thank you for coming everybody my name is hans who going to be your teacher today i guess if you cannot see well enough feel free to move closer if you can hear me tell me to speak up i'm going to try and move us through this is quickly as possible it might take as long as an hour you're welcome to ask any questions you want anytime you want however if i think we're getting off on a tangent about medicaid liens or what medicare will pay for i'll say could you come and see me afterwards because people have places to go and i could be here literally two three hours i'll stay i'm happy to stay i just got to get you folks on your way if you've got places to go so again if you can't hear tell me to speak up we're going to talk about the mechanics the basics of long term care insurance i can tell you this having been in the spears news coming up on twenty years i've seen a lot i've heard a lot you'll probably be surprised at some of the things you learn today about long term care insurance things you thought were true that aren't things that are not true that are in either event if you get if you can't see this let me know you've got to understand that as i said i've been in this business long time and i've heard not as much lately but over the years i don't need long term care insurance because i'm not going to a nursing home to problems with that modern long term care policies going back to the early ninety's cover much much much more than nursing homes and if you need a nursing home i'm going to give you a reality check it probably won't be your decision as to whether or not you go to one it might be your spouses it might be your children's it might be your lawyers you live alone your widowed you fell you got a broken hip you can't stay at home anymore so long term care insurance is much much more than nursing home coverage ok yes in the 's that's what it covered nursing home only that was the drill not while that's long gone now what you must understand is that there are two kinds of care you can get when it comes to long term care and there are two hour rena's in which you can get care and here they are first of all this looks a little blurry is it there are two kinds of two places you can get long term care in the home or the community or in a facility you'll notice i didn't say nursing home there are three kinds of facilities there's a nursing home facility an assisted living facility and then there's a specialized facility like the boston allt simer center in jamaica way in jamaica plain so it's home or community based care when i say community i'm talking about a very popular adult day care program i have a number of clients who are out on claim and their policies pay for adult daycare one i can think of is whitney place over on route nine in natick in either event your care will be delivered in one of two or rena's home community or facility that's the whole spectrum now that said there are two kinds of care you can get ranging from home and community to facility one is skilled care also known as professional care the other risk a studio care also known as maintenance care trust me when i tell you the majority of the care people need is even in a nursing home now how do i define professional care i define professional care as a kid a is cared delivered by a person who has a license to do that oh you're a registered nurse professional care you're a physical therapist professional care you're a psychiatry is to helping with mom's dementia professional care you've got a license to do what you do the other is custody care now you'll understand if you don't already you know he's right most care is because most people unless you're like my mom who had her hip done in two thousand and four at les he needed physical therapy and visiting nurses every day to check on the wound and get her moving after about a week all the skilled care is done the rest is custodial help with bathing dressing eating toileting making a tuna sandwich feeding the dog so two places home a community and facility and two kinds skilled or custodial now i'm going to get off target here for just second let's talk about medicare the federal entitlement program as opposed to medicaid the federal welfare program the reason medicare does not pay much for a long term care service is because medicare is designed for acute problems broken hips car crashes heart attacks cross acute care think of it as health insurance because that's really what it is with a little bit of a side component for one hundred days in a nursing home long term care insurance is the polar opposite of acute care it's designed for chronic care long term care most people in the business whether an insurance broker or a doctor or a geriatric consultant for the most part people agree the line in the sand changes from acute care to chronic care at about ninety days so if someone thinks your care is going to be needed for more than ninety days you're going to be in an acute care situation acute care and then if you're really not healing well you're going to be in a chronic cares and disagree situation after about ninety days that's why medicare won't pay for more than one hundred days in a nursing home because they're not in the chronic care business so as i said most people most of the care people need it's custodial for example let's say you're in a you're in a nursing home yes some people in a nursing home are genuinely wounded they need to be  there they do get skilled care but most of the people in a nursing home need help bathing dressing getting into the chow array or the bath walking getting things like that it's not particularly intensive but it is very important it's still custodial care so when people ask me well what is a long term care insurance policy cover all typical good policies cover everything you see here nursing homes assisted living continuing care retirement communities adult daycare hospice and home health care for example the medicare hospice benefit or only pays for services it doesn't pay for  board my mom ended up in parmenter hospice in wayland her long term care policy paid the whole enchilada if she was just on medicare they would have paid a room and board scuse me they would have paid the services and my family would have paid the room and board but a good long term care policy pays the whole thing and of course home health care that's the big one doesn't everyone primarily really want to stay at home i know why would now i do have a client in lincoln who was widowed in two thousand and three and i remember she moved to willard village of continuing care retirement community in bedford and she sent me a christmas card one year and says she's this the exception not the rule she goes i'm very glad my long term care policy pays for all this stuff even in the continuing care retirement community and i'm really glad i moved out of lincoln because after let's call her husband joe after joe died and it wasn't a big house but it was a lonely place her kids are in chicago she's in lincoln mass living alone in a house on a gray winter day tough mentally tough and now she's in a continuing care retirement community they go grocery shopping they go to the museum of science they have entertainment they have movies they have travel they have social engagement she goes i'm really happy here but she's the exception but the rule you know she had more social support and interaction home would have been the place for her now when you go to design a policy and this is this is a little abstract for some people you've got a couple of major decisions to make the first is when you design your coverage is how much per day do i want the insurer to pay me as a maximum the state of massachusetts although i work in several states and i live in just over the state line in tax free exeter new hampshire i grew up around here but i live in accident hampshire the state of massachusetts