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Shawn Britt

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Shawn Britt has been engaged in the life insurance and long term care industry for more than 25 years. She joined Nationwide in 2000 and has been a member of Nationwide’s advanced sales team since 2005. Britt has been a major influence in the development and promotion of Nationwide’s suite of long term care product solutions. She is a frequently published author of white papers and articles on long term care for Nationwide as well as the insurance industry. She has been widely published and interviewed regarding long term care for numerous trade publications and nationwide media that include the CLTC Quarterly Digest, National Underwriter, Financial Advisor, Center for Long-Term Care Reform, The Wall Street Journal, CBS New Money Watch, Market Watch Radio and LifeHealthPro. Britt is a frequent presenter and keynote speaker at numerous industry events and conferences including AALU and ILTCI. She has served on the Board of Financial Professionals for CLTC and currently serves as a CLTC contributor. She also served for several years as an adjunct professor at The Ohio State University and has been recognized as an alumnus of the month by The American College. Britt may reached via email at britts@nationwide.com.

The Case For Affluent Clients Buying Long Term Care Coverage

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Many clients—and some financial professionals—think that insuring for long term care is something reserved for the middle class and that more affluent clients can afford to self-insure. In truth, affluent clients should consider purchasing long term care coverage as well. Because this client group can generally afford better health care, they are more likely to deny the need for long term care. But studies show that the longer you live, the more likely you will need long term care.1 Therefore, the good health these clients often enjoy could increase their chance of needing long term care in the future.

Affluent clients may pay more for long term care
In addition, long term care services will most likely cost more for affluent people. According to industry expert Claude Thau, affluent clients may not only be more likely than middle class Americans to need long term care services in their lifetime, but the cost of their care may be more expensive.2 That’s because affluent people:

  • Tend to want better quality long term care, which will be more expensive.
  • Are more likely to stay home regardless of the cost to do so.
  • Are more likely when entering a facility to choose a costlier private room.
  • Are more likely to select an upscale facility and/or location in town.
  • May be less likely to receive care from their children; their children often have higher profile and/or demanding jobs, and they may have relocated for career advancement.

Insuring the portfolio—not the person
Many affluent clients hope they will never need care but believe that, if they do, they can afford to pay for it out of their own pocket. That’s why a traditional long term care discussion that centers on the risk of needing long term care—and the importance of insuring that risk—may not go very far. Remember that because these clients may perceive themselves to be “healthy and in good shape,” they are more prone to denying that long term care will be part of their future.

It may be more impactful to discuss the consequences to the client’s portfolio if a long term care event occurs at an inopportune time with regards to market performance. In other words, talk about insuring the portfolio—not the person.

Insuring the portfolio against an unexpected long term care event
These clients have most likely lived through the Dot Com crash of 2000, the 2008 crash blamed on the real estate and banking industry debacle and perhaps even the market crash referred to as Black Monday that occurred on October 19, 1987. Ask your client if they believe the market could take another tumble. Since the answer will probably be yes, you may get a better response to a discussion that includes statements like these: “I would like to discuss insuring your portfolio against an unexpected extended health care (long term care) event at a time when the market and your account values are down. To do that, I would like to help you create a dedicated stream of income—one that is not tied to the market but is ready to go at a moment’s notice—to help pay for any long term care expenses you may have without jeopardizing our strategy for your portfolio.”

While it’s not possible to predict how and when an account will recover from such events, a financial professional may want to remind the client that: “It could be hard to build your account values back up when you are withdrawing substantial amounts of money from your account to pay for the type of care you want and need.”

Although these clients can probably afford to self-insure their potential long term care expenses, they should know that: “There is no guarantee such an event will occur at a time that is convenient to market performance and your portfolio.”

It helps to share this reminder: “It’s my job to discuss ways to help you protect and grow your assets.”

Self-insuring vs. “self-assuring”
Affluent clients may be more interested in a discussion that centers on protecting their portfolio. It all comes down to how to self-insure. First, agree with your client that they can afford to self-insure. But then add that there is more than one way to self-insure, and you’d like to show them a way that is potentially more cost effective. Encourage your affluent client to think in terms of self-assure rather than self-insure.

