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Long-term care insurance: myths and facts

Long-term care insurance: myths and facts

Martin V. Jones

Paying for major long-term care services for a sick or disabled family member can impoverish a family very quickly. To avert this possibility, approximately three million U.S. families have purchased long-term care insurance (LTCI) from private insurance companies in the last decade. Is this an option for people with MS?

With the help of a research grant from the National MS Society, I have attempted to define the dimensions of the problem and to identify possible ways of coping with it.

My data come primarily from responses to six questionnaires. Two of these were completed by people with prolonged, mild MS, one by people with severe MS residing in nursing homes, two by companies selling LTCI, and one by state insurance offices.

Unfortunately, there is no current program or form of insurance, public or private, to help middle-income people with more severe MS pay for long-term care. NMSS advocacy programs seek volunteers to lobby for reforms to address this need.

The end-product of my research, a consumers’ buying guide directed to people with mild MS seeking to buy LTCI, will be completed later this year. This is a condensed report on my findings.

Myth One “MS is inevitably a disabling disease.” As one survey participant with mild MS put it, “The hardest thing to deal with is the way that people automatically think |wheelchair!’ when they hear |MS’.” Similarly, one insurance company, in explaining why they reject all LTCI applications from people with MS, said: “Eventually, custodial care is almost inevitable.” The prevalence of this misconception is illustrated by the finding that half of the approximately sixty companies that responded to the industry survey automatically refuse to consider LTCI applications from all people with MS.

Over 800 people with mild MS answered a request in INSIDE MS to participate in one of the surveys. All of them have had MS for over ten years; they range in age from 27 to 82, reside in all 50 states, and represent 150 career specialties. The fact that over 90 percent of them reported a high degree of freedom from disabling symptoms suggests that in the total MS population, there must be many thousands of people with mild MS. The results of the survey are interesting and suggestive but cannot be considered conclusive, because this was not a random sample.

Myth Two “No one with MS can get this type of insurance.” The industry surveys show that although half of LTCI companies automatically reject applications from all people with MS, an equal number will consider them, on a case-by-case basis. Generally, three conditions must be met. First, the applicant must have had MS for a “prolonged” period of time, ten or more years. Second, she or he must currently show no major MS symptoms, no disability, and no obvious problems with “activities of daily living”–dressing, bathing, eating, and so on. Third, like any other applicant, the MS applicant must be in good general health.

There is at least one company in every state that will consider LTCI applications from healthy, nondisabled people with mild MS. In some states, there may be as many as ten.

There is one complication. Most of these companies are reluctant to publicize their willingness. The would-be consumer will need to be persistent. Approximately 25 percent of 120 people surveyed with mild MS, ages 55-79, have tried to buy LTCI. About a third of their applications were accepted. Most of the rejected applicants had applied to companies that automatically reject all MS applicants.

Who should buy LTCI?

Some consumer advocates have questioned how well LTCI meets long-term care needs. Any potential buyer should check policy terms carefully. My surveys show that people with mild MS can obtain coverage. With these points in mind, a prudent buyer will consult an investment counselor, lawyer, or trusted family member who knows one’s goals, resources, and financial obligations for help in deciding whether or not to purchase LTCI.

Martin Jones, PhD, an economist, has received a series of grants from the National MS Society to research the availability of long-term care insurance for people with prolonged, mild MS.

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