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To bet on Medicaid expansion is ill advised. Considering the burden our SS will be to support and the limited state and local dollars. That is why so much new is being built in affluent areas where public amenities and health care providers exist. Just like the affluent parents of Boomers flocked to the well heeled growing suburbs so will we if able. The demand for services in North Raleigh today wil pale to future demand as all of these affluent transplants hit their mid to late 70's and older.
Medicaid is 25% of the state budget where I live. The Feds pick up the other half of it. It's choking the state. Poor people don't vote. I think it's kind of inevitable that Medicaid will be cut, not expanded. Medicaid won't get you the free ambulance trip to the free ER. Expensive procedures won't be covered. Chronic conditions will be treated "cheapest way possible". I would imagine Medicaid coverage for nursing homes will also be trimmed back. They probably won't do anything about rich people moving money around to qualify for Medicaid nursing home care but they'll redefine what that level of care is.
I may be completely wrong about this but I suspect that when the late-Boomers hit age 80 twenty years from now, nursing home for poor people is going to be a ward with a dozen beds. There are simply too many of us who didn't save and not enough population growth to create the tax base to support it. I think that anyone my age planning this who assumes that Medicare and Medicaid won't have dramatic changes to the bad is fooling themselves.
Medicaid is 25% of the state budget where I live. The Feds pick up the other half of it. It's choking the state. Poor people don't vote. I think it's kind of inevitable that Medicaid will be cut, not expanded. Medicaid won't get you the free ambulance trip to the free ER. Expensive procedures won't be covered. Chronic conditions will be treated "cheapest way possible". I would imagine Medicaid coverage for nursing homes will also be trimmed back. They probably won't do anything about rich people moving money around to qualify for Medicaid nursing home care but they'll redefine what that level of care is.
I may be completely wrong about this but I suspect that when the late-Boomers hit age 80 twenty years from now, nursing home for poor people is going to be a ward with a dozen beds. There are simply too many of us who didn't save and not enough population growth to create the tax base to support it. I think that anyone my age planning this who assumes that Medicare and Medicaid won't have dramatic changes to the bad is fooling themselves.
I don't think you are wrong I think your thoughts about a ward with a dozen beds is right on spot. Prior to SS they were called the poor house and many of the elderly landed there. That was with a much shorter life expectancy than today. Part of the intent of SS was to minimize that. I am always amazed when I see middle aged folks supporting politicians who want to cut Medicaid who then turn around and talk about using it in old age. Not sure they realize that the same Medicaid that supports the younger poor also supports their aging needs. All of this is one of the reasons that CCRC's coming on line are designed to have no Medicaid Beds as taking Medicaid down the road would threaten their solvency. Buying into a CCRC that takes Medicaid increases the risk for that company.
We have discussed this over and over so everyone knows my views at this point. I won't rehash them.
Usually self insuring is no plan . It is keeping your fingers crossed and hoping you don't need care and if you do it is after you are funded and when markets are not down 40% . Most folks who self insure do nothing special to protect that money.
They also count that money in the balance they use to determine their draw rate. They do not know that a safe withdrawal rate is based on spending down principal possibly to near zero.
If the money is insurance it should not be counted as part of the income stream money. It may not be there if you are another y2k or 1966 retiree
I wonder if people when they talk about self insuring are planning on having a minimum of two years worth of funding available which will run well into the 200k plus range per person. They may think that six months worth of funding is enough but a quality facility will often want two years worth to consider them. Include a spouse and it is well over 400K. Consider the potential tax implications of just trying to access the money to pay as you go etc etc. I said at a point you need to have at least 100K in after tax dollars in retirement and got told by a few including my friend RTB that was crazy. Ok maybe crazy but how are you going to pay the elimination period, Assisted Living, Memory Care, in home nursing etc etc or all of the other cost associated with elderly illness.
You have thinks covered as do a few other people who fully appreciate it isn't just how much you have but how it is constructed. You can have retirement income of 150K per year and not have the investment money for a buy in. Or you could have the money for a buy in and not be able to afford the monthly fees. Trying to age on the cheap may be dwidling in attractiveness as we Boomers age and compete with each other for services and facilities.
You don't get moved into higher and higher risk groups. In fact, that's the whole point of purchasing LTC insurance when you're in your 50s and relatively healthy.
exactly . i made the mistake of waiting 2 extra years . by waiting a got surcharged 500 a year more for now being pre-diabetic . there are no surcharges after you have the policy . they are so strict as to who they take . they will not even take the broker who services us because he is over weight .
I am always amazed when I see middle aged folks supporting politicians who want to cut Medicaid who then turn around and talk about using it in old age. Not sure they realize that the same Medicaid that supports the younger poor also supports their aging needs.
In my opinion, it's a brilliant piece of brainwashing by the truly rich to get people to vote against their economic interests. Fox News and Angry White Man radio are the dominant "news media" sources in this country. They use fringe social issues like gun control and abortion rights to get moderate income people to vote against their economic self-interest.