The client’s assets or available income and/or other financial needs will dictate the long term care insurance solutions. There may be a greater need for life insurance coverage now and long term care funding later. Or, the client may be in a position where specific long term care coverage is more appropriate.

Regardless of your client’s needs, there are various solutions that can address long term care and financial strategies. Let’s look at an example using a cash indemnity linked benefit policy and how it would play out in a self-insure scenario vs. a self-assure scenario. This example uses smaller numbers for simplicity, and assumes a 55-year-old female, couples rate, non-tobacco, six-year benefit duration and no inflation option.3

Self-insuring
A person who intends to self-insure might place $100,000 in a secure money market account or other liquid investment. When long term care is needed, they would spend that $100,000 (plus interest) on long term care expenses and have the total flexibility of cash to pay for any type of care they want, as well as any other needs they might have. If that person is still alive and needs care when the $100,000 (plus interest) is gone, they would have to tap into their accounts and other personal resources to continue paying long term care bills. The need for these funds could come at a time when those other account values have suffered downturns.

Self-assuring may be more efficient
Purchasing cash indemnity long term care coverage will produce a different outcome. This same person places $100,000 into a linked benefit long term care policy, purchasing a long term care benefit pool of $541,000. When care is needed, the first $100,000 of benefits would essentially come from their own premium dollars. But once that $100,000 is used, the policy offers $441,000 in additional benefits, paid by the insurance company—not the person’s assets—available to help pay for long term care expenses.4 On the other hand, the self-insure plan would not have provided these extra dollars provided by this insurance protection. And since the policy pays benefits by cash indemnity, the individual will maintain the flexibility of care choices without restrictions from the insurance company.

The key to having a successful long term care discussion that will motivate your affluent client to take action is to center the discussion around portfolio success and how the use of insurance can help protect their portfolio by providing a hedge against long term care expenses. By doing so, you can help them understand the importance of purchasing long term care coverage. If more long term care is needed, funds come from insurance rather than assets.

References:

  1. Council on Aging—“Should I Buy Long Term Care Insurance?”, September 2016.
  2. Affluence is a Key Variable in Long-Term Care Considerations, Claud Thau,Ingram’s Magazine, August 18, 2017.
  3. Stated benefit amounts are based on hypothetical examples, and actual benefit amounts received will vary with changes to age and ratings.
  4. These numbers represent the approximate long term care pool benefit for a 55-year old, female, non-tobacco, and couple rate on a cash indemnity linked benefit long term care policy.

Finding The Right Fit For Your Client’s Long Term Care Planning

Overcoming obstacles and objections you may face is key when discussing long term care planning with your clients. Once your client is on board, it is important to help them choose long term care coverage that best fits with their overall financial strategy.

Helping clients understand long term care insurance
Common questions that clients may have are:

  • How much is long term care insurance?
  • What does long term care insurance cover?
  • How are long term care benefits paid?
  • How does long term care insurance work?

How much does long term care insurance cost?
The cost of long term care coverage depends on factors including age, sex, and health of the insured as well as planning details such as the amount of coverage, whether inflation is added, and whether or not the long term care plan will be paired with a financial product. The variety of products available today can provide an opportunity to match a policy with a client’s budget and other potential planning needs.

What a long term care policy covers
While basic coverage is universal among most policies, it is important to read the contract for small details and variances in coverage. Contractually, all policies cover the basics such as:

  • Home Health Care
  • Assisted Living
  • Adult Day Care
  • Nursing Home Care

However, the type of long term care benefit payment model the policy uses may also help to establish what other long term care services the policy benefits can be used for, and/or how much of the benefit dollars will be available to be spent for a particular type of care service.

Long term care benefit payment models
While there are many variations, long term care benefits models generally fall into two categories—reimbursement and cash indemnity plans.

Reimbursement
These policies only reimburse the actual cost of qualifying care, up to the issued policy benefit amount. Bills and receipts must be submitted each month to determine the amount of reimbursement. Keep in mind that reimbursement policies may have limitations and do not cover all expenses a person may consider necessary for their care, thus there may be items or services on a bill that will not qualify for reimbursement (i.e. hair care from the facility’s beauty parlor, massage therapy, or upkeep of home care is being received in). Such expenses will have to be paid for out of pocket.