will not allow you to buy less than fifty dollar a day benefit and honestly fifty dollars a day in this business is nothing nothing so the minimum fifty you can buy generally up to about five hundred six hundred a day there's no effective ceiling but there is a floor in the state of massachusetts so you've got to figure out what's the cost of services in the in the area that i live in let me be specific here let's say you're in a high end assisted living facility in brookline or belmont do you think the assisted living facility cost in brookline is going to be the same as it will be in springfield mass now so what you're going to try and do when you pick a number like how much is enough i want to buy enough but i don't want to buy too much and then pay so you've got to look at the cost of care in your area so that's that's one number you have to look at how much in generally in ten dollar increments one ten a day to sixty a day three fifty a day you could have anything you want the second thing you've got to decide is the benefits period how long do i want my benefits to last i understand the difficulty in trying to predict the future or as a yogi bear used to say about the future it's too hard to predict or something like that so the state of massachusetts is also dictated that you cannot buy a benefit period shorter than two years i wish they would allow it because a lot of people would be very happy with one year but they don't in either event how long you can buy two three four five six eight ten lifetime benefit periods in other words forever used to be very popular and as the cost of this product has increased over the years a lot of insurers have withdrawn the lifetime benefit from the marketplace if you ask me to look i'm an independent broker i don't work for any particular insure  you can't buy me with sales contests and rolex watches i don't go there ever so i can shop at an event there are ways i can get you a very very very long benefit period if you wanted one lifetime for  practical purposes is gone so how much per day do i want how long do i want the benefit to last and the elimination period is insurance speak for duck the ball the elimination period to be thought of as it did duck to pull measured in days instead of dollars now like any detectable while there may be some dance you can do and get someone else to pay for your care during that time for the most part plan on you paying the cost of your care during your deductible period during your elimination period that know no ninety days was the my definition the generally accepted definition of chronic care when chronic care begins the question was the elimination period is that the ninety days the most popular a lumination oddly enough that people choose is ninety days which you can have zero twenty thirty sixty ninety one hundred one eighty we're going to explain that in a minute but the elimination period is a separate decision you make on your own and there's nothing to do with the ninety days of chronic care yet we'll talk about that i'm not sure i answered your question ok so you've got to try and figure out how much for how long after what kind of a waiting period what kind of inductive will let me tell you something when my mother had her hip replacement surgery and we're going to talk about what constitutes a clane i got medicare to pay for her care while she recovered from hip surgery but at the same time i qualified her for benefits because i know what i'm doing so medicare paid for her care during her elimination period and when she got ninety days of care in the hospital and afterwards the long term care kicked in because she had issues she hadn't really healed that's a very interesting circumstance where you can get someone else to pay for your care during the elimination period it doesn't happen that often but it can be done that's why i tell all my clients if you have a claim you gotta tell me about it because i want to be a fly on your shoulder i wan look listen watch and advise and it doesn't cost you a thing and i'm really good at this so let's do some math here as the slide indicates ok hans i buy this policy i pay me and my husband we might pay five thousand dollars a year for the two of us combined or seven thousand or whatever the number may be how much money did we just get ourselves you know what do we buy for example if you bought a life insurance policy and paid two thousand dollars a year for one hundred thousand dollars death benefit you know i pay two i've got one hundred coming so what's the number on a long term care plan other how much meat is on that bird here's how you figure this out like the slide has indicated if you bought two fifty a day for eight hundred twenty five days of benefit period which is five years if you multiply the amount per day times the number of days in the benefit period you selected here is how much money you just have in the first year at your disposal ok i just bought two fifty a day with a five year benefit period i have four hundred fifty six thousand dollars at my disposal for my long term care this is before we get to the inflation increase you probably should buy so every year this will go up automatically guaranteed tax free at maybe three percent four percent five percent per year automatically so it's that you chose five percent interest next year you're going to be at about four hundred sixty thousand just like that so every year we'll index up much the way your social security should index up we call it cola or cost of living so mary and john both bought policies they designed them to be t fifty day five year benefit period the in the if it's in the first year they each have four hundred fifty six thousand dollars available or almost a million dollars now if you think that sounds like a lot of money it is and you need a lot of money to pay for long term care when i got into this business in hundred eighty or so the average nursing home cost in greater boston was about two twenty a day now it's probably the point upon where you go you're probably looking at easily three fifty a day maybe more four hundred a day for a high end facility and i'm not picking on nursing homes i mean you can if you can stay at home please do now one question i get is this was ok the two fifty a day i see the five year benefit period what happens if i only use my benefit at one twenty five a day whereas the rest of the money go nowhere it stays in your policy for your use another day we know that if john doe bought two fifty a day he's got one thousand eight hundred twenty five days of care coming to him and they don't have to be back to back you don't have to use it seven days a week you could use this policy two days a week four days a week skip a whole week if your son's visiting in either event the unused daily benefit amount has the effect of making your benefit period longer so if john doe bought to fifty a day with a five year benefit period but only used it at one twenty five a day his benefit period will be ten years at that rate of consumption which is a really really good thing yup yup exactly start another claim you know you don't once your claim is eligible to be paid you've met your elimination paired if you even have win there are many ways you several ways you could get your elimination period down to zero but once you meet your elimination period no product i've ever sold and no product worth the paper it's printed on ever makes you meet deductible twice in a lifetime you meet it once you are done i have a lady in hartford connecticut right now one claim this is her third company she has stuns me because most people go on claim they don't come off she's now on her third round with john hancock and they just keep paying and paying and paying so in their second claim and a third claim she had no elimination period to me no deductible so you can go on claim off claim as many