Do LTC care have pay out caps?

[Anonymous]

Anonymous wrote:My relatives have an LTC. One of them is in his 70s and got diagnosed with terminal cancer. The LTC offered to just pay out $75k and call it a day. I told them take $100k.

LTC offered that becasue they knew they'd have to pay more otherwise. I told them to take it becasue you have to use their certified providers, and he had certain people he'd rather care for him. Why make his wife spend his last few months filing paperwork with the LTC company every week to get reimbursed? Let her enjoy her time. They happen to be well off so it was not a big dent financially.

Oh wow, haven't heard of that. So the surviving relative will not need the LTC?

[Anonymous]

Anonymous wrote:
Just today I contacted our LTC insurance company for a print out of the benefits as we are updating our legal affairs and trying to consolidate our financial affairs. We think it is important to share the LTC information with our adult children as it is an important part of your financial resources as you age. Because we have a daughter with a disability, we got the policies early. You definitely see the daily rate that will be paid and for how long. And sometimes the policy amounts can be transferred from a spouse if one dies and has not used all the benefits.

It is also definitely a good idea to review your legal affairs periodically and to name a successor as appropriate because life circumstances can change for anyone. And I can tell you that a 97 year old could make a choice to update his will and had the acumen to get his doctor to attest to his mental faculties without telling anyone. He was still driving so no need to ask for a ride! His wishes were respected, but then the seven siblings worked out a division that was fair to all taking into account the impact on all.

I can tell you that it is very difficult to find an experienced lawyer to deal with the intricacies of a Special Needs Trust for one with a disability if you want to find one who will have continuity of services as lawyers retire, too, so to have a firm with others able to handle the legal issues over time. If you move to another state, it is always wise to check to see if anything needs to be revised if you do have a family member with special needs or are a guardian for someone.

When folks are wondering about their options on a CCRC, or AL, just be glad you do not have a son or daughter who must be 62 to qualify to go with you! It is a federal rule in how they are set up. Yet it limits the options on future care for so many families even those who can private pay. (Some can qualify at 55 to be in an AL place.)

Did you mean this for the thread on SNT?

And yes, agree on the conundrum with the 62 age threshold. Part of me wonders if this will become less relevant as the boomer generation passes. Our developmentally disabled sibling remained at home with our parents until the last few years of their life when they moved into a group home for greater socialization opportunities.

What I've more recently observed is that younger parents now plan for some form of an independent life for their children with disabilities, especially as they reach 18/early 20s.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:There is almost certainly an overall cap on expenses. Some policies do have a cap on how long benefits can last so I don’t know if using benefits lightly could trigger that period.

My father had the fed LTC plan that was considered the Cadillac version. The max was $6k a month for 15 months or something like that. This was in 2018. He paid for it for 15 years and only got to use it for one measly month.

This is like complaining that you have paid for health insurance all year, but haven't been sick, and so haven't been able to use it. In other words, idiotic.

It’s actually a point to consider. These plans can be expensive!

Yes. Our financial planner has suggested that we continue to put our money into savings as we may have enough to not need to use LTC. That still makes me anxious but we are following this advice.

Get a better financial planner. That's horrible advice.

[Anonymous]

Anonymous wrote:

Anonymous wrote:My relatives have an LTC. One of them is in his 70s and got diagnosed with terminal cancer. The LTC offered to just pay out $75k and call it a day. I told them take $100k.

LTC offered that becasue they knew they'd have to pay more otherwise. I told them to take it becasue you have to use their certified providers, and he had certain people he'd rather care for him. Why make his wife spend his last few months filing paperwork with the LTC company every week to get reimbursed? Let her enjoy her time. They happen to be well off so it was not a big dent financially.

Oh wow, haven't heard of that. So the surviving relative will not need the LTC?

That sounds more like a life insurance policy than a long-term care insurance policy.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:There is almost certainly an overall cap on expenses. Some policies do have a cap on how long benefits can last so I don’t know if using benefits lightly could trigger that period.

My father had the fed LTC plan that was considered the Cadillac version. The max was $6k a month for 15 months or something like that. This was in 2018. He paid for it for 15 years and only got to use it for one measly month.

This is like complaining that you have paid for health insurance all year, but haven't been sick, and so haven't been able to use it. In other words, idiotic.

It’s actually a point to consider. These plans can be expensive!

Yes. Our financial planner has suggested that we continue to put our money into savings as we may have enough to not need to use LTC. That still makes me anxious but we are following this advice.

Get a better financial planner. That's horrible advice.

My mom has plenty of money AND got a LTC plan years ago. She’s in memory care and we’re paying 20K monthly for her care - LTC pays 15k of that bill. dementia or disability can wipe out your savings very quickly.

[Anonymous]

My mom has plenty of money AND got a LTC plan years ago. She’s in memory care and we’re paying 20K monthly for her care - LTC pays 15k of that bill. dementia or disability can wipe out your savings very quickly.


Can you describe in a bit more detail your mom’s circumstances/setup? We have an only child and I’m determined to make our older years as easy on him as possible.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:There is almost certainly an overall cap on expenses. Some policies do have a cap on how long benefits can last so I don’t know if using benefits lightly could trigger that period.

My father had the fed LTC plan that was considered the Cadillac version. The max was $6k a month for 15 months or something like that. This was in 2018. He paid for it for 15 years and only got to use it for one measly month.

This is like complaining that you have paid for health insurance all year, but haven't been sick, and so haven't been able to use it. In other words, idiotic.

It’s actually a point to consider. These plans can be expensive!

Yes. Our financial planner has suggested that we continue to put our money into savings as we may have enough to not need to use LTC. That still makes me anxious but we are following this advice.

Get a better financial planner. That's horrible advice.

