Couple of Questions and a Story.

Bryan T.

New Member
11
Hi, I’m new here having just joined the other day. I’m heading in the direction of getting my licenses back. I was dumb and let them fall by the wayside. I had a Life Accident and Health license for 19 years and just let it go. I was inactive and don’t know what I was thinking.

Anyway, I was in the LTC sales arena in its beginning. I marketed for one of the first two companies that offered it. Then everyone jumped in the game and things got competitive and for some reason I got side tracked.

Without a doubt, the best commissions I made were in the LTC market. I only did it part time and didn’t sell thousands of policies, but I did maintain 100% persistency in what little I did sell. Even though it was small, I was kind of proud of it. That’s all history though and I’m thinking of jumping back in the game and need to get up to speed and of course get the licenses back.

I ran into a guy’s wife I know Friday. He lives about a mile from me. He was never one of those friends you stop by or call everyday. I haven’t seen the guy in eight or nine months and had no clue what had happened to him. I’m going to tell this story because it may help some of you agents or people in Insurance Land that are contemplating LTC coverage.

You agents know what I learned way back and that is that stories help you sell. You potential LTC buyers, stories have to be used to paint you a picture that no brochure or computer presentation can paint. So, this is a real, true story that is still unfolding right now.

Paul, the guy I know, was not in the best of health. He has some kind of degenerative neurological disease, I couldn’t tell you which one, but it isn’t ALS. I have watched him go down hill the past few years, but he was not in a wheelchair, just slowed down to a shuffle in his walk and naturally couldn’t do anything anymore.

Last August, Paul wound up in the hospital with Pneumonia. His wife had a particular type that was new to me. Anyway, Paul went into a coma for 20 days and he became Septic and his organs started shutting down, kidneys naturally. He came out of the coma and is on Kidney Dialysis and bedridden. He has been in a nursing home for the past, almost 90 days.

You agents know where I’m heading, but for your prospective insurance buyers on Medicare particularly, 90 days is all you get initially out of the hospital, then you’ve got to go somewhere. In Paul’s case, he’s coming home and unfortunately his wife and family are going to attempt to take care of them. General Public, it can’t be done and the doctors have told her, she will wind up down with him, and she admitted that to me in her story.

I heard the horror stories back in the day and nothing has changed. It can and will happen, but in this case Paul’s wife has no choice. He’s going out the door, if it’s on the nursing home curb, bottom line. Why, they can’t afford to pay cash and have no LTC coverage.

Paul was on Medicare due to his disability and I watched their assets dwindle over the last few years. He is now on Medicare/Medicaid and that’s all. Paul was not a freeloader in his life. He had a college education and worked in an industry where he made good money, He invested his money and due to his disease, has nothing much left and now this.

Now, I want to cover the cost. Now, remember this, we are located in Podunk, USA. These numbers might be much higher depending on your location. I know you agents know this, that was for the General Public. The hospital stay, I can’t remember how many days, totaled up to, the wife told me, $660,000.00. Now, Paul, I would imagine, will be covered and the hospital may write off the difference in what Medicare and Medicaid pays. To be honest, I don’t have a clue of the reimbursement rate today. The nursing home was adding up at a rate of $5,900.00 per month. Back in my day $1,700.00 a month was about the norm around here.

I’ll plug something in here and you agents can correct me. The Medicaid rules were change back in my LTC business days. I don’t know where they are today, but then they began a look back period, I think it was called. One couldn’t transfer their assets to another to become eligible for Medicaid. If caught you could be in a bind. Five years, pops into my mind in the look back period. Then, when the recipient and his or her spouse are both deceased, they will come and take you estate, whatever is left. Then if a balance is due they still look to the children. Am I correct? Is it still the same?

I know you agents have heard it and I have too. People say they will just put aside money and pay their own way. General Public you can’t self-insure if you are not the mega rich like Buffet or Gates.

General Public, whether you have one of the “Junk Policies they are calling them now, or Medicare, or a PPACA plan. Check out what you have. Don’t believe me, or anyone else. Investigate it for yourself. READ YOUR POLICY if you have one and remember the large print giveth and the small print taketh away.

