# LTC discussion and self-insure trust discussion



## seniorpetra (Jan 17, 2020)

Hello,
I need to discuss regarding the LTC and " Self-insure" trust for long term care.


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## mathjak107 (Jan 18, 2020)

We were going to self insure for ltc ...but we were featured in money magazine many many years ago and their team of pros convinced us we were not doing a good thing .

We agreed ....the problem with self insuring is you need a huge sum of money day 1....like insurers , you need to keep that money safe and that means low returns ..  

That money can not be counted as part of the income generation pool either ...as even the 4% safe with drawl rate assumes that money can dwindle away under poor outcomes .

They showed us that just by  keeping that lump sum invested normally we could take just a tiny portion of the gains and pay a premium on a real LTC policy...

In short I would never self insure.. we ended up getting a ny state partnership plan for long term care ....it gives us 6 years in home care and 3 years in a nursing facility ...when the insurance runs out all assets are 100% protected and Medicaid picks up the bills ...the stay at home spouses income is protected too ....there is no look back , no spend down , no nothing ...

That is the deal with our partnership plans


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## Rich29 (Jan 19, 2020)

I agree with Mathjak. While the premiums for our two LTC policies aren't cheap, knowing that a fixed plan is in place for
down the road is very comforting. I think it would take a lot of discipline to separate and not touch funds for self insuring, especially if life gets in the way.


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## mathjak107 (Jan 19, 2020)

it still does not solve the problem of protecting assets once that money runs out and or impoverishing the stay at home spouse


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## OneEyedDiva (Jan 20, 2020)

I have no choice but to "self insure".  I have/had pre-existing conditions that made me un-insurable both with our state retiree LTC plan offering and AARP's. For that reason I'm continuing to save/invest using most of my SS.  I live in New Jersey which has some of the highest nursing home rates in the country.  My retiree insurance through Aetna will pay for 120 days per benefit period of nursing home or home health care but I believe that is via reimbursement, not up front. Benefit periods start again after 60 days of being out of a skilled nursing facility (SNF).  Each admission to a SNF must be via transfer from a hospital. It is my hope that if it ever comes to that...I'd be able to get a very good care at home or at least be able to use that option for awhile. The cost difference is quite significant. This website shows the monthly cost of SNF by state as well as the cost of different care options. https://www.seniorliving.org/nursing-homes/costs/


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## mathjak107 (Jan 20, 2020)

OneEyedDiva said:


> I have no choice but to "self insure".  I have/had pre-existing conditions that made me un-insurable both with our state retiree LTC plan offering and AARP's. For that reason I'm continuing to save/invest using most of my SS.  I live in New Jersey which has some of the highest nursing home rates in the country.  My retiree insurance through Aetna will pay for 120 days per benefit period of nursing home or home health care but I believe that is via reimbursement, not up front. Benefit periods start again after 60 days of being out of a skilled nursing facility (SNF).  Each admission to a SNF must be via transfer from a hospital. It is my hope that if it ever comes to that...I'd be able to get a very good care at home or at least be able to use that option for awhile. The cost difference is quite significant. This website shows the monthly cost of SNF by state as well as the cost of different care options. https://www.seniorliving.org/nursing-homes/costs/


what about a hybrid  life . ltc insurance policy ? they are way less tougher to get

https://www.investopedia.com/insurance/paying-longterm-care-how-its-changing/


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## OneEyedDiva (Jan 20, 2020)

mathjak107 said:


> what about a hybrid  life . ltc insurance policy ? they are way less tougher to get
> 
> https://www.investopedia.com/insurance/paying-longterm-care-how-its-changing/


Thank you...I will check into this.


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## mathjak107 (Jan 20, 2020)

while not my first choice for ltc , they  can serve a purpose...  the hybrids though are one of the most costly ways to get coverage though in a very sneaky way .

they do require a fairly large lump sum and you forfeit the interest to pay for the ltc policy .... they never have to raise your costs because increases are built in as interest rates go up and they keep your interest .....


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## Lethe200 (Jan 20, 2020)

mathjak107 said:


> it still does not solve the problem of protecting assets once that money runs out and or impoverishing the stay at home spouse



Have you looked into the division of assets after the policy runs out? We have LTCi policies, so I've never paid much attention to discussions of asset division. But I know it's recommended by some, and actually I have a Net friend who did it when her husband had to suddenly go into a nursing home . She was advised to do it by both the VA rep and her CPA.

I believe one of the issues with it is that there is an asset limit, as she had to "spend down" very quickly before doing the division. She certainly is not rich (five years after the death of her spouse, who sadly passed away after about a year in SCN), but she was able to keep the house and can support herself with a part-time job and SocSec.

If I recall, one of the reasons I don't follow asset division posts is that when I first read up on it, the limits were low enough that it wasn't applicable to us. When one lives in an expensive RE area, the appraised value of a home is large enough that it isn't possible to divide the value yet stay under the limits.


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## Pecos (Jan 20, 2020)

We have paid-up "hybrid life insurance" and are planning to self insure beyond that.

But frankly, the amount of money that a couple will actually need is a bit of a "crap shoot."


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## mathjak107 (Jan 20, 2020)

Pecos said:


> We have paid-up "hybrid life insurance" and are planning to self insure beyond that.
> 
> But frankly, the amount of money that a couple will actually need is a bit of a "crap shoot."


which is why we opted for a state partnership plan for ltc .. pretty much all offer them , but only two states offer full asset protection like ours does . most are dollar for dollar protection .