times as you need to and you do not have to meet your deductible of your elimination period ever again me let me ask you this did i answer your question about going on an off plane absolutely oh i know what you're thinking no you're thinking about the medicare restriction for home health care you have to be you've got to be banged up to get medicare to pay for a home health care benefit one of the restrictions of medicare rules is you cannot leave your home except with extreme and taxing effort which means you can't go to boca for the winter unless you're in a wheelchair probably in a no no in terms of long term care insurance no such restriction at all none you can go anywhere you want anytime you want with anywhere anyone you want just because you're wrong plain doesn't mean you gotta stay at home like you've got an ankle bracelet on like a cross like a criminal like your own whether they call it a house ho or something god no absolutely not true if you think that's true send me something that someone has sent you saying yeah you can't leave i'd love to see that right and again i will repeat myself you remove your question reminds me of the medicare restriction about traveling too much or leaving the home if you really go to medicare dot gov and pull up their their document about home health care they will detail in there the circumstances under which you're able to really travel and you know go to boca raton for the winter you can only leave with extreme and taxing effort that's what the law reads no such restriction in our world none in fact i have a client in weston who lives up in norm big a point ninety nine a meager road out on claim with genworth she goes to arizona every winter and continue years or claim there when it's warm again she comes back to weston can they don't care as long as you are compliant with the terms of the policy meaning do you still qualify they don't care where you live or where you get care for the most part u s or canada if you need it in israel they're going to have a problem if you need it in lebanon you're going to have a problem because they're consider war zones aside from having a basic civil war or insurrection you can get care pretty much anywhere in the world because then it's a question ok so any time you don't use the full daily benefit amount your benefit period must get longer a beautiful thing about i've got clients who have two year benefit period during the like their fourth year of the claim because they're only tapping a little bit of the benefit they're not using the maximum every day because they don't need the maximum they get just enough help to do what they do maybe a little help from the son of the daughter in law everybody's as happy as they can be ok you figured out how much per day you want you figured out yeah i'm good with a three  benefit period or four year or two year whatever i'm ok with a thirty day elimination period a thirty day deductible now how else can i shape and design this policy just for me and my husband or just for me and my wife here's how you do it the first thing you need to do is make sure that the policy keeps up with inflation inflation must be offered to you under federal law it's the law you do not have to buy it you just have to be able to be able to buy it you have to be offered it to try and keep this simple most people by a five percent simple or a five percent compound annual increase to their policy which means every year your benefits are going to go up by five percent automatically tax free one question people sometimes have when they hear me tell you that well does my premium go up every year new can it theoretically yes in reality every year completely insane out of the question don't even think about it the policies all are written to allow for premium increases if you saw one increase in a lifetime today that would be extraordinary but it does happen pardon oh yeah it happens it happens but it's a very taxing process for the insurer it's a public relations nightmare and it's  just a crappy situation all around but that's more or less been addressed quite effectively in the last three to five years by changes the insurance made to mistakes they admitted they made we will want to hear one of the reasons premiums go up it's called the lapse rate they blew it on their estimation of the lapse rate the lapse rate as the number of people who buy policies never use them and then cancel them that i don't want to pay  anymore so they insure gets all these premiums all these years but never has to pay a clane they projected the lapse rate at five percent every for every hundred people five will quit with never submitting a claim doesn't sound like a big number five percent it's a huge number you know what the relapse rate is they were banking on all these people paying paying paying and never submitting a claim which means it's just pure gold for them one half of one percent to one percent in reality for every hundred people who buy coverage one half of one percent to one percent cancel their coverage without a claim which means they'll call it one percent when they planned on five percent was actually one percent that's a five hundred percent error isn't it you planned on five years actually once you're five hundred percent off people when they buy this product hold onto it for dear life very very very least in my customer base over seventeen eighteen years i've had one person cancel out of the hundreds and hundreds and hundreds of clients i have one one ok inflation is one way to to tune up your coverage the younger you are the more important it is that you buy inflation you do not have to but it must be offered other options are maybe a two percent three percent four percent factor some insurers might tie the inflation increase every year to the consumer price index shared care this is a very very interesting rider or option if you are married or even unmarried but live in a committed relationship what the shared care option does is it ties your policy to your husband's policy or ties your policy to your wife's policy let me be clear here it allows one spouse who is out on claim to tap the other's pool of money at the death of one's spouse the other and harris the others remaining pool free of charge what this does it helps address some really important questions i hear all the time ok hans my wife and i are thinking about buying coverage what happens if i run out of if i use my four year benefit period i smoked the whole policy well then you can tap your wife's policy so your for your benefit period because their shared is actually an eight year benefit period and that's sort of like well that's a real relief because i don't know how long i'm going to be on the plane you might be  claim too much might be in claim two years because the policies are joined at the hip whatever you had your spouse has access to also so that addresses the how long is long enough it also addresses the opposite what if i buy these product with my wife but i never use it that's the flip side what if i have a heart attack and die in my sleep which happens it deals with that very effectively also why because upon the death of one spouse the survivor inherits the the deceased persons benefits the whole policy so we talked about how your for your benefit period could become an eight year benefit period if you need it and can virtually what if you die your spouse will get all the money in your policy worry i have clients down an adult borough this couple bought a john hancock policy from me in two thousand and eight the the husband died in two thousand and eleven i remember getting a copy of a letter from john hancock to the surviving spouse her name was barr saying dear barb sorry to hear about the death of your husband because you bought the shared care writer when you purchased your long term care insurance we're pleased to tell you that your benefits