Now, for my other question, where does LTC fall in this PPACA thing. I have the law in a PDF file, but I don’t have another lifetime to read it and seek legal interpretation if needed. Can y’all get me up to speed on this?

Sorry I wrote a book, but while I was here I thought I would give you agents another horror story to tell and give the public a real life situation.
 
Bryan,
Not sure what the point of your story is.
Bottom line is you've been out of the business for 19 years. LTC insurance is a totally different landscape today and you need to go back to school and re-educate yourself.
 
Long term care insurance has evolved now. there are other alternatives aside from the "traditional ltc insurance" that you knew. In terms of medicaid, you can make the most out of it for long term care because there is a program called the long term care insurance partnership which is a collaboration between the government and private insurance companies. And with this program you don't have to use all of your asset to qualify...True that having ltc coverage is important because it is something that most people are glad they got, many seniors end up losing all their assets after being on long term care services, so self insuring is a no, no unless you got millions of money in your savings account. You may want to visit infolongtermcare.org, they have comprehensive information about ltc news, blogs and guides. Hope this helps :)
 
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Arthur,

Maybe I didn't make myself clear. Let me see if I can clarify things.

I have not been out of the business 19 years. I was licensed for 19 years and just let it go 4 years ago. Granted it has been a while I'll admit, and I'm here seeking a little info. I know it's a different landscape today that's why I'm here trying to learn a little, before I go back to school.

I have followed some areas, to a limited degree, even though I wasn't directly involved. I do know this for a fact and the story tells it. Medicare has not changed from my days of selling Medicare Supplements and LTC. I would be willing to bet, the average person on Medicare still has no clue what they actually cover and the Pre-Medicare may know even less, if that’s possible. I stay abreast of things too, through my wife, who works for a neurosurgeon and pre-certifies treatment, not only Medicare, but the insurance companies. I could tell some stories in that too as far as the hoops that have to be jumped through and it will only get worse is my guess.

The story tells several things:

1. From a general health insurance prospective period. In this Flu season, with one of the deadliest forms out there this year, so I read, H1N1, I believe it’s called, and Pneumonia being the killer complication from the Flu, it can happen to anyone. One form is Septic Pneumonia and that is what my friend Paul had. I slipped and just called it Pneumonia.

The $660,000 can easily happen to anyone regardless of a so called “Junk Policy”, PPACA plan, Medicare, Medicaid, Hospital Indemnity Plan or whatever.

By the way, my wife ran across a lady with an employer provided Hospital Indemnity Plan last year. She could hardly walk, needed surgery, but didn't have the treatment because she couldn't’t come out of pocket and thought she had the old 80/20 type policy. Where would she be in a situation like this?

Also, if you didn't’t know it, these days, if you go into a hospital for something simple today, without a Staph infection, you might wind up with a Staph infection before you get out. A Staph infection can lead to Sepsis too and a situation as my friend Paul, without the pneumonia. Oh, my wife has a school classmate who is the Infection Control Nurse at the hospital next door to her office and I started my limited knowledge on Staph after she told my wife some stories. There is a whole bunch of Staph running around, with the majority harmless, but in this scenario the dangerous culprit is Staphylococcus aureus.

I have also seen a story on TV of a big hospital in San Francisco, where the Chief of Staff was interviewed on Staph and the high rate and what they did to bring it more under control. Simple hand washing was the answer. So maybe you can use that yourself and tell somebody to watch their health care provided to make sure they not only wash their hands, but wear a new pair of gloves.

The point here is that these are just two little thing that could put any of us in Paul’s situation. I always tried to use examples, situations, and scenarios and I guess here is no different.

I had a couple of sites to direct you to, but I'm too new to be able to use that feature. Google, or Bing it and look for emedicine health on sepsis and Mayo clinic on Staph

These weren't my points, but they are now.

