Back

Free Site registration

Sign up today and gain full instant access to member-only content

  • Earn CE Credits

  • Access our Discussion Boards

  • E-Newsletters - Retirement Planning, Wealth Advisor

  • Attend Coaching Sessions and Web Seminars, Podcasts and more

UPDATED: Silver Tsunami: Are Boomers Out of Luck With Medicare?

July 1, 2010
¦
Advertisement

Back in March we wrote about the potential long-term care crisis that could plague boomers during their later years.

The story was based on a study by the Center for Retirement Research at Boston College, which found that in over 300,000 simulations the average lifetime health care expenditure for a typical married couple at the age of 65 is $197,000. This figure covers insurance premiums, out-of-pocket costs, and home health costs. With nursing home costs included in the equation, that amount jumps to $260,000, with a 5% risk of exceeding $570,000.

Malcolm Cheung, vice president of long-term care product and risk management at Prudential Insurance, noted in an interview back in March that fewer than 10% of American adults have any sot of long-term care insurance. “This is a crisis down the road as the demand and need for LTC increases and the dollars that are available to fund it in the public sector don’t increase at the same rate,” Cheung said. “More and more of the burden is going to be placed on the individual.”

Cheung’s assessment from four months ago appears increasingly prescient given recent news about the state of Medicare. Specifically, a recent report in USA Today pointed to surveys by national and state medical societies showing a rise in the number of doctors limiting Medicare patients roughly six months before millions of baby boomers will begin to enroll in the government program. The limitations come after Congress opted not to halt an automatic 21% cut in payments that went into effect on June 18. Doctors had already complained long before the cut that Medicare does not pay enough to cover the patient costs. According to the American Medical Association, 17% of doctors in America refuse Medicare patients, with that number increasing to 31% for primary care physicians.

But now, those numbers are expected to rise even higher. As pointed out in the USA Today report, a recent survey by the American Academy of Family Physicians found that 13% of respondents didn’t participate in Medicare in 2009, up from 8% in 2008 and 6% in 2004. Meanwhile, the American Osteopathic Association says 15% of its members do not participate in Medicare and 19% aren’t accepting new Medicare patients. With the 21% cut in Medicare cuts, the association expects both numbers to double.

What this means for advisors is that they will likely have to place even greater emphasis on discussing long-term care insurance with boomers. It is a fairly giant leap to say that boomers are already facing a long-term care crisis, but the recent developments with Medicare points to potential problems as they age.

This is an updated version of the story that ran on Thursday.

Do you think long-term care insurance has become more important to retirement planning?

Postby MoneyGal2020 >> Thu Jul 01, 2010 2:31 pm

Mr. Cheung only refers to the medical aspects of long-term care when he says, “Medicare does pay close to 50% of the long-term care bill in this country” Medicare does not provide for any 'in home' or required nursing care for long-term care patients. And, if doctors begin opting out and the government has to assume an even greater financial role...Medicaid, watch out! Rather than the silver tsunami, I prefer to call it the arrival of the 'Ka-Boomer ' generation. We are a worldwide ticking (social services) time bomb.

MoneyGal2020
Joined:
Thu May 06, 2010 12:57 pm
Postby Bradly T. >> Thu Jul 01, 2010 5:16 pm

Good observation and points by MoneyGal - due to age of patients/residents, it is likey Medicare is paying for almost ALL medical costs in nursing homes - but they are paying zero for residential, board, transportation and housekeeping care and the less ambulatory the patient, the lower percent of total cost paid by Medicare. Any doctor that doesn't take Medicare will need to retire in 10 years...they're all bluff and bluster!! Who the hell are they going to treat as the silver tsunami retires?? Group medical for retirees is disappearing as fast as boomers are retiring. These whiners making 10 times the median income just slay me. Let them quit or go to hades - who cares? The point is they won't, they'll just whine louder. By the way, the Medicare cuts passed years ago have yet to take effect...Obama just signed the 20th extension on their poor behalf. Geriatrics is, and will remain for decades, the fastest growing medical cash flow cow. Does anyone really believe the docs are going to leave that market on the table?? Gonna move to India or China for the youth markets who have no insurance at all, trading for eggs and goats instead of taking U.S. Medicare??? I'm all for reforms to reduce malpractice insurance costs and redundant or unnecesary tests based on liability paranoia (or docs lab ownership interests), but the billable charges by docs is outlandish and so is their resistance to RN and practitioner provided care. They are a principal reason for the COST of care and the COST of insurance and I am not sympathetic. Too few doctors making too much money shutting down care competition for their own self interest. Let them eat cake.

Bradly T.
Joined:
Mon Mar 30, 2009 3:35 pm
Postby Community Manager >> Fri Jul 02, 2010 9:22 am

Do you think long-term care insurance has become more important to retirement planning?