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## mathjak107 (Jan 20, 2020)

michael kitces looked at the hybrid plans .

*Executive Summary*
As traditional long-term care (LTC) insurance becomes more and more expensive, and interest rates remain at ultra-low levels, planners and their clients have become increasingly interested in so-called “Hybrid LTC” policies that match together a life insurance or annuity policy with LTC coverage, especially with a more favorable set of tax rules that took effect in 2010. For many, though, the primary appeal of hybrid policies is the simple fact that, unlike their traditional LTC insurance brethren, the premiums really are guaranteed and cannot be increased in the future. Given some of the extraordinarily large premium increases that traditional LTC coverage has experienced in recent years – especially for some of the early policies issued in the 1990s and early 2000s – a cost guarantee is remarkably reassuring.

Yet the reality is that the guarantee of LTC premiums in a hybrid policy may be entirely offset by the fact that the insurance company controls the cash value, and is under no obligation to pay a going rate of return, especially if interest rates rise. In other words, it doesn’t really matter that the insurance company can’t increase the premiums on the policy by $4,000/year, when the company can simply under-pay on the interest rate by $4,000/year to accomplish the same result! And while the cash value of a hybrid LTC policy generally does remain liquid, taking a withdrawal to reinvest to get better, higher rates would entail surrendering the policy and forfeiting the LTC coverage! In fact, for some types of hybrid LTC policies, the arrangement contractually provides no rate of return to the client at all, and is essentially the equivalent of the client selling a call option on interest rates to the insurance company, where the more rates rise the greater the company wins at the expense of the client!



https://www.kitces.com/blog/is-the-...-annuityltc-insurance-policies-just-a-mirage/


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## StarSong (Jan 21, 2020)

DH and I are self insuring, at least partly because CA's Medicaid asset seizure is less draconian than most states.  If there's a living spouse, the family home (of any value) is excluded from asset assessment, the spouse can keep $126K in liquid assets, and $3161 monthly "spousal allowance" is also shielded.  None of this is subject to a later clawback if the non-Medicaid spouse survives the Medicaid spouse. Not even when both spouses have passed.   

Yes, there are a lot of scares regarding long term nursing home care costs, but in my experience very few people actually spend months or years in Skilled Nursing Facilities these days. In fact, over the past 20 years none of my or my husband's relatives have spent long periods in SNFs. Assisted Living, yes. Nursing homes, no.

The lion's share of SNF patients are released within a few weeks.  ALs have picked up more and more of the care previously only supplied by home health aides and nursing homes.  

With hospice and end of life care moving toward not prolonging life when there's little quality remaining, I don't see myself or my husband needing years of SNF care.   Maybe that's naive.  Who knows?   

Good ALs cost roughly $4K a month, memory care with all the bells and whistles are closer to $5K. We could manage that. SNFs are closer to $10K, a less doable option and a far less pleasant environment.


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## Liberty (Jan 22, 2020)

StarSong said:


> DH and I are self insuring, at least partly because CA's Medicaid asset seizure is less draconian than most states.  If there's a living spouse, the family home (of any value) is excluded from asset assessment, the spouse can keep $126K in liquid assets, and $3161 monthly "spousal allowance" is also shielded.  None of this is subject to a later clawback if the non-Medicaid spouse survives the Medicaid spouse. Not even when both spouses have passed.
> 
> Yes, there are a lot of scares regarding long term nursing home care costs, but in my experience very few people actually spend months or years in Skilled Nursing Facilities these days. In fact, over the past 20 years none of my or my husband's relatives have spent long periods in SNFs. Assisted Living, yes. Nursing homes, no.
> 
> ...


Lets pray we and your family never need full nursing home care.  I do wonder if in the earlier days the options were less than today.  Both my MIL and her father spent years in a SNH facility.


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## StarSong (Jan 22, 2020)

Liberty said:


> Lets pray we and your family never need full nursing home care.  I do wonder if in the earlier days the options were less than today.  Both my MIL and her father spent years in a SNH facility.


Life is fraught with risks and gambles.  

Hubby and I have both expressed strong desires for an easy exit over a long-term nursing home existence because of a condition that offers no hope of improvement.      

Guess we need to start stashing meds that will offer an easier way out of this life if it comes down to that.


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## Liberty (Jan 22, 2020)

StarSong said:


> Life is fraught with risks and gambles.
> 
> Hubby and I have both expressed strong desires for an easy exit over a long-term nursing home existence because of a condition that offers no hope of improvement.
> 
> Guess we need to start stashing meds that will offer an easier way out of this life if it comes down to that.


Yeah, Star...or get that "one way ticket to Oregon" as hub says!


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## StarSong (Jan 22, 2020)

Liberty said:


> Yeah, Star...or get that "one way ticket to Oregon" as hub says!


It's just up the coast...


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## Butterfly (Jan 22, 2020)

I cannot imagine much of anything worse than year after year in some nursing home with no hope of recovery or improvement or any quality of life.  If I ever find myself facing something like that, I hope I can find the courage to do something about it.  A judiciously applied .38 to the temple comes to mind if all else fails . . . .


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## StarSong (Jan 22, 2020)

Butterfly said:


> I cannot imagine much of anything worse than year after year in some nursing home with no hope of recovery or improvement or any quality of life.  If I ever find myself facing something like that, I hope I can find the courage to do something about it.  *A judiciously applied .38 to the temple comes to mind if all else fails . . . .*


Eek!   Couldn't do that.  What a terrible scene for someone to stumble on, not to mention clean up.  Pills would be my exit of preference.