Actually it's pretty standard advice that the best candidates for LTCI are the people who have a nest egg but not a large one-- those with less savings fall back on medicaid and those with more "self-insure".

I asked our insurance agent (who actually sells LTCI) if we should get LTCI and even his response was it wasn't worth the cost to fully insure, although we might want to partially insure.

[Anonymous]

Anonymous wrote:

My mom has plenty of money AND got a LTC plan years ago. She’s in memory care and we’re paying 20K monthly for her care - LTC pays 15k of that bill. dementia or disability can wipe out your savings very quickly.

Can you describe in a bit more detail your mom’s circumstances/setup? We have an only child and I’m determined to make our older years as easy on him as possible.

There’s nothing easy about this phase of life but it’s great that you’re thinking this through now. What kind of info do you want to know?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:There is almost certainly an overall cap on expenses. Some policies do have a cap on how long benefits can last so I don’t know if using benefits lightly could trigger that period.

My father had the fed LTC plan that was considered the Cadillac version. The max was $6k a month for 15 months or something like that. This was in 2018. He paid for it for 15 years and only got to use it for one measly month.

This is like complaining that you have paid for health insurance all year, but haven't been sick, and so haven't been able to use it. In other words, idiotic.

It’s actually a point to consider. These plans can be expensive!

Yes. Our financial planner has suggested that we continue to put our money into savings as we may have enough to not need to use LTC. That still makes me anxious but we are following this advice.

Get a better financial planner. That's horrible advice.

Actually it's pretty standard advice that the best candidates for LTCI are the people who have a nest egg but not a large one-- those with less savings fall back on medicaid and those with more "self-insure".

I asked our insurance agent (who actually sells LTCI) if we should get LTCI and even his response was it wasn't worth the cost to fully insure, although we might want to partially insure.

We were told we could likely self insure and if we did LTC we should only do 1 year. It is a gamble either way of course. My Dad just passed away with No LTC insurance. His only time in skilled nursing was covered by Medicare after a hospital stay. If my mom had not been with him, he probably would have needed more of course.

[Anonymous]

I am the poster who mentioned we got LTC years ago (20 to be exact) as we have a disabled daughter whose care we will need to plan for. I posted here because the point of looking at LTC is important for most families. W, as the above poster did want to cover our health care and living options, to reduce the impact of support on our daughters as much as possible. Actually, even if you are extremely wealthy, the idea of finding a long-term place for a disabled adult to reside before say one might qualify by age for a specific setting is extremely hard. You do not exactly see a lot of agencies saying we have new apartment or home options. And then there is the issue of staffing any setting. But more to the question at hand, we happened to get LTC with no time restriction on paying for care, which I verified. This kind of plan is not usually done today, BUT there are also a lot more flexible way to fund and develop a LTC plan with companies if you do not have one. In our area the local senior center regularly has programs related to future planning, and it was fascinating to hear about some of the new options. Of course, as we need a well-referenced lawyer with experience in our planning, if you were looking at a creative way to fund LTC, you need to be working with a well referenced insurance broker/agency. Also, the center here has an insurance broker who will at no cost review a person's LTC contract and/or situation to make suggestions of how one might proceed. In one case, the person said, she helped a woman get the $300K unused portion of LTC that her husband had, but did not use as the insurance company had never told her the coverage could be transferred.

If you are thinking of getting legal help to shield your assets, you do need to do it with the idea that there are several legal questions on the relatively simple long-term Medicaid application form regarding various transfer of asset questions with the 5-year look back period. In our area, there are elder law lawyers who can meet with you and explain their services and listen to your needs to see if one might be a resource. What was clearly pointed out is that it is the contract that will govern the services and any guarantee of services that a person will receive in a CCRC or other setting, so it may be important to have any contract reviewed by your lawyer before you sign.

[Anonymous]

You need to look at the actual policy ~ they may even have a paper one

[Anonymous]

My mom bought a LTC policy back in the 1990s and THANK GOD it had no cap because she has been in LTC for ten years and I'm sure it has paid $500,000 by now.

Who knows if such policies are even available now and how crazy the premiums are.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

My mom has plenty of money AND got a LTC plan years ago. She’s in memory care and we’re paying 20K monthly for her care - LTC pays 15k of that bill. dementia or disability can wipe out your savings very quickly.

Can you describe in a bit more detail your mom’s circumstances/setup? We have an only child and I’m determined to make our older years as easy on him as possible.

There’s nothing easy about this phase of life but it’s great that you’re thinking this through now. What kind of info do you want to know?


I think a lot of LTC planning is in part making sure the family members feel their loved one is adequately supported in the way their loved one or they themselves would want to be cared for. I would hope that my DH and/or myself are cared for in a way that allows family members to maximize whatever time they spend together, without having to think about things like "is my family member being fed properly; do they have help with toileting; is someone interacting with them in a significant way; if they have limited mobility, is someone paying attention and repositioning them to avoid decubitus ulcers". Has your mother been able to age in place? If not, did she move to a facility of her own choosing? If she moved to a facility, is it a place that you yourself could see yourself spending your last few years?

TIA for your input!

[Anonymous]

They usually have a daily cap, say $350, and a total cap like $300,900 depending on what you bought.

Currently expensive to start and they continually raise the premiums.

True as a previous poster mentioned, you need someone to manage making sure the reimbursements happen. It’s more work than you’d think.

Also, unless a CNA, they do not accept just anyone for the caregiver to get paid.

[Anonymous]

Anonymous wrote:They usually have a daily cap, say $350, and a total cap like $300,900 depending on what you bought.

Currently expensive to start and they continually raise the premiums.

True as a previous poster mentioned, you need someone to manage making sure the reimbursements happen. It’s more work than you’d think.

Also, unless a CNA, they do not accept just anyone for the caregiver to get paid.

My Dad was paying $600 a day last year.