Cash Indemnity
These policies are generally more flexible than reimbursement plans. Once payments begin, there is no monthly paperwork required and the full available long term care benefit is paid each month. The insurer places no restrictions on how long term care benefits are used for care. Benefits can be spent on whatever care services are desired. This would include using 100 percent of the long term care benefits to pay for unlicensed care (including immediate family members) as well as to pay for ancillary care needs such as prescriptions, home maintenance, laundry, etc.

Making the most of your long term care planning
Choosing the best coverage for your client’s situation is a multi-step process. It starts with looking at his overall financial strategy, both current and future. This would include:

  • Assessing whether additional life insurance or retirement planning is needed.
  • If legacy planning is desired (whether family legacy or charitable giving).
  • Financial protection of a surviving spouse.
  • How much income or which asset is available to fund the long term care coverage.
  • What long term care benefit model would be preferable.

Once you have determined these planning points, you can move forward with product choice. There are several ways to fund for a long term care event, including:

  • Traditional long term care insurance.
  • Long term care rider on life insurance.
  • Linked benefit (Hybrid) long term care coverage.

Each one of these solutions works differently, addresses different concerns, and provides its own unique way to pair with an overall financial strategy. These differences may even affect when to buy long term care insurance.

Traditional long term care insurance
This policy only pays if a qualifying long term care event occurs. While often providing the most coverage for the least cost, premiums are not guaranteed. There may be more flexibility in choosing options such as elimination periods, benefit periods, and inflation. With most carriers, only lifetime premium payment schedules are available and, generally, these policies only pay long term care benefits by reimbursement.

This solution may be valued by people who:

  • Do not want or need life insurance.
  • Want more customization of benefits.
  • Understand that the policy is essentially “use it or lose it” regarding premiums paid (a few companies offer riders for an additional cost that return unused premium to beneficiaries).
  • Are looking for the most coverage for the least amount of premium.

Life insurance with a long term care rider
This solution is for people with a life insurance need, but also have long term care concerns. This policy can help provide family protection now but, if life insurance needs diminish in the future, the policy can transition more into being long term care protection. Long term care benefits are paid as an acceleration of the death benefit but, if long term care benefits are little used or never needed, any remaining death benefit will be paid to the beneficiary. Some solutions can guarantee both the premiums and long term care benefits (as long as premiums are paid as scheduled). There is a multitude of premium schedules available and both reimbursement and cash indemnity benefits are available depending on the carrier chosen. This solution provides the best leverage of death benefit but may not provide the greatest amount in long term care benefits compared to other products.

This solution may be more desirable for people who:

  • Currently have a life insurance need.
  • Want both life insurance and long term care but don’t want to buy each separately.
  • Want more choice in premium schedules—either to fit a budget or pay up premium obligations quickly.
  • Like the idea of a leveraged death benefit that pays if the policy is little or never used.

Linked benefit (also known as Hybrid) long term care coverage
These policies are for people whose primary need is long term care but want cost recovery if long term care is little or never needed. This policy has two benefit pools linked together:

  • The first benefit pool is life insurance with a long term care rider, and long term care benefits are paid from this benefit pool first. If long term care is never needed, the death benefit is guaranteed to be at least equal to or better than the total premiums paid.
  • The second benefit pool continues to pay long term care benefits but is for long term care benefits only.

These policies have options more similar to traditional long term care coverage such as choice of benefit periods and inflation options. Policy premiums and long term care benefits are guaranteed (assuming the premium is paid as scheduled). These policies can be purchased with a single premium and limited pays such as five or 10 years, and some insurance companies offer longer premium schedules such as pay to age 65 and pay to age 100.

This coverage is good for people who:

  • Primarily want long term care coverage.
  • Are looking for some customized policy options.
  • Want guaranteed premiums and benefits.
  • Want premium protection if the policy is little or not used.

Summary
Long term care planning can be an important part of a retirement strategy. There are more options than ever for finding long term care coverage that can fit into a client’s budget as well as their current and future financial approach.