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## Aunt Bea (Jan 22, 2020)

I agree I wouldn't want to put anyone to the trouble of cleaning up my remains or my apartment.






Hopefully, by the time I get to that point, we will have a simple pill that we can take and be on our way.


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## mathjak107 (Jan 23, 2020)

my wifes father inlaw was a big smoker ...he used to say all the time  . why should i stop smoking if i enjoy it , for what , so i can live a year or two longer ?  if i get cancer i will just pull the trigger on my gun .

well he got lung cancer and he cried like a baby for being so stupid , he begged for each additional day to live ...

so all this talk about doing one's self in rarely comes to pass as we have a huge drive to live .


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## StarSong (Jan 23, 2020)

mathjak107 said:


> my wifes father inlaw was a big smoker ...he used to say all the time  . why should i stop smoking if i enjoy it , for what , so i can live a year or two longer ?  if i get cancer i will just pull the trigger on my gun .
> 
> well he got lung cancer and he cried like a baby for being so stupid , he begged for each additional day to live ...
> 
> so all this talk about doing one's self in rarely comes to pass as we have a huge drive to live .


I'm sorry about your FIL, @mathjak107.  That must have been difficult to watch.  Did he do a long stint in a nursing home?


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## mathjak107 (Jan 23, 2020)

StarSong said:


> I'm sorry about your FIL, @mathjak107.  That must have been difficult to watch.  Did he do a long stint in a nursing home?


he was at home ... he lived 2 days after we got married . they carried him downstairs , he saw us get married and died 2 days later


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## mathjak107 (Jan 23, 2020)

mathjak107 said:


> he was at home ... he lived 2 days after we got married . they carried him downstairs , he saw us get married  , which we had to do at the house so we cancelled our wedding plans and  he died 2 days later.
> 
> 
> so all those who think they are pulling the trigger better have a back up plan for when they don't or can't


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## StarSong (Jan 23, 2020)

mathjak107 said:


> he was at home ... he lived 2 days after we got married . they carried him downstairs , he saw us get married and died 2 days later


So he wasn't confined to a nursing home, literally lying there waiting to die for months or years with no hope of any improvement?


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## Liberty (Jan 23, 2020)

My dad worked in a foundry when he was young and smoked.  He became disabled and lived for 9 years at home.  Always said "he and God had a deal".  He always was able to read, play pool, shoot his long guns hunting, etc. and took care of himself right up till he took his last breath in his own bed.


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## Rich29 (Jan 23, 2020)

Some of the recent posts seem to question on the value of LTC for Nursing Home coverage. These arguments
have merit for some. I just want to point out the LTC policies (at least ours) includes Stay at Home lifetime benefits as well.
This means you can use all of the LTC lifetime benefits for home care for physical ( bathing, toileting, dressing, etc.) issues
or cognitive impairment such as alzheimer's.


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## Liberty (Jan 23, 2020)

Rich29 said:


> Some of the recent posts seem to question on the value of LTC for Nursing Home coverage. These arguments
> have merit for some. I just want to point out the LTC policies (at least ours) includes Stay at Home lifetime benefits as well.
> This means you can use all of the LTC lifetime benefits for home care for physical ( bathing, toileting, dressing, etc.) issues
> or cognitive impairment such as alzheimer's.


Think that's really a good plan, unless of course it is too costly to maintain premiums.  Do think the future will have more economical  home care franchises and more visible assistance for home bound people of all ages, due to the growth rate of  aging baby boomers.  This should help most all of those who might need it.


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## Butterfly (Jan 23, 2020)

StarSong said:


> Eek!   Couldn't do that.  What a terrible scene for someone to stumble on, not to mention clean up.  Pills would be my exit of preference.



Pills would be my first choice, as well.  You've gotta know what you are doing to take enough of the right thing (or combination of things) to kill you, not throw them up, and not wind up a vegetable.  That's why I said "if all else fails."


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## Butterfly (Jan 23, 2020)

Aunt Bea said:


> I agree I wouldn't want to put anyone to the trouble of cleaning up my remains or my apartment.
> 
> 
> 
> ...



There are actually cleaning companies with teams of people who do nothing but clean up crime scenes, suicide scenes, etc.  We had to hire one to clean up a scene in a rental property I once helped manage.  They did a wonderful job and you would never have known anything happened there.  They have special cleaning supplies that will get anything out of anything, even lovely hardwood floors.  The people who do that make pretty good money, too, but I wouldn't have the stomach to do it.


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## mathjak107 (Jan 23, 2020)

Liberty said:


> Think that's really a good plan, unless of course it is too costly to maintain premiums.  Do think the future will have more economical  home care franchises and more visible assistance for home bound people of all ages, due to the growth rate of  aging baby boomers.  This should help most all of those who might need it.


We did not buy our ny partnership plan for the 3 years coverage ...we bought it for the benefits and total asset protection once the insurance was up


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## Aunt Bea (Jan 23, 2020)

Liberty said:


> Think that's really a good plan, unless of course it is too costly to maintain premiums.  *Do think the future will have more economical  home care franchises and more visible assistance for home bound people of all ages, due to the growth rate of  aging baby boomers.*  This should help most all of those who might need it.


I'm a little bit leery of the quality of home care workers, I'm afraid that I would end up like Doris Duke or Brooke Astor.

