Long Term Care Insurance (LTCI): Face To Face For The Best Policy

Many ask, but few are serious
"Oh, well, I really didn't want an agent to come out here," says the voice on the phone. "I thought you would just send me some stuff in the mail."

That is a typical response from people who have sent LTCi response cards to our company. However, there is a real, common sense reason for sitting down with an agent to talk about LTCi especially if you can find one who is actually a CLTC (Certified Long Term Care). All insurance is complex–LTCi is especially so.

Worried about scams? Face to face is best
While a person can hand you a scam anywhere, you are much safer when you see him face to face, get his name, license number and the name of a company you can call if you have questions about the legitimacy of the agent. Usually, however, it's simply much easier to say "no" over the phone, or just avoid sending the application in when you have done it through the mail. The truth is those who want quotes over the phone or who want to "get information through the mail" are more often just looking for some sort of excuse not to purchase LTCi.

What an agent will do

Designing a policy that fits your needs is a multi-step process that involves educating you along with determining your needs. A good agent understands the process of providing the coverage you need and will not enter your home and immediately begin filling out an application. Instead, he/she will engage in conversation–often about your family, your previous work history, general information about your finances, and discussion about your health and major medical insurance coverage.

Most agents are trained to share information very informally, so you don't even realize you are telling them things they need to know in order to decide if LTCi is right for you. If it seems like the agent is "prying," remember, he is required ask for personal information. Surely you would rather give such information to a person you can see and even call later if you have questions.

Needs analysis: finding out if you qualify

Two of the most critical areas of discussion will be about your health and your finances. The agent will be looking for medicare and medicare supplement insurance if you are over 65, or for major medical–either private or from your employer–if you are still working or were able to keep your employer's health insurance when you retired. The one thing the agent does NOT want to hear is that you are on Medicaid, the government program for those with a severely low income. If you are on Medicaid, you are not eligible for any type of LTCi because it is considered double coverage. Medicaid will pay your nursing home bill should you ever need extended care.

Since LTCi is medically underwritten, the agent will ask you about your health. It is the agent's responsibility to help you avoid any unnecessary inconvenience or doctor's reports that would just result in a rejection. If you already have crippling diseases, major illnesses or extreme obesity, you will not qualify. The same goes for cognitive impairment such as dementia and Alzheimer's disease.

Finding out if you need it

Once establishing that you may qualify based on your health (remember, the company will still see a doctor's report in most cases), the agent will ask you about your home and family. Do you have children who would be able and willing to participate in at least part of your care, assuming they outlive you? If you have a lot of stairs in your home, have you made plans to move in with someone or to go to an assisted living facility? Is your spouse already deceased, leaving you to fend for yourself if you need physical help? Are you a disabled veteran who would be on a priority list for a VA nursing home if you should need it. Knowing your precise situation will help the agent to design a plan for you.

In addition to understanding your family situation, the agent will ask you about your assets. One of my recent contacts is a millionaire thanks to a workman's comp settlement. He worked on scaffolding many stories above a concrete parking area. One of the scaffold boards broke just as he was crossing it with a heavy load. He plunged to the street ,breaking nearly every bone in his body except, incredibly, his back. An enormous settlement pays him for the rest of his life and includes care in a nursing home when he can no longer get around his home with his wheelchair, walker, and other equipment. The man has enough money to buy the nursing home. He does not need LTCi insurance.

While some people are wealthy enough that they don't need LTCi, others, while not necessarily poor, actually have very little to protect. If you live in a mobile home on a rented lot, have no savings or investments, and are living on little more than your social security check, you will probably qualify for Medicaid if you ever do need nursing home care. However, even if your assets do not warrant LTCi, your personal preferences might. You may simply want the option of home care or assisted living. Or you may want to protect your dignity and spare your family the hardship of taking care of you. You will not have such choices if you are dependent on Medicaid.

Completing the App and telling you what to expect

Once your agent has determined that you are medically qualified and that you have a need for LTCi, he/she will fill out the application for you. He will design a basic benefit that you are comfortable with and will discuss available riders. Don't hesitate to ask questions, including whether the agent will be available to help you with the policy in the future–or if you will be at the mercy of the 800 number series once the company has your money.

Once the agent has completed the application, you will need to write a check for the first month's premium. This check will start the application process, pay for doctor's reports, and issue the policy if you are accepted. NO agent can guarantee that you will be accepted as the underwriters do not share the doctor's reports. However, if you are rejected, the check you write will be sent back to you in full.

Some companies require a face to face assessment. If so, the agent will tell you, and might even make the appointment from your home. You can decide what time of day you want the assessment and you have the right to know what the assessing agency will do. Generally, the purpose of such a visit is to make sure you do not already have some crippling condition or cognitive impairment.

Once you are accepted

The best companies will not send your policy to you in the mail. Instead, the agent will visit you again and will go over your policy, showing you what to do in the event that you should need to start using it. This visit is the perfect time to ask any questions that might have occurred to you once the agent left your home. The only other thing you need to do is share your decision with your family. You will find that it is the most thoughtful gift you could ever give them.