of just increased and i remember the number that to this day two hundred eighty eight thousand dollars free here so your pool of money remember the four fifty six we talked about in my scenario she would have gotten a letter that said you've got another four hundred fifty six thousand free forever that's the power of the shared care benefit so let's be clear it helps you deal with how long is that right benefit period nobody knows all i can tell you is that you're going to double it if you need it ok swell how what happens if i buy this and never use it upon your death your spouse inherits it which means because they're connected at the hip we have two people we have doubled the chance that someone's going to use it instead of it being quote wasted know you don't understand it they both buy policies upon his or her death whoever survives gets the others benefits free but whatever's left in the policy it could be a whole policy and completely intact never use world it could be like the couple in hampstead new hampshire where he used about half of that then died his wife got the other half whatever is left because there's no shared care there's no shared care to apply because there's no one to share it with you both have to have coverage irrelevant there's no one to share it with unless correct there is no beneficiary there was no benefit that's correct well yeah the odd thing about long term care insurance is that people have a huge problem with paying for it year after year and then worry about wasting the premium but they don't have any problem with paying homeowners year after year without a claim or auto insurance year after year without a claim and dying and not wasting it this is insurance like everything else if you don't have a claim i guess you could say you wasted it but you had coverage the whole time if you needed it so and from where i sit as a consumer not an insurance broker as a consumer i'm like damn glad i got what i got it you know i'm glad my home is in short i'm glad i have insurance on my car i'm not wild about paying any of it but i'm not going to run around without no the first phone call in your case would be to medicare and submit a claim to medicare if you're sick or injured now if you fail to recover from your illness or injury this policy me come in right behind it it depends what your problem is we're going to talk about what a claim looks like in other words ok i get it i understand it covers nursing homes assisted living home health care adult day care continuing to try and communities hospice i understand it covers all that when can i restoration of benefits writer by the way shared care if i had to sell you only one writer one option would be to be shared care inflation they're really really important the older you are the less important felician is i had a woman years ago down in norwell mass who was eighty three when she went to buy it and i said you know the cost of inflation to add inflation to your policy could be a little rugged why don't we buy you a hybrid daily benefit amount then the greater norwell costs is let's say the greater normal cost for it was general for the worst worst case would be to fifty a day by three hundred a day and skip inflation you're eighty three you're not really going to see a lot of benefit out of between now and the day you die you're just not and she goes yeah that's a great idea and she ran it by her three daughters who are all nurses they go yeah he's right inflation isn't worth it just by a higher daily benefit  nt then you might need right now to kind of like duplicate or fabricate the effects of an inflation increase and move on and that's what we did another very interesting right was called restoration of benefit it's widely available basically it means of ok let's talk about the pool of money lou the pool of money in our original example was four hundred fifty six thousand the restoration of benefit feature will put all the money paid in a claim back in your policy if you meet certain criteria and here is the criteria it's very simple if you bought a policy that in the head of four hundred fifty six thousand dollars pool and had a claim for a hundred grand your pool with then be reduced to three hundred fifty six thousand now if you can stay off of planes they all work the same way if you can stay off of claim for six months or more in other words you're not eligible in other words you're in good enough help that you cannot submit a claim for six months at the at the six month and one day mark they're going to put the hundred grand back in your policy so you have a brand new contract they're going to put that hundred thousand in my example back in your plan and give you a brand new policy and people say well why would they do that because they're very good at what they do they understand marketing they're charging appropriately for it they're making money on it it's just another good reason to buy long term care insurance restoration a benefit is powerful remember the lady in hartford i said who's been on claim three she's on her third claim this is over a nine year period she's already had her benefits restored twice twice so works so we have an inflation we have the shared care benefit if there's a spouse or significant other involved and we have the restoration of benefit feature are there any question it's me the question was can i define claims and eligible we're going to talk about the claims eligibility in just a moment but i will answer your question now in one thousand nine hundred ninety six remember everyone's heard of the word hipaa ok you need a hip or release hip of this hip of that well hip a was invented hundred ninety six and these policies are what we call hipaa compliant now when we get to what constitutes a payable claim i will be referring to federal law so credential declined your claim they're not declining it perceval the federal government has said you don't meet our rules so the claims rules are actually federal law claims and eligible means that you are not disabled enough to submit another claim in other words you're in good enough health that you are not eligible to submit a claim so if you go on claim then come off of claim because you're doing so well if you can if you can stay well for six months and the restoration will kick in you've got a brand new plan so claims and eligible is another way of saying i'm healthy enough i don't need this i'm good so a day one eighty one you've got a brand new plan did that answer your question good the last thing we're going to talk about is the zero  eliminate period basically this is your deductible remember i said you can have zero twenty thirty sixty ninety in massachusetts the biggest deductible or elimination period you can have is three hundred sixty five days that's insane that's never ever ever something you should buy it's too much you know what a year or care would cost you depending on where you are let's say you're in a nursing home in brooklyn it's one hundred eighty thousand and you've got a one year to dr bill you're going to pay the hundred eighty thousand that's insane no no no don't don't do that but you could have zero if you wan ok let's talk about the three ways money is paid out the most common way money is paid out is what we call the reimbursement model this is what they do they literally reimburse you for the expense in question referring to the screen let's assume you have a two hundred fifty dollar a day daily benefit amount your d b a let's assume you have one hundred fifty dollar expense i got two fifty available the charges one fifty how much are they going to pay one fifty they're going to reimburse you dollar for dollar for the expense that leaves the hundred dollar difference in your policy which means your benefit period of course as i said before is going to have to get longer which is good the money that is not spent on your