I kind of like the idea of having a care team in a more structured environment.

It seems like it's a whole lot easier to get into this world than it is to get out of it.


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## StarSong (Jan 24, 2020)

Aunt Bea said:


> *I'm a little bit leery of the quality of home care workers, I'm afraid that I would end up like Doris Duke or Brooke Astor.
> 
> I kind of like the idea of having a care team in a more structured environment.*
> 
> It seems like it's a whole lot easier to get into this world than it is to get out of it.


Boy do I ever agree with you on this!  Most of the home care workers I've seen aren't worth beans, and far too many steal people blind.


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## Liberty (Jan 24, 2020)

StarSong said:


> Boy do I ever agree with you on this!  Most of the home care workers I've seen aren't worth beans, and far too many steal people blind.


What's happening around this area of Texas is that background checks and "bonding" is being done on those wanting to work, before hiring with a lot of the services...especially the franchises.


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## StarSong (Jan 25, 2020)

Liberty said:


> What's happening around this area of Texas is that background checks and "bonding" is being done on those wanting to work, before hiring with a lot of the services...especially the franchises.


Yes, they do that in CA also.  Sadly, it's a pretty holey net that doesn't catch all the scoundrels.  It also doesn't prevent previously honest caregivers from taking advantages of crimes of opportunity.  Patients with failing cognitive abilities are unable to safeguard their information and valuables with rigorous judgement.  Easy prey.   

It becomes very difficult to prove or reconstruct how things happened. The family discovers that bank accounts have been cleaned out, valuables are missing, their relative can't remember who, what, when and where, and a caregiver or two has skipped town - or the country. 

If it sounds like I know whereof I speak, it's because I saw this happen, up close and personal. Twice.


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## mikermeals (Feb 2, 2020)

For the past  10 years we have been putting money monthly into a Vanguard Star fund which is a balanced fund and "should be" enough to take care of ltc.  Most people have home health care these days to that is what we are counting on.  I have monthly self funding in our retirement budget.  Of course there are no guarantees but this is the plan so far.


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## mathjak107 (Feb 2, 2020)

mikermeals said:


> For the past  10 years we have been putting money monthly into a Vanguard Star fund which is a balanced fund and "should be" enough to take care of ltc.  Most people have home health care these days to that is what we are counting on.  I have monthly self funding in our retirement budget.  Of course there are no guarantees but this is the plan so far.


And if you have a stroke tomorrow then what ?  Are you ready and financed ?


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## mikermeals (Feb 2, 2020)

mathjak107 said:


> And if you have a stroke tomorrow then what ?  Are you ready and financed ?


Yes I am still employed and have health insurance and other disability plans.  Even Medicare covers the hospital/doctors and medicine.  I look at LTC as nursing home/assisted living and home health care and hope I will have enough saved up for when I hit 85-95


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## mathjak107 (Feb 3, 2020)

mikermeals said:


> Yes I am still employed and have health insurance and other disability plans.  Even Medicare covers the hospital/doctors and medicine.  I look at LTC as nursing home/assisted living and home health care and hope I will have enough saved up for when I hit 85-95


my question was more addressing what happens if you are like my co-worker ..he fell off a ladder painting and broke his wrist and hip .. at age 55 he had a stroke during hip surgery . he was left paralyzed and in a nursing home ... his family was impoverished at this point  at 114k a year  for the home..so crap happens at younger ages too .


  after much thought about self insuring we went with a ny state partnership plan .

we wanted it not so much for the 3 years insurance , even though a snf is 120k-140k a year in our area , we wanted it for the perks after the insurance ran out .

no shifting of assets , full asset protection , pretty much full income protection for the stay at home spouse  , a special version of medicaid picks up the bills after the insurance runs out .

i mentioned in another thread , the fact that money magazine did a feature story on us years ago .

they wanted to put their team of pro's against me  since i did all my own planning .

i wanted to self insure and they were against it for so many reasons . they were right .

those who say they are self insuring really have no plan . they hope they don't need care and they hope they have the funds .

but once the stay at home spouse goes in to survival mode those funds become a battle ground usually .

the issue with self insuring is that like any insurance :

you need the funds to cover you day 1 . you have to invest that insurance money in a safe and secure fashion . it can not just be thrown in the pool of money generating your income since that assumes it can always go to zero doing so .

to self insure  properly means safe low returns on that money .

for just a small percentage of the gains from keeping our money invested normally we can pay for a full blown , inflation adjusted policy that covers 3 years in a snf or 6 years assisted living or in home care .

so we ended up going the policy route .

most of our attorney's work today is the self insurer's . they are scrambling at the last minute trying to preserve assets and to protect the income of their spouse .


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## mikermeals (Feb 3, 2020)

You are 100% correct.  My plan is not for everyone.


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## treeguy64 (Feb 3, 2020)

LTC, for what?  So you can live each boring, painful, unproductive day thinking about what your life used to be???  So you can regress to an almost infantile state wherein you'll have your diaper changed, your body bathed, your meals spoon-fed to you, as you vegetate in front of the TV screen?  Hell no, not me!

To the poster who implied that those who talk about committing suicide never have the wherewithal to actually do so:  I knew eight suicides, personally.  They did what needed to be done.  Three made a big mess, the other five thought things out and were no trouble to cart off.

When the times comes, if it does, I will neatly, and cleanly, make my exit, no big deal!

FWIW:  Years ago, I did intense research into LTC policies.  They were all a huge rip-off, and the fine print showed that you were never going to get the deal you were told you would get, by the selling agent.