2. Medicare still kicks you to the curb after 90 days and Paul's got to go somewhere.
3. The need for long term care (Nursing Homes) is still there regardless what coverage one has or hasn't got and will only get greater with us boomers coming along and Paul is one.
4. Back Paul up, before his disability and present situation with Medicare and Medicaid and where would he be?

These are just a few things one might read into the story. I hope I cleared the picture up a little. I haven’t quite enrolled in school yet, but I’m headed that way.

Karen,

Thanks for the info I’ll read up on it. Things have changed and will continue to change from now on.

All I was trying to do here was to tell a story that was apparently irrelevant, but I don’t think so. I was using it to get up to speed on what was going on today in LTC.

I was offering it for use as; I used other people’s stories in my sales years ago. I can make various scenarios out of this one. I knew guys that would lie their a** off to get the sale, and a couple lost their license, as they should have, but I used true stories to help me sale. This one is true, it just came from me.

The products might have changed, but the sales basics haven’t. Diseases have gotten worse though and many lead to these type situations.

I hope I have brought the picture into focus.
 
Karen,

Thanks for the info I’ll read up on it. Things have changed and will continue to change from now on.

All I was trying to do here was to tell a story that was apparently irrelevant, but I don’t think so. I was using it to get up to speed on what was going on today in LTC.

I was offering it for use as; I used other people’s stories in my sales years ago. I can make various scenarios out of this one. I knew guys that would lie their a** off to get the sale, and a couple lost their license, as they should have, but I used true stories to help me sale. This one is true, it just came from me.

The products might have changed, but the sales basics haven’t. Diseases have gotten worse though and many lead to these type situations.

I hope I have brought the picture into focus.

Wow, that was a lot of information, thank you for that..I didn't know that every little infection could be fatal to everyone. We all should be extra careful..however, in cases like Paul's it is indeed so sad to hear that he has gotten through a lot of difficulties...it is just comforting to know that there are still people or agents like you who do selling by putting a picture into the situation so you can offer a solution based on their needs. It is true that a lot of agents who approach selling life,health, home or long term care insurance by feeding the clients what they need and what they don't without listening and understanding the clients first.. You are correct, the products has changed, they may even have evolved, but they way the sales are conducted hasn't :(
 
You mentioned something I heard years ago but I don't know which state enforce it. The part about children being responsible for the cost of a parent's care. Do you have any info on that and which states do it?
 
"You may want to visit infolongtermcare . org, they have comprehensive information about ltc news, blogs and guides. Hope this helps..."
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Nice way to plug your business website (.org???) disguising yourself as a helpful servant. Please read the rules of the Forum.
 
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"You may want to visit infolongtermcare . org, they have comprehensive information about ltc news, blogs and guides. Hope this helps..."
******************************
Nice way to plug your business website (.org???) disguising yourself as a helpful servant. Please read the rules of the Forum.

Yes, if I never have to read "hope this helps" at the end of a post again I will be happy.
 
"You may want to visit infolongtermcare . org, they have comprehensive information about ltc news, blogs and guides. Hope this helps..."
******************************
Nice way to plug your business website (.org???) disguising yourself as a helpful servant. Please read the rules of the Forum.

Just to clear things out, I am not an employee of ILTC nor a sales agent...I don't even own the company nor am I connected with it. I am a freelance writer and I contribute articles to their website and they happily post it. I just witness what my parents experience when they used to pay for my grandparents nursing homes and long term care services. So I started writing about it, hope this explains it :)

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You mentioned something I heard years ago but I don't know which state enforce it. The part about children being responsible for the cost of a parent's care. Do you have any info on that and which states do it?

I believe it is the case of John Pittas, it has something to do with the filial responsibility law, 29 states have the filial law:
Alaska
Arkansas
California
Connecticut
Georgia
Indiana
Iowa
Kentucky
Louisiana
Maryland
Massachusetts
Mississippi
Montana
Nevada
New Hampshire
New Jersey
North Carolina
North Dakota
Ohio
Oregon
Pennsylvania
Rhode Island
South Dakota
Tennessee
Utah
Vermont
Virginia
West Virginia

Hope this helps :)
 
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