claim per day doesn't just vaporize it's still there for your use so a reimbursement policy will pay an amount equal to the expense the end and indemnity policy will pay you the full two fifty per day in my example so if john doe has a two fifty per day policy on an basis the one fifty would be paid for you your expense and they give you the hundred difference literally give you one hundred dollars for that particular claim so in a reimbursement model one hundred stays in the policy within an they're paying the whole to fifty one way or another that's pretty slick to get money every day out of an insurance company in addition to having your expenses paid the third by the way the reimbursement model probably ninety percent of the policies yes the reimbursement policy will reimburse you exactly for the amount of your expense no more the indemnity policy will pay you the exact amount of your expense and the difference between that and the daily benefit amount let me repeat myself if you bought two fifty a day you have one hundred fifty dollar expense for john doe home health care service they'll give  hundred fifty to the home health care service and give you the hundred dollar difference literally give you the difference left over so the indemnity model's a very effective way to have a benefit paid because you're going to be getting the maximum amount of we can talk about that again later if you like so reimbursement pays the exact amount of expense the indemnity pays the expense and gives you anything left over yes but that's not hard yeah but considering you're going to be the one sending the records to the insurance company you will all you'll already be in the middle of all the record keeping anyways and i help my clients too that i help people who are not clients of mine do that it's easy once you have your system set up that's not a lot of work but it's a process most people only do once in a lifetime so they never really get pretty good at it i do it every week so i'm really good at it by the way the cash model is the last one they don't care what the expense is they're going to pay you the whole daily benefit amount of times thirty days so if you had one day of care a week or for four days of care in a month in my example they're not going to pay you the one fifty per day they're not going to pay the two fifty they're going to pay you seven thousand five hundred dollars in a lump sum that's what i own i own a combination of the indemnity and the cash but i thought it fifteen years ago so it's it's rolls royce coverage but that was before prices went cuckoo however for the record i will tell you that when i have two different policies from different insurers one of them did whack me a fifty percent rate hike a couple of years ago fifty percent brutal that probably be the only time in my life come alive or see it but even though it was fifty percent i cut back mine my benefits a little bit to keep it affordable but i didn't cancel anything this stuff was a fire wall around my estate i'm not going to end up on medicaid and you know welfare if i without a battle so i yeah i was really irritated fifty percent was just gruesome by the way my other policy in fifteen years hasn't had a rate increase at all so go figure for purposes of simplicity if you buy coverage you probably really going to end up buying a reimbursement policy and there's nothing wrong with that but just the way it is if you ask me to find you indemnity plan i probably could ok people want to want to know all the time and it's a great question it's a very important question when can i submit a claim when does this pay i've got a couple of consulting with up  winchester and the woman suffering from a little bit of dementia and i've explained a tour probably five times that her claim is not yet eligible to be submitted her dementia her mild dementia is is causing her to have a synaptic breakdown she doesn't understand my explanation what i've tried to explain to her is that the rules for submitting a claim are established by the federal government not prevention not john hancock not meant life not only ons federal law the insurers are only complying with federal law here's what the federal law as of one nine hundred ninety six when hipaa was invented these are the hipaa rules there are two ways two categories of problems you can have that will say justify submitting a claim the first is what i call the physical set of issues the second is a mental set it's really really simple to submit a claim and get it paid you have to have problems with your activities of daily living or your a d t else most of you have probably heard the phrase a d before joe joe has problems with his eighty l's the activities of daily living that you need it problems with per law are the inability to eat bas transfer maintain confidence go to the bathroom or dress without substantial assistance from another person if you have problems with two or more of those federal law says your claim should be approved the only difference between this and the other one that will talk about in a minute you need problems with two or more of your activities of daily living and someone has to certify that they think those problems are going to last more than ninety days that's how we come full circle back to the difference between acute care and chronic care this is the definition of chronic care according to the feds yet ninety days is the difference acute care and chronic care so if bob has problems with by the way transferring is getting up from a chair to a bed or bed to a chair whatever that's what transferring is if bob has problems with bathing and dressing for example and bob's doctor thinks it's going to last more than ninety days the claims approved or are maintaining continence and walking or dressing and eating or bathing and dressing any combination of these five activities of daily so you need two or more by the way in some states like california the law says you have to be offered at least five activities of a live in california i think it's seven which is good because the larger the list of possibilities you could have trouble with the better it means you have more opportunity to qualify now the next question well who decides if betty is having problems with their activities of daily living and who's going to decide that yeah i think they're going to last ninety days or more typically it's a a nurse or registered nurse who comes to visit with you with a geriatric background they have a special there are specialists in senior issues there are  medical professional typically a license nurse and they will meet with you and ask you a bunch of questions maybe ask you to walk across the room they know you're using a walker they know you're using a four prong cane whatever that's how they will assess you you're welcome to challenge it i by the way i've never had an assessment turned down if i think if i think you are eligible i'm generally a mom right people call me up my dad fell the so i might go to visit them it's really none of my business but they want me to given them an opinion i've never been wrong every claim i've ever thought was an eligible claim was an eligible claim so i got a pretty good feel for some one situation so federal law says the physical trigger set must be met you need to have problems with two or more of your activities of daily living we think they're going to last more than ninety days claim is approved the other trigger as we call it is not physical at all it's mental if you are diagnosed know followed by words you very carefully if you are diagnosed with severe cognitive dementia your claim is approved without any ninety day requirements up with the activities of daily living your physical issues have to be expected to last more than ninety days doesn't work that way with the mental issue oh you've got alzheimers severe claim approved boom in federal