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## StarSong (Feb 3, 2020)

treeguy64 said:


> LTC, for what? So you can live each boring, painful, unproductive day thinking about what your life used to be??? So you can regress to an almost infantile state wherein you'll have your diaper changed, your body bathed, your meals spoon-fed to you, as you vegetate in front of the TV screen? Hell no, not me!


A terrifying prospect, to be sure.  Even worse, so many lose their ability to process what's going on around them.  They're frequently terrified, don't recognize family members, and disappear a little more each day.  A terrible way to drift away from life.


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## Liberty (Feb 3, 2020)

treeguy64 said:


> LTC, for what?  So you can live each boring, painful, unproductive day thinking about what your life used to be???  So you can regress to an almost infantile state wherein you'll have your diaper changed, your body bathed, your meals spoon-fed to you, as you vegetate in front of the TV screen?  Hell no, not me!
> 
> To the poster who implied that those who talk about committing suicide never have the wherewithal to actually do so:  I knew eight suicides, personally.  They did what needed to be done.  Three made a big mess, the other five thought things out and were no trouble to cart off.
> 
> ...


I've often wondered about the validity of the long term care policies.  The big selling point today seems to be "at home care".  Did have a company client, that the VP (a woman) of the company became paralyzed and they had a policy that paid for an 8 hour caregiver daily for years.  She finally died.


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## mathjak107 (Feb 3, 2020)

Liberty said:


> I've often wondered about the validity of the long term care policies.  The big selling point today seems to be "at home care".  Did have a company client, that the VP (a woman) of the company became paralyzed and they had a policy that paid for an 8 hour caregiver daily for years.  She finally died.


all i know is we didn't buy our partnership plan for the three years coverage . we bought it for the asset protection and income protection it provides for ever once the insurance is up .


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## Liberty (Feb 3, 2020)

mathjak107 said:


> all i know is we didn't buy our partnership plan for the three years coverage . we bought it for the asset protection and income protection it provides for ever once the insurance is up .


You know, I do think this is the main issue for most folks...protecting the remaining spouse's assets.  Maybe its the "burden of riches"...lol.  You can't take it with you so obviously, if you care about your spouse, you want to make them as comfortable as you can for their remaining years.


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## mathjak107 (Feb 3, 2020)

Liberty said:


> You know, I do think this is the main issue for most folks...protecting the remaining spouse's assets.  Maybe its the "burden of riches"...lol.  You can't take it with you so obviously, if you care about your spouse, you want to make them as comfortable as you can for their remaining years.


for sure that is the reason ... i dont want my spouse to live an impoverished lifestyle ... my dad was in a home for 6 years . it was devastating


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## treeguy64 (Feb 3, 2020)

Get your will properly drawn up.  You can do it yourself, if you're up on laws that apply in your state.  Then, it's a simple matter of making sure your surviving mate gets your life insurance proceeds, the house goes into your mate's name as sole owner, and any other things of value become your mate's sole property.  You don't need some rip-off LTC policy to do the preceding.  If that's your thing, though, knock yourself out!


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## Don M. (Feb 3, 2020)

We took out a LTC policy almost 25 years ago.  With our luck, if we have insurance, we almost never need it, but the first time we try to "save" on costs, that is usually what goes wrong.  So, I'm hoping that all this money just goes down the drain, and we pass quickly.  
My next priority is to get all our affairs in order, while we are still mentally alert, and probably set up a Trust with all our assets, for the kids, so that if/when we become incapacitated, and pass away, our kids don't have to go through all the hassles of "probate", etc.


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## mathjak107 (Feb 3, 2020)

treeguy64 said:


> Get your will properly drawn up.  You can do it yourself, if you're up on laws that apply in your state.  Then, it's a simple matter of making sure your surviving mate gets your life insurance proceeds, the house goes into your mate's name as sole owner, and any other things of value become your mate's sole property.  You don't need some rip-off LTC policy to do the preceding.  If that's your thing, though, knock yourself out!


Life insurance does not help your spouse live until you are dead ..it does no good when she has depleted your assets down to a minimum and you are alive in the nursing home ...you Need to transfer assets five years before ,,what if it’s the spouse you transferred the assets to that needs the car ..this does not sound to good


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## treeguy64 (Feb 3, 2020)

mathjak107 said:


> Life insurance does not help your spouse live until you are dead ..it does no good when she has depleted your assets down to a minimum and you are alive in the nursing home ...


If *I* need help living, I WILL be dead!  Yeah, I know, suicide clause.  Thing is, I don't actually need insurance to provide for my heirs.  Alive in a nursing home???  Uh, that's not living!


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## mathjak107 (Feb 3, 2020)

treeguy64 said:


> If *I* need help living, I WILL be dead!  Yeah, I know, suicide clause.  Thing is, I don't actually need insurance to provide for my heirs.  Alive in a nursing home???  Uh, that's not living!


That whole plan including shifting assets sounds bad


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## treeguy64 (Feb 3, 2020)

mathjak107 said:


> That whole plan including shifting assets sounds bad


Worry about what works for you, man. I know what works for me. I can't remember ever asking for your advice.


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## mathjak107 (Feb 3, 2020)

treeguy64 said:


> Worry about what works for you, man. I know what works for me.


