs in the workplace and conducts workshops & educational classes concerning LTC and the CLASS Act for employers and employees.  If you would like to know more about the CLASS Act and how it might impact your company call us.

We also provide  Resources, training, and assistance to brokers looking to educate and help their clients with Long Term Care and understanding the CLASS Act.

For help or more information contact Doug Ross at 800-483-1115, send an email todross@empowerltci.com, or visit our site at www.empowerltci.com.

CLASS Act Myth #2: Your Premiums Will be Held in a Lock Box to Pay Benefits

Despite our current deficit and the fiscal condition of government programs like Social Security and Medicare, many people believe a Federal program has to be better than private insurance.

I can certainly understand that when you look recent events like government bail outs of banks, automobile manufacturers and homeowners under water with their mortgages. But at some point, bills come due, and the combined effect of America aging and the burden of our current entitlements are the reasons the CLASS Act is to be funded completely by participant premiums.

When you hear your premiums go in to a lock box, do you feel secure? Can you visualize a large box made out of heavy steel with a giant lock? Unfortunately this isn’t how it works. The Federal government uses trust fund accounting. The money coming in from premiums is included with all other revenue collected and used to pay current obligations. At the same time, those premiums are credited to a trust fund that will accumulate interest. The problem is, even the Federal government can’t spend the same money twice.

Anything accumulated in the trust fund becomes an IOU from the general budget and we all know what condition that is in. According to the bi-partisan fiscally conservative Concord Coalition, Congress could have moved the CLASS program entirely out of the budget and invested the premiums in private securities that would have been available to pay claims, but genuinely funding the program would have eliminated money Congress needs to pay for healthcare reform.

In my next blog we look at Myth #3 – CLASS Act premiums are less likely to increase in the future than private insurance.

Empower helps employers of all sizes implement long-term care insurance benefit programs in the workplace and conducts workshops & educational classes concerning LTC and the CLASS Act for employers and employees.  If you would like to know more about the CLASS Act and how it might impact your company call us.

We also provide  Resources, training, and assistance to brokers looking to educate or help their clients with and Long Term Care and understanding the CLASS Act.

For help or more information contact Doug Ross at 800-483-1115, send an email todross@empowerltci.com, or visit our site at www.empowerltci.com.

CLASS Act Myth #1: CLASS Benefits Solve the Long-Term Care Problem

Without crossing into the realm of political opinion of big government vs. small government and the correctness of our entitlement programs, the fact is many Americans believe the Federal government programs come with an official seal of approval. In other words, many people will participate in CLASS Act without fully understanding the issue or the difference between private and the CLASS Act. If it’s run by the government it must be better, right?

Well sometimes reality isn’t pleasant, but CLASS won’t solve the long-term care problem for most people. First, CLASS Act will not enroll its first participant until around 2013, and once enrolled, five years of premiums must be paid in before benefits can be collected. That means anyone older than 57 cannot be eligible to receive benefits until they reach age 65. Considering that 40% of people currently using long-term care services are under the age of 64, CLASS will be too late for you?

CLASS Act will pay a cash benefit of no less than $50 per day based on the number of ADL’s you cannot perform without assistance. That means the minimum annual benefit is pegged at $18,250 per year. Have you looked at the cost of care lately? It varies by the type of care you need or desire and there are large differences depending on the region of the country you live in.

In 2008, the average cost of home care throughout the United States was $20 an hour according to the Metlife Market Survey of Home Care Costs, but if you live in the northeast or other high cost states, the cost is as high as $28 per hour. And if you are in a high cost state like MA nursing homes and assisted living facilities average over $100,000 and $50,000 respectively.

Without education many Americans participating in CLASS will not understand the true nature of the problem and think they are covered with the nominal benefit they’ll be eligible for.

Empower helps employers of all sizes implement long-term care insurance benefit programs in the workplace and conducts workshops & educational classes concerning LTC and the CLASS Act for employers and employees.  If you would like to know more about the CLASS Act and how it might impact your company call us.

We also provide  Resources, training, and assistance to brokers looking to educate or help their clients with and Long Term Care and understanding the CLASS Act.

For help or more information contact Doug Ross at 800-483-1115, send an email to dross@empowerltci.com, or visit our site at www.empowerltci.com.