law so again if someone says well hancock turned on my claim well hancock turned down your claim but there were only following federal law they didn't make this up the feds did congress did under hip in one thousand nine hundred six you know why they did this in hipaa because over the years different insurance companies have different claims criteria was making people cuckoo who's got the easiest claims criterion people start shopping from and sure now everyone's on the same playing field it made a lot of sense it makes a lot easier for everyone for brokers selling it to insurers administering it to consumers trying to understand it everyone has the same rulebook nationwide no ifs ands or buts they really cleaned it up and made it sensible so you can qualify for your benefits with physical issues or you can qualify for benefits with mental issues my mother had a fast moving brain tumor in two thousand eight and while it wasn't all timers it was cognitive dementia severe i won't tell you what she did besides starting fires on the stove and trying to drive the car out on the i was it was awful all cognitive severe cognitive by the way off all timers must be covered by federal law you cannot buy a policy that does not cover alzheimer's by the way you want to hear something scary for every one hundred people who go out on claim for whatever reason ok your claims are proven for every one hundred people fifty of them go out on claim for one thing else on this one into long term care insurance claimants claim for all timers now i'm not a doctor but i would call that an epidemic if one or two people in your neighborhood without a claim and had the same thing i would call that an epidemic and the feds saw that coming and go like there's no way in the world we're going to allow these products to be sold in our country unless they cover all timers because you know one insurer would that's the first thing they'd try and cut out if they had but if they had the ability oh definitely not in fact i just got done looking at an amex policy for a couple in medfield mass one of the things i do free is i refused to policy reviews and i sent them a written paul i was spoke at the medical council aging in november and they said would you look at my mother in law's hammocks policy american express in down in jupiter florida and it wasn't money monetary only if the daily benefit should have been higher the person should have been sold inflation which they did not by big mistake when you're ninety one well now that you're ninety one but the basics of the policy were really good and they added it's funny you asked that they added what we call a third benefit trigger because it was the policy was purchased in ninety two we had a third trigger here we have the physical trigger here we have the mental trigger there's a third trigger and or policy called medically necessary that's like being a gambler and having a bunch of aces up your sleeve medically necessary means forget physical forget mental my doctor says i need home health care four days a week done the third trigger was very liberal very flexible very generous and very easy to qualify for she has an inner amex policy so to answer your question yet was done in ninety two yeah the benefit should be higher but that's not a design problem that's not the way the prof the policy is not the problem the designer was the problem but the product the words on the paper were terrific so no good old policies can probably just because the the third benefit trigger which is to receive this is this is why i specialize oh no god no once these policies are written the individual policies the written stone you can cancel them they can't cancel you unless you don't pay for the product individual policies are bulletproof take that's why people would call me up after met life announced they were leaving the business and left the business and i have customers with all of these companies because i'm an independent i shop around amongst company to company to company for you people call me up frantic i heard all the answers leaving the business i said it doesn't matter these are non cancelable policies they can leave they can move to ghana stand for all i care they still owe you their contractual obligations they cannot dump you now if you bought your long term care insurance policy through an employer like the met life product at raytheon it's a group product they can cancel you anytime they want if there's it might it might convert to an individual maybe it depends upon whether it was originally written as a group policy or an individual policy i can sell a group policy to a group or i can sell an individual policy to a group so the question is where they was the group c just because you're in a group doesn't mean you're buying a group product you could be in a group and be sold a group product you could be in a group and be sold an individual product the best of those worlds as being in a group with a group rate what on what we call individual paper now don't start losing sleep well oh i'm on a group product i could be canceled yeah it doesn't happen very often but it has and if you're in a true group product or a group and you convert after you leave you might be converting to an individual products you might be now on your own as an individual but with a group product it's we'll talk about it after the fact if you'd like but don't sweat bullets but right and then they win and we're not going to let them do that you find someone like me who do it for you all day long free of charge whether you're my client or not i help many many many people free some insist on paying me some really insist on paying me and i'll go ok give me two hundred dollars that's why i'm here that's why i'm here to help you that's why i've been here i've probably been here spoken here five six seven times i've spoken to probably twenty five councils throughout the state from north hampton a new report the norwell and back again because the way i work the council's appreciated i fact that the the last slide will cover just that the speaking engagement i had where i made the same presentation at the midfield counsel edging in november was a classic example where the guy emails me afterwards and goes you know i really learned a lot in midfield and i your last slide was really intriguing you said you do free policy reviews i go yeah would you look at my mother's amex policy fine email it to me if you can scan it but also make sure some of these policies still have the application staple in the back with date of birth and social security number don't ever do that fax it to me mail it to me or email it to me after you white it all out and then converted to a p d f in other words get me the document and then i gave him a four five page written review and he was while the body goes that is just what we're looking for and my brother in law who's administering who will administer mom's claim in jupiter florida was really thankful too because he didn't know what he had on mom i'll show you a slide at the end and be happy to do that happy to do that i did that for a woman in somerville about five or six years ago who was getting shafted by a real dirtball insurance company i've never like these people i've never sold their products ever and i won't mention who they are but i got forty eight thousand dollars in retroactive benefits out of this company for her husband and i found the home health care agency out of there because they were ripping or off to billing or for services he didn't have he was a insulin dependent diabetic on kidney dialysis in a wheelchair at home and the home health care agency was like she made the mistake of doing what we call an assignment of benefits and i don't want to get behind i want to finish up and we can talk but basically she says the home health care agent says can we bill jondo life directly it'll be easier