I do .. but I don’t want people here taking what you said  about life insurance and asset shifting as being a good answer ..as far as a spouse and a plan it is badly flawed


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## treeguy64 (Feb 3, 2020)

mathjak107 said:


> I do .. but I don’t want people here taking what you said  about life insurance and asset shifting as being a good answer ..as far as a spouse and a plan it is badly flawed


No, if one has the assets to provide for a partner, after one's death, the plan is, decidedly, NOT flawed.


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## mathjak107 (Feb 3, 2020)

Well that is not what you eluded to at all in what you suggested ...the problem is people parrot what others say and just keep perpetuating myth or misinformation ..in this case someone with out the resources will take what you said as the answer and it is badly flawed as a plan


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## treeguy64 (Feb 3, 2020)

mathjak107 said:


> Well that is not what you eluded to at all in what you suggested ...the problem is people parrot what others say and just keep perpetuating myth or misinformation ..in this case someone with out the resources will take what you said as the answer and it is badly flawed as a plan


Ignore.


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## Aunt Bea (Feb 3, 2020)

LTC is a serious concern but at this point in our lives, most of us will be unable to make any significant changes in our finances. 

We can take the time to understand Medicaid and the impact that it may have on an independent/surviving spouse.

IMO this is a good place to begin to understand some of the terms, federal limits, state limits, etc...

https://www.medicaidplanningassistance.org/mmmna-definition/


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## mathjak107 (Feb 3, 2020)

Each state has different rules so it is always best to see what your options are with an experienced  elder law attorney in advance of a problem


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## Floridatennisplayer (Feb 3, 2020)

Elderly gentleman last year in my parents condo complex in Florida off‘d himself in his condo.  End stage cancer, in home care, been lingering for a year with another long year in front of him.  Wrote a beautiful letter to his family, waited until his wife went to the grocery, turned on the shower, sat down on the floor of the shower and pulled the trigger.  Problem solved.


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## mathjak107 (Feb 4, 2020)

problem solved for that person , not for the family that has to deal with the loss


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## Butterfly (Feb 4, 2020)

StarSong said:


> A terrifying prospect, to be sure.  Even worse, so many lose their ability to process what's going on around them.  They're frequently terrified, don't recognize family members, and disappear a little more each day.  A terrible way to drift away from life.



I would hope I have the courage to solve the problem before it got to that.


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## StarSong (Feb 4, 2020)

Butterfly said:


> I would hope I have the courage to solve the problem before it got to that.


Me, too.


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## Liberty (Feb 4, 2020)

mathjak107 said:


> problem solved for that person , not for the family that has to deal with the loss


To many, the issue is to know "what might happen" - worst case scenerio - and how to prepare for it.
To us, that would be if either one had a stroke/or incapacitation and was then admitted to a nursing home for the rest of their life.  With a stroke it can be here one minute and far away the next, leaving the loved one(s) to cope with the decisions.  Like Aunt Bea said, knowing your states laws - & the "spend down" requirements for Medicaid are very important.  Of course, we all hope nothing like that would ever happen to ourselves or our loved ones, but knowledge is power.


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## mathjak107 (Feb 4, 2020)

being my dad spent 6 years in a home after a stroke and it financially really  hurt his wife ( not my mom )  it is an important part of our planning .

as long as we have out ltc partnership plan that aspect is covered for us


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## Liberty (Feb 4, 2020)

mathjak107 said:


> being my dad spent 6 years in a home after a stroke and it financially really  hurt his wife ( not my mom )  it is an important part of our planning .
> 
> as long as we have out ltc partnership plan that aspect is covered for us


Yes, its important to realize what might be needed, and to cover that base to protect assets, if possible...hoping of course, its never needed to "run that trap".  Being hit emotionally and financially is about as bad as it could get.  Hope your step mom or whatever you call her is doing better today!


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## mathjak107 (Feb 4, 2020)

she is , she passed away a few years ago .

but the home really left her in a pickle when my dad went in . it isn't just assets that are restricted but income is restricted for the stay at home spouse too


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## Liberty (Feb 4, 2020)

Retirement Educator said:


> Mutual of Omaha has a life product that allows for accelerated care (chronic care). I've used this for several clients with pre-existing conditions that precluded them from getting LTC, but were approved for life coverage. I am happy to talk further if you have any questions.


Mutual of Omaha was the company that raised our supplement rates the most for no reason...we went elsewhere and 
saved a couple hundred bucks a month.  We took no meds and had no pre-existing conditions.  Ah well, it is what it is in the insurance world. You can't win, period.


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## Liberty (Feb 4, 2020)

Retirement Educator said:


> Couple of thoughts - 1. traditional long-term care has no guarantee on premiums. That's for sure. It's a difficult world to navigate when all carriers are raising rates. 2. with hybrid products, you are able to purchase via guaranteed premiums, as it provides LTC style benefits, but on a life insurance chassis. Having premium guarantees and in many cases, the ability to one lump sum or a guaranteed 10 year schedule is vital to this planning.


Yep, it can be a racket for sure.  Lots of complaints on LTC policies.  Might be a license to steal depending on the lender.
Its like everybody wants a buck from the seniors these days.  LOL


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## mathjak107 (Feb 4, 2020)

Retirement Educator said:


> Couple of thoughts - 1. traditional long-term care has no guarantee on premiums. That's for sure. It's a difficult world to navigate when all carriers are raising rates. 2. with hybrid products, you are able to purchase via guaranteed premiums, as it provides LTC style benefits, but on a life insurance chassis. Having premium guarantees and in many cases, the ability to one lump sum or a guaranteed 10 year schedule is vital to this planning.