I know someone who is living on military officer survivor's benefits. She's violently against anyone else in the country receiving any public benefits but is up in arms any time something about veterans funding comes up. It's amazing hypocrisy.
Truthfully trying to project this years out is Herculean in nature. We are to large a group and government already to burdened with debt. The ability of government to sell bonds to accomidate like they did starting in the fifties is no longer there. What are we going to have shifts for living in assisted living etc and up like we did elementary schools? Will you get the bed in the AM and another person in the PM?
One of the evolutions of CCRC's and one of their marketing goals is to enable you to lock in a certainty by going in early or by going on a waiting list with a refundable deposit of say 5K.
You're spot on in this and your follow-up posts. It is impossible to project what that kind of cost is going to be. You can bet though that we could end up in a ward with a dozen in the room. As for hot bunking you might check with Submariner about that. He would be our resident expert on that. (Love ya Submariner)
Quote:
Originally Posted by Vision67
Redneck LTC plan: Glock and 1 bullet.
That might be for you but I think I am too much of a coward to pull that trigger on myself. If you were teasing do not take offense to my comment.
Quote:
Originally Posted by augiedogie
I don't have a plan. But I know God does, so I don't worry about it.
Many people can't fathom a plan. First because they don't have the resources and second because it is as Tuborg says Herculean. The numbers are staggering. The cost per year of just minimal health insurance is huge. It is even worse if all you have to pay for it is a minimum wage paycheck and SS that is getting chopped because you make more than 16k in that make ends meet job.
Quote:
Originally Posted by BellaDL
Here is our plan to handle long-term care:
First, we try to stay as healthy and fit as long as possible with exercise (both physical and mental) and diet.
Secondly, if we ever need nursing home care, we want our stay to be as short as possible. This means having our living will and advanced directives for medical decisions, and plan to relocate to right-to-die states or countries.
Lastly with respect to the finance question, we are prepared to self pay. We are not very rich but do not worry too much about the scenario when we run out of money and have to rely on medicaid for LTC. I know that there are a lot of 'horror' stories about nursing homes which accept medicaid patients. The way I see if, if it I was in such a nursing home, I'd likely not to be in a mental condition to care one way or the other, and if I am mentally alert enough to care, I'd just focus on finding ways to end my life asap ;-)
From what I have read about LTC insurance, I think that are too expensive with unpredictable premium increases and future payouts. IMO, the ROI is not very good for us to obtain LTCi.
True and this is where some of us have to look at the numbers. So maybe you don't take LTCi and everything works out great. Then you won otherwise you lost. But you still had to make the decision and play the game. Or you take a bit of your income and fund up some LTCi. Not a lot. Say you just take a policy that pays 100k per year for 3 years. That is 300k you don't have to take out of savings or the sale of the family home. That could mean the difference of rib eye steak or Kraft Mac and Cheese.
We talk a lot here on SS. Great questions all of them are and I would not have it any other way. Yes this topic has come up before. I have dropped it here twice in the 5 years I have been on C-D. I will probably drop it again in the future. It may seem like I am trying to aggravate you but I am really just making sure that we keep things in mind that "ARE" a possibility. Life happens when we close out this page. We go to work, attend plays and concerts. We go to church and we go to sleep. We do all the things that show we are alive. In the end you need to make the choice. Our friends here bring in their experiences to the topics we discuss. We relate it to our own lives and to how we see the world.
I wonder if people when they talk about self insuring are planning on having a minimum of two years worth of funding available which will run well into the 200k plus range per person.
I'm planning 5+ years, $100K/year in 2016 dollars. That's my mom's burn rate. That's part of why deferring Social Security until age 70 is such a big deal since it's COLA-protected. If I have $42.8K coming in inflation-protected and I'm not paying Federal income taxes because of the huge medical deduction, the equity from selling my home should easily cover it even if I zero out my other assets.
I'm planning 5+ years, $100K/year in 2016 dollars. That's my mom's burn rate. That's part of why deferring Social Security until age 70 is such a big deal since it's COLA-protected. If I have $42.8K coming in inflation-protected and I'm not paying Federal income taxes because of the huge medical deduction, the equity from selling my home should easily cover it even if I zero out my other assets.
A man with a plan. Hopefully that money grows safely but that's another discussion. Related but perhaps not now. I am wrestling with that myself, inflation and which way to go.
I have a plan....one bullet on my 77th birthday, otherwise known as my "expiration date". once you know the end date, life gets much easier. Specifically all retirement planning, including health care gets much easier as you know exactly how long you have to be funded. Seems so simple.
I have a plan....one bullet on my 77th birthday, otherwise known as my "expiration date". once you know the end date, life gets much easier. Specifically all retirement planning, including health care gets much easier as you know exactly how long you have to be funded. Seems so simple.
Unless the day before you are experiencing the love, joy and nurturing of others. Still want to check out/expire?
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(Love ya Submariner)