on you yet that sounds good so i start looking at the bills said mary with a here on wednesdays he goes no i was in new jersey well you got a bill for his schtick couldn't have been here i was in new jersey so they were burning or and i got oh i was i went nuts let's see if i got this right you're ripping off an eighty one year old man and her and her and his eighty two year old wife really i will eat you alive with the state of massachusetts i'll put you in the boston globe unless you send a check overnight to these people for this amount based upon my calculations of the days ripper off very rare that i've encountered a home health care agency ripping people off but i have and i'm no one to tangle with because i'm just a rabid dog when it comes to that well no no this is just criminal you are an absolute dirtbag and i'm not going to be shy about telling you that this woman was so thankful and her sons were so thankful and that her husband was so thankful they found me because i spoke at the medford council in aging and the men uniformly with the shine counsellors well i train the shine counsellors i train one hundred three of them in the last five years so they get to know me in this woman was complaining about she's something she goes something isn't right with this insurance company well this guy might be able to help you and i did forty eight thousand dollars in retroactive benefits and i got rid of the dirtbag insurance home health care agency very rare i'll be very diplomatic and he's very rare but it did happen and i got him i got the insurance company and i got the whole milk care agency oh yeah oh yeah i got a christmas card from her too this is like and she slipped a check in there and i will tell you i cashed it ok ramos time how to lower the cost of coverage to the shorter benefit period for your benefit period will give you more benefit than a three year benefit period so it makes sense that if you want to reduce the cost of the coverage choose a shorter what we call a shorter be shorter benefit period choose a lower daily benefit amount you'd like three hundred two hundred works by two hundred choose a longer elimination period in other words increase your deductible of five hundred dollar out of your doctor bill will cost you more in premiums on a one thousand dollar auto deductible it's just like any other deductible two simple versus compound inflation compound inflation growth is the gold standard when you're trying to build money whether your stock goes up five percent a year or whatever it is goes up five percent a year it matters whether it's calculated on a simple or compound basis compound is better it doesn't mean you should buy it under saying compound is better choose a very large daily benefit amount and drop inflation entirely remember i told you about the eighty three year old woman in norwell who wanted to buy the long term care insurance and i said look let's call her marge marge if you want inflation i'll sell it to you but it's not a good value when you're eighty three and her three nurses son and daughters i explained it to them too they go this guy is absolutely right mom if you need to fifty by three hundred no inflation move on that's what we did very cost effective drop all the options and writers don't buy and just buy don't buy inflation don't buy shared care don't buy restoration of benefit just strip it down to its basics lower the home help we're going to just skip this this is going to get a little convoluted to explain pass on and apply with a spouse insurance companies love it when two people apply burse is one and they will drop your premium by a low least fifteen percent each if a husband and a wife apply together you know one of the reasons they do that first of all they're getting twice the business aren't they wow john ng mary jo they know statistically that when there was a spouse in the home for a home health care claim that the cost of the claim is less to t insurer when there's a spouse in the house why because their rendering care too and they don't have to pay for it your the loving wife bob had a stroke three days a week you give him care the other three days you bring in home health care agency paid for by potential so many times a spouse involved typically they know statistically the claim is less costly to them if there's a spouse involved so we can get to people who have that's great and they win because they get significant price reductions as consumers another way you can do it is by through by through your business you can get additional discounts if you are a business ok we're almost done many only in the state of massachusetts can this happen one thing people don't seem to understand about medicaid medicaid is the federal welfare program medicare is the federal entitlement program how many people know th again my mother is out on she's getting medicaid funded nursing home down in wall fans mean after she dies they want the money back yes they do that doesn't always mean they will come and get it but federal law says they must when i say they i'm talking about the states every single state as of one nine hundred ninety three is bound by federal law to do something called recovering we gave you eighty eight thousand in medicaid benefits we want the eighty eight thousand back we're going to come in recovery well it's kind of a convoluted situation i'm already really poor when i qualify for medicaid what do you think you're going to come and get your house  the house and how do they do that they put a lien on it only in massachusetts can you get protection from a lien by buying long term care insurance true on we're going to get to the sin minute here's how it works the state of massachusetts in two thousand went to the federal government and said look we understand recovery we understand why we get it how about this would you grant consumers in massachusetts a waiver a pass protection from the lean if they bought just a little bit of long term care insurance yeah we do that and here's how it works if you buy a long term care insurance policy in the state of massachusetts that pays at least one hundred twenty five dollars a day as a daily benefit amount if the one twenty five covers skilled nursing they all do if they buy it for at least a two year benefit period which is the minimum in the state anyways you can get a lien shelter on your home so you can collect medicaid and not get a lien on your home now just because you had medicaid benefits doesn't mean the state's going to send a swat team to your house with a lien in one hand and a quarter in the other but they have they literally sent the sheriff to some people's houses in some states adoption by the policy maintain one twenty five year have at least a two year benefit period and if you ever needed medicaid you can go out and whoever your heirs are will be able to own your home with no federal lean on it some people manage sometimes the children will pay for it that's a good question also just because you qualify for medicaid doesn't mean you don't have a red cent to your name you are allowed to have a certain amount of income there is but it's often enough to pay for a long term care policy that meets the bare minimum one hundred twenty five a day and a lot of money to your benefit period i mean with their the state is offering you the bare amount they could negotiate with the feds to get you a lien exemption so your question is right on how ok i'm if i'm so poor that i qualify for welfare how my going to for this depends when you buy it you could you could buy this ten years ago because the rates are based on your age and your health if you bought it ten years ago it could be quite affordable there's lots of ways you could own long term care insurance and still qualify for medicaid that's they they do take into account the fact you won't long term care insurance when you apply absolutely