Retirement Educator said:


> Mutual of Omaha has a life product that allows for accelerated care (chronic care). I've used this for several clients with pre-existing conditions that precluded them from getting LTC, but were approved for life coverage. I am happy to talk further if you have any questions.


these hybrid policies are the most costliest way to get coverage ... if you have a choice to go other routes you should really look in to other ways first in my opinion .

as famed reasearcher michael kitces points out :

the reality is that the guarantee of LTC premiums in a hybrid policy may be entirely offset by the fact that the insurance company controls the cash value, and is under no obligation to pay a going rate of return, especially if interest rates rise. In other words, it doesn’t really matter that the insurance company can’t increase the premiums on the policy by $4,000/year, when the company can simply under-pay on the interest rate by $4,000/year to accomplish the same result! And while the cash value of a hybrid LTC policy generally does remain liquid, taking a withdrawal to reinvest to get better, higher rates would entail surrendering the policy and forfeiting the LTC coverage! In fact, for some types of hybrid LTC policies, the arrangement contractually provides no rate of return to the client at all, and is essentially the equivalent of the client selling a call option on interest rates to the insurance company, where the more rates rise the greater the company wins at the expense of the client!


https://www.kitces.com/blog/is-the-...-annuityltc-insurance-policies-just-a-mirage/


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## mathjak107 (Feb 4, 2020)

Liberty said:


> Yep, it can be a racket for sure.  Lots of complaints on LTC policies.  Might be a license to steal depending on the lender.
> Its like everybody wants a buck from the seniors these days.  LOL




hybrids  are  a poor deal in the end .. these hybrids can be the most costliest way to get coverage.

you can be sure anytime you try to get products to fulfill dual rolls and to try to act as something they aren't it ends up being a mediocre product and over priced for what it can actually do


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## mathjak107 (Feb 5, 2020)

Aunt Bea said:


> LTC is a serious concern but at this point in our lives, most of us will be unable to make any significant changes in our finances.
> 
> We can take the time to understand Medicaid and the impact that it may have on an independent/surviving spouse.
> 
> ...




There my be quite a few things one can do which is why it is important to see what the options are in your state ... 

new york , ct and florida are the first states to actually have courts  allow right of refusal to have little recourse ...

a now land mark case in ct had the judge order medicaid to find a  fair amount for lets call her mrs jones to pay for her husbands care without upsetting her lifestyle .. 

the judge said he did not want a state of seniors living in impoverishment because we have a bad long term care policy in this country ...

new york , fla and ct adopted this view . our estate attorney said that now has has all negotiation cases instead of recovery cases .

there are laws left in place to be utilized in many states just so 2 people don't end up on assistance . there are ploys like loans that can preserve half the assets .

so it is always worth consulting with a good attorney .


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## Aunt Bea (Feb 5, 2020)

mathjak107 said:


> There my be quite a few things one can do which is why it is important to see what the options are in your state ...
> 
> new york , ct and florida are the first states to actually have courts  allow right of refusal to have little recourse ...
> 
> ...


I'm not disagreeing with you, that's why I posted the link.

IMO it's important for each of us to do our homework and understand how Medicaid works instead of living in fear of the unknown or because of various horror stories that get passed from one senior to another.

I also believe that consulting with an attorney or experienced social worker has merit but before I consult a professional I want to do my own homework and gather a list of concerns so the visit and the possible cost have value for me and my situation.

In many cases, average people of average means have little to fear from Medicaid but they do have to be able to navigate the ins and outs of the system as it relates to them and their family members.


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## Butterfly (Feb 5, 2020)

Aunt Bea said:


> I'm not disagreeing with you, that's why I posted the link.
> 
> IMO it's important for each of us to do our homework and understand how Medicaid works instead of living in fear of the unknown or because of various horror stories that get passed from one senior to another.
> 
> ...



Very true.

And I also believe that one of the most common mistakes people make is not to understand that the Medicaid rules vary a lot from state to state, so they believe that what works for their Aunt Hattie in Rhode Island  will work for them in another state.   People think that the Medicaid rules are federal, and they are not.  Not being aware of your state's particular rules can lead to disastrous decisions.


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## Floridatennisplayer (Feb 5, 2020)

I remember my Fidelity team a few years ago telling me how so many wealthy clients would come in cluelessly wanting to know how to hide or shelter assets so they could qualify for Medicaid.  He would tell them, “Seriously? You want to try and convince the government that your 3 million in investments and a paid for 2 million dollar home qualifies you for a government low income program?”


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## mathjak107 (Feb 5, 2020)

Floridatennisplayer said:


> I remember my Fidelity team a few years ago telling me how so many wealthy clients would come in cluelessly wanting to know how to hide or shelter assets so they could qualify for Medicaid.  He would tell them, “Seriously? You want to try and convince the government that your 3 million in investments and a paid for 2 million dollar home qualifies you for a government low income program?”


Just like our tax system has your fair share of taxes , is whatever the lowest amount you can get them to using the laws and tools left in place for that purpose , so is protecting assets .

There are laws and tools purposely left in place for protecting assets  and that is both legal and not hiding assets ....states don’t want to support two people , one of which is the impoverished spouse ...so all these things are left in place to be utilized.