Community Manager
Joined:
Thu Nov 13, 2008 10:30 am
Postby Bob H >> Fri Jul 02, 2010 9:46 am

Community Manager wrote: Do you think long-term care insurance has become more important to retirement planning? More important? Don't think so. But it is critical for every retiring client to address this. Their options are: 1) let an insurance company worry about the risk; 2) self-insure by setting aside a hundred thousand or more and never touching it or 3) live with the risk. I think the sane approach is to let the insurance company's worry about it but in each case, we counsel the clients on their options and let them decide. Their choice is documented and they sign off on the rationale. If the client decides to live with the risk and eventually faced bankruptcy due to it, I don't want their children coming back to me for their inheritance. Bob

Bob H
Joined:
Thu Nov 13, 2008 10:30 am
Postby la >> Sat Jul 03, 2010 10:34 am

Medicare does pay for nursing homes but only after you have become poor that is out of money or used a fancy lawyer to move your assets into purgatory. So if you want to wind up in a govt home then you must begin spending down those assets so you too can become a welfare case. I can tell from experience a govt run home is just that a pretty sad home. I would suggest to all that you must read up on the qualification to ruled a welfare ready person. They do let you keep your wedding rings so no Iphones for the home. -la

la
Joined:
Wed Apr 07, 2010 10:09 am
Postby northwoodsjoe >> Sat Jul 03, 2010 11:22 am

Medicare does NOT pay for nursing home care. That would be state run Medicaid. In order to qualify, you must apply and, depending on the state, say goodbye to most of your assets. Hopefully you have a Partnership Plan in your State. This will help protect some of the clients assets. This is a critical part of planning. Any planner/advisor who isn't discussing this with their "boomer" clients is not serving their clients. If the client doesn't have enough assets, fine.........let them go to Medicaid. If they have a few million, then self-insure. Anyone in-between needs LTC and needs a Planner to explain their options.

northwoodsjoe
Joined:
Mon Aug 31, 2009 4:40 pm
Postby Bradly T. >> Tue Jul 06, 2010 9:03 am

Don't know where la gets her/his information....also no such thing as "govt homes" (except VA). All nursing homes are required to accept Medicaid if entrance is by private pay and most nursing homes have an allotment of "medicaid" beds for initial entry....by law, all care must be identical for private pay and medicaid residents....and, as pointed out by joe, Medicare pays zippo for nursing home care except for medical care to those on Medicare otherwise. You're no financial planner if you don't know spend down, community spouse asset and income rules, and patient income support for community spouse rules in your state. Also per joe, all states are now under the Partnership rules for asset preservation. Widows, widowers, and singles have greatest challenge...marital estates have many planning options. Helping boomers with their parents' elder care options is a great way to gain clients.....and prepares us for the boomers future needs.

Bradly T.
Joined:
Mon Mar 30, 2009 3:35 pm
Postby Bradly T. >> Wed Jul 07, 2010 9:41 am

Bob H - While I have same discussion and provide same 3 options for planning, I'm not using the signed disclosure you describe. Memory lapse of clients in the future and children's anger can bring liability - even if discussed with client. Like the disclosure idea. Do you apply to other planning topics? Proof of discussion and client choice/election of optional strategies? Also, how do feel about the premium risk of using LTC as risk manager and viability of insurance company making promises decades away. I have concerns about cost containment and future surrender/lapses by over-stressed retirement budgets and premiums that double or triple over 20-30 years. Do you present the premium risk as part of your LTC discussion? I used to think insurance was a no brainer....but for 55-65 yrs old, I'm wondering what the world will be like by claim time and if policies sold today will be in force and viable.

Bradly T.
Joined:
Mon Mar 30, 2009 3:35 pm
Postby Bobbie >> Wed Jul 07, 2010 1:37 pm

Bradly T, I DO used signed disclosures in other areas. This started some 6 or 7 years ago when several of my clients, after a couple of years of prodding, still hadn't gotten their estate planning documents created or updated. I sent them a letter that basically said, "Bobbie told me to do this and it isn't her fault I haven't." I asked them to sign on the bottom and return it to me. Its amazing how often this one action got them off the sofa to do what I had requested all along. And if it didn't, well I have that signed letter in my file. These days I send such letters much sooner rather than wait for a couple of years of inaction. You never know when that bus will hit you. You could use this "technique" for life insurance, LTC, etc. I even used it when I had a client who wanted to buy a house that cost much more than he should spend. I sent him a letter stating that if he continued with the purchase, he should have a discussion with his children (who were all for it as it moved him closer to them) to tell them that by age 75, it is likely they would have to supplement his pension and social security income. He is now 70 and just a couple of months ago I had to "remind" him of that discussion and show him the signed letter. And so it goes. Bobbie

Bobbie
Joined:
Thu Nov 13, 2008 10:30 am
Postby Bob H >> Wed Jul 07, 2010 9:35 pm

Bradly T. wrote: Bob H - While I have same discussion and provide same 3 options for planning, I'm not using the signed disclosure you describe. Memory lapse of clients in the future and children's anger can bring liability - even if discussed with client. Like the disclosure idea. Do you apply to other planning topics? Proof of discussion and client choice/election of optional strategies? Also, how do feel about the premium risk of using LTC as risk manager and viability of insurance company making promises decades away. I have concerns about cost containment and future surrender/lapses by over-stressed retirement budgets and premiums that double or triple over 20-30 years. Do you present the premium risk as part of your LTC discussion? I used to think insurance was a no brainer....but for 55-65 yrs old, I'm wondering what the world will be like by claim time and if policies sold today will be in force and viable. 1) Every meeting is followed up with a letter. So we doc all the discussions although only LTC is signed off. 2) We talk about the issues with the client Show them past increases so they are aware of it. As far as I know, no company thats ever sold LTC has walked from their responsibility.

Bob H
Joined:
Thu Nov 13, 2008 10:30 am
Click to read all comments (11)
Advertisement