absolutely the mistake people used to make is they buy one twenty five a day for two years use it then apply for medicaid now they don't have two years left these are the minimum you have to have in force when you apply for medicaid so john doe mi go out on claim for a year he's got one twenty five a day but he's only got one year benefit left because he's been using his palsy then he applies for medicaid the mistake folks make is that they they use the policy down to a point below the minimum requirements thus they no longer qualify for the lien exemption when they apply you have to have at least one twenty five a day left and at least a two year benefit period left in your policy when you apply for medicaid you'll know what you bought it will be right on your policy you can open up for an o b what's called the policy schedule mary doe to your benefit period daily benefit amount one twenty five a day skilled nursing check home health care check or sisters living check easy speaking of which i want to show you something we're almost done here folks bear with me with regards to the lien exemption we're talking about on page nineteen of the big white document if you look at the page in the middle it says what is a mass health or medicaid qualify policy here is where they discuss what i'm talking about now we're not going to get into this now i want to finish up but i will stay let me get done and then i'll stick around if you like ok a few comments to you you can go on playing off of claims then back on claims i've been doing this a while so i kind of anticipate the questions that's why that's there i hear that question so often it's like make it a bullet point on the slide so yeah you can go on claim off and claim these policies are portable they're good in any state what if i move to california to be near my son my son load of fun move to california it'll pay it doesn't the polls they don't care where you live they really don't as i said before if there's civil war insurrection going on in guatemala you do not want to move to guatemala my father once went to a vacation oh my god it was in like kosta rica during civil insurrection it's like rep that would be a broker or someone like me who really knows their stuff it's a complex product in a complex business jack of all trades don't impress me i've seen people who are in my business i sell life insurance i sell long term care i sell fixed annuities i sell variable annuities i sell whole life universal life term life disability i do financial planning i can roll it they do all this stuff and you want me to believe you're really good at every single one of those now now i don't believe it i'm very good at what i do because i don't i only do two things long term care and life into that's all i do i don't do financial planning i can advise you about a cd or  annuity or for one care roll over i don't know i know people who know but i stick to what i know best avoid working with a captive agent a captive agent can only sell for one company in this business you must shop around i'll quote typically four companies at once there are a lot of companies in this business nationwide but the ones that are there are dominant and i represent all of them so when i give you a quote in a spreadsheet i'll quote john hancock genworth mutual of omaha trans america all across the top you can see the price the design is the same let's see how everyone stacks up that sort of like buying the same house in four different neighborhoods that exact house over there let's put let's price it in waltham newton belmont and wayland for the same house let's see which one costs the least that's where you should go and you won't know unless they show it to you a captive agent can only show you one company's product that's also why captive agents tend to be rather pushy they only sell one company one product if they don't get you to buy that product they don't make any money they don't really care what you need i don't care what you buy i'm an independent i sell the same product as a captive agent and if you don't play anything that's fine too but i'm not chomping at the bit to get you to buy this because i have sales quotas i'm a captive agent i'm only owned by the company i got to answer to a sales manager i have quotas to i don't answer to anyone ever no vacations no role no sales quotas no sales reports i don't owe anyone anything and i've worked that way since i've been in this business for twenty five years nobody owns me i've never been a captive and they keep trying to recruit me a there's nothing you have i want so badly that i'm willing to basically sell my soul and only sell your product and wave the flag about how good it is i've got insurance for people many many many applied with genworth few years ago they term me down i can't buy it now i said who did you buy it from so i happen to know the captivation i go i didn't tellers and you're still eligible the problem was she bought to a captive who was a generous captive and i sold the same product but as an independent general turned her down hancock did not but she's wanting around thinking i'm uninsurable i've got the scarlet letter on my forehead no one will look at me no if you'd like to print just protect the house go to the states specify benefit member we just talked about the lean that's what we're talking about there are rarely physicals involved although that's starting to come around when i say physicals i'm talking about they might want current blood and urine tests like life insurance the law was pull your medical records the question is now do they want to be a little more invasive some do some don't it's based upon your age and whether or not they have caused you could be young but if you've got a blood disorder they're to want to know more and however yeah there it is down about the bottom blood in your own what's available to you free written detailed policy reviews proposals reviews telephone conference call i sometimes i work with a an outfit in wellesley at the intersection of one twenty one call g w way their big financial planning outfit and they'll fax me or email me proposals from other agents or other financial planners to review so when i say free policy reviews i'll look at this fellow's mother in law's amex policy in florida when i say proposal reviews i'm talking about a consumer who went to someone who says this is what you should buy they took the proposal and gave it to their financial planner their financial planner sent it to me and i'm completely objective if i think it's a great proposal i'll go yeah buy it sure or change that or run every way we're a very easy matter where from that's a really great proposal to don't even think about it i've seen some interesting work research and answers to technical questions a lot of the minutia and detail that i know came from people like you who goes you know i'm a vet and i've heard this about the v a and that about what's the real story and i'll dig in i'll do homework and i'll do and i'll do research for you a gency library i've got cost of care studies i've got white papers i've got all kinds of stuff spread sheet ing lastly people go like will give me a quote and i'll send you a one page spread sheet with all the insurers across the top all the design criteria down the left side so you can see objectively apples to apples comparison a particular quote across four or five long term care insurers and you go oh the differences amongst life insurers long term care insurance costs these days are getting closer and closer not so different but you could still see easily a twenty five percent spread they used to be fifty to one hundred percent spread until the industry kind of got their act together and they're much more conservative now i am done thank you for coming if you have any questions let me know i'll stay as long as you want i hope you found it helpful ok