Just like taxes , those better informed can certainly legally protect assets and comply with medicaid. Being smart and or informed is not a crime


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## Liberty (Feb 5, 2020)

mathjak107 said:


> hybrids  are  a poor deal in the end .. these hybrids can be the most costliest way to get coverage.
> 
> you can be sure anytime you try to get products to fulfill dual rolls and to try to act as something they aren't it ends up being a mediocre product and over priced for what it can actually do


Its not just hybrids that have a lot of complaints.  Not too long ago, had an agent try to sell us a policy by offering to share which companies had the least complaints.  Like that's what you want to do, pay through the nose all those years and than have to fight for your benefits, because they can argue you aren't eligible, because you are too healthy to need it - those 5 daily things criteria that have to be met can also be a license to steal.  

Get a good lawyer.


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## mathjak107 (Feb 5, 2020)

Which is why the 3 years coverage our plan gives is of no great concern ...it is all about the deal with our state once the insurance is up


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## Floridatennisplayer (Feb 5, 2020)

You can’t insure for every possible event.  So, I plan to be a burden on society.  Got to draw the line somewhere.


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## mathjak107 (Feb 5, 2020)

we only insure for the things that could be catastrophic if it is us ..unlike insurers who can play with statistics  , humans can only have two out comes .. it is us or it isn't .  someone has to be on the wrong side of the statistic   ,  is it you ? 

insurers can even tell us how many people a year will die , but they can't tell us who .


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## Liberty (Feb 5, 2020)

mathjak107 said:


> Which is why the 3 years coverage our plan gives is of no great concern ...it is all about the deal with our state once the insurance is up


You are only insured for the amount of the usage (with the state equal asset protection), unless your state is way different than other states ...so, its also a given that many rich folks can't be "totally" insured in the state partnership plans.  They've got way too much asset valuation.  They take care of themselves.

http://www.longtermcareinsuranceonly.com/long-term-care-partnership-programs.html


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## mathjak107 (Feb 5, 2020)

Liberty said:


> You are only insured for the amount of the usage (with the state equal asset protection), unless your state is way different than other states ...so, its also a given that many rich folks can't be "totally" insured in the state partnership plans.  They've got way too much asset valuation.  They take care of themselves.
> 
> http://www.longtermcareinsuranceonly.com/long-term-care-partnership-programs.html




nope , here in new york  we have full total asset and income protection . ... we could have had a dollar for a dollar plan for less money but we went for total asset .

"Those who buy a Partnership LTC insurance policy, and adhere to all the rules that govern this policy, can apply for MEC in the event that the care-related expenses are extending beyond the initially planned period. A major benefit of the NYSPLTC is that, unlike Medicaid, MEC allows people to protect some or all of their assets.

The asset protection possibilities are based on whether the person who bought the Partnership LTC policy chose a Total Asset Protection plan or a Dollar-for-Dollar Asset Protection plan."


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## mathjak107 (Feb 6, 2020)

mathjak107 said:


> nope , here in new york  we have full total asset and income protection . ... we could have had a dollar for a dollar plan for less money but we went for total asset .
> 
> "Those who buy a Partnership LTC insurance policy, and adhere to all the rules that govern this policy, can apply for MEC in the event that the care-related expenses are extending beyond the initially planned period. A major benefit of the NYSPLTC is that, unlike Medicaid, MEC allows people to protect some or all of their assets.
> 
> The asset protection possibilities are based on whether the person who bought the Partnership LTC policy chose a Total Asset Protection plan or a Dollar-for-Dollar Asset Protection plan."


MEC   is a special version of medicaid that was created to go with our partnership plans .

when you have full asset protection you have no look back , no spend down , no income limitations on the stay at home spouse , which is a biggie .. all well and good you preserve assets using trusts or other means but  the stay at home spouse is still left with a very very low income by regular medicaid rules , plus no recovery .

so these benefits after the insurance runs out are very powerful .

if we leave the state though then the plan reverts to a dollar for a dollar  .


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## Liberty (Feb 6, 2020)

mathjak107 said:


> nope , here in new york  we have full total asset and income protection . ... we could have had a dollar for a dollar plan for less money but we went for total asset .
> 
> "Those who buy a Partnership LTC insurance policy, and adhere to all the rules that govern this policy, can apply for MEC in the event that the care-related expenses are extending beyond the initially planned period. A major benefit of the NYSPLTC is that, unlike Medicaid, MEC allows people to protect some or all of their assets.
> 
> The asset protection possibilities are based on whether the person who bought the Partnership LTC policy chose a Total Asset Protection plan or a Dollar-for-Dollar Asset Protection plan."


That's good to know - New York is such a pricey place to live, its good they do have extended measures to help the normal folks!


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## mathjak107 (Feb 6, 2020)

We hardly pay state and local taxes in retirement .new york excludes a lot of our income sources. it is unlikely normal folks would be involved with the partnership plans unless they had a lot of assets to protect ..

we pay 8k a year for the 2 of us and we get a 1600 dollar tax credit from the state ... policies are priced so you pay in about 1 years care  in future dollars by whatever they determine the sweet spot to be .

but in the mean time each years premium covers you for that year , just like life insurance ,  car insurance or home insurance . if you discontinue it , well you were covered each year ... we always pay  insurance premiums for things not likely to happen to you .

98% of term life policies are never paid out on , yet most people raising families have it .


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## mathjak107 (Feb 8, 2020)

only new york and indiana  offer full asset protection at this stage ... all states have partnership plans ... but they are dollar for a dollar , meaning if medicaid  spends 200k on your care ,200k in assets are protected.

these cost much less than full asset protection plans .


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