Planning for parent's retirement health coverage

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johnaltabc
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Joined: Sun Jun 04, 2023 12:38 pm

Planning for parent's retirement health coverage

Post by johnaltabc »

Planning for parent's retirement has been very overwhelming. Quick story is my parent's have more than 6 million in assets, but they are uneducated and have difficulties navigating through the planning. We live in California.

Currently, I'm planning to sign my parent's up for Medicare A, B, D and medigap G. Then they told me they do not want to be in a nursing home and want 24/7 care at home should need arise.

Few questions:
1) Should I consider any other insurance options?
2) Are there insurance that cover in-home 24/7 care -- and if so, what are they called? And if purchased, would it still be advised to get medicare gap g?
3) Does medicare gap g cover the in-home 24/7 care?
4) Are there better ways to plan for 24/7 care?

My parent's friend recommended talking to a "Financial advisor" who successfully convinced them to buy permanent life insurance. Luckily, I was able to change their minds after a lengthy effort. The main issue is I feel like we need guidance on how to navigate all this, but it's difficult to discern actual advisors vs sales-people.

Any advice or things I can look into would greatly be appreciated. Thanks.
Last edited by johnaltabc on Sun Jun 04, 2023 1:24 pm, edited 1 time in total.
BarbBrooklyn
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Re: Planning for parent's retirement health coverage

Post by BarbBrooklyn »

How old are your parents?

Are they willing to move to someplace that is on one level and ADA compliant?

Or they insisting that they remain something akin to a 150 year old home with one bathroom, not on the entry level? In other words, is their "plan" within realistic boundaries?

My aunt and uncle, with your parents'l evel of assets and in a single level ranch house were able to stay at home until "the end". At least Aunt was. She only had medical issues

Uncle had dementia and no level of in-home care was feasible.

I would not 'promise" anything other than doing what is best for their needs.
Last edited by BarbBrooklyn on Sun Jun 04, 2023 3:58 pm, edited 1 time in total.
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HomeStretch
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Re: Planning for parent's retirement health coverage

Post by HomeStretch »

Welcome to the forum!

Your plan to have your parents enroll in Medicare Parts A, B, D and a medigap plan is good. Their state likely offers assistance through free SHIP counselors (or something similar) with enrollment and choosing the best Part D / Medigap plans for them.

The Medicare.gov website is also helpful. Your parents should each set up an online account at the Medicare website. They should also set you up via the online accounts as an Authorized Representative in case you ever need to speak with Medicare on their behalf. Keep a copy of their log on credentials for Medicare (as well as SSA, IRS and any state tax authority) in case you need to act on their behalf.

If you haven’t already done so, the Medicare for Dummies book may be helpful to read. It will give you guidance on the appropriate time to enroll, info on premium surcharges (IRMAA) if their income is high, etc.

Medicare doesn’t cover long-term care (although it will cover short-term rehab stints, PT, OT). Your parents will need to self-pay these costs or have a long-term care (LTC) policy. These policies usually have limited benefits and likely will not cover all costs from Day 1 for as long as needed. If your parents run out of assets to cover LTC, they would need to apply for Medicaid LTC benefits which is state dependent.

Good luck. I know from experience that it can be time consuming to assist aging parents. You are lucky they have $6 million in assets. That should enable them to buy a lot of assistance in-home if needed as they age. But keep in mind that dementia diseases and/or serious medical issues may impact their ability to remain safely and well cared for in their home until they pass. But cross that bridge when and if you come to it.
dbr
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Re: Planning for parent's retirement health coverage

Post by dbr »

Long term care insurance that can offset some costs of in-home care exists.

You don't say what your parents annual spending looks like nor what their income sources other than spending wealth might be, but a first take in this would be that $6M in assets is already more than sufficient self-insurance for in-home care. A first step would be to investigate the resources available and cost of such care. For example, one could probably hire live in multi-person staff for maybe $300k/year and afford 20 years of that for $6M. But it depends on how much other income needs to be supported here.

Government coverage for in-home care is not under Medigap but under Medicaid, for which someone with $6M does not qualify, nor should they.
Topic Author
johnaltabc
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Re: Planning for parent's retirement health coverage

Post by johnaltabc »

BarbBrooklyn wrote: Sun Jun 04, 2023 1:07 pm How old are your parents?

Are they willing to move to someplace that is on one level and ADL compliant?

Or they insisting that they remain something akin to a 150 year old home with one bathroom, not on the entry level? In other words, is their "plan" within realistic boundaries?

My aunt and uncle, with your parents'l evel of assets and in a single level ranch house were able to stay at home until "the end". At least Aunt was. She only had medical issues

Uncle had dementia and no level of in-home care was feasible.

I would not 'promise" anything other than doing what is best for their needs.
Thanks for the reply.

They are about 65 years old and they specifically told me they want care at home (I'm assuming one of their current properties). They don't want to go into nursing home because I guess they heard stories about bad nursing homes -- I don't really know what nursing homes are like. I also don't really know what's within realistic or not yet because I'm still very new to this and doing all the research myself.

So your uncle ended up being sent to a 24/7 care nursing home? Do you happen to know what kind of health coverage he had or did they just pay for all of the expense their assets?
Topic Author
johnaltabc
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Re: Planning for parent's retirement health coverage

Post by johnaltabc »

HomeStretch wrote: Sun Jun 04, 2023 1:14 pm Welcome to the forum!

Your plan to have your parents enroll in Medicare Parts A, B, D and a medigap plan is good. Their state likely offers assistance through free SHIP counselors (or something similar) with enrollment and choosing the best Part D / Medigap plans for them.

The Medicare.gov website is also helpful. Your parents should each set up an online account at the Medicare website. They should also set you up via the online accounts as an Authorized Representative in case you ever need to speak with Medicare on their behalf. Keep a copy of their log on credentials for Medicare (as well as SSA, IRS and any state tax authority) in case you need to act on their behalf.

If you haven’t already done so, the Medicare for Dummies book may be helpful to read. It will give you guidance on the appropriate time to enroll, info on premium surcharges (IRMAA) if their income is high, etc.

Medicare doesn’t cover long-term care (although it will cover short-term rehab stints, PT, OT). Your parents will need to self-pay these costs or have a long-term care (LTC) policy. These policies usually have limited benefits and likely will not cover all costs from Day 1 for as long as needed. If your parents run out of assets to cover LTC, they would need to apply for Medicaid LTC benefits which is state dependent.

Good luck. I know from experience that it can be time consuming to assist aging parents. You are lucky they have $6 million in assets. That should enable them to buy a lot of assistance in-home if needed as they age. But keep in mind that dementia diseases and/or serious medical issues may impact their ability to remain safely and well cared for in their home until they pass. But cross that bridge when and if you come to it.
The Authorized Representative info is good, I will do that. I did end up picking up Medicare for Dummies book. It gave a lot of great info, but it's still all very overwhelming haha. So even long-term policy will likely not cover their needs fully; that's unfortunate.

Thanks for all the info.
123
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Re: Planning for parent's retirement health coverage

Post by 123 »

There are lots of threads on Medigap policies versus Medicare Advantage plans. There are many strong opinions on both, the opinion people have is largely influenced by their own experience which is based on how healthcare works in their area. What is best for your parents depends on what medical providers they use and if they plan to travel to the extent that they are likely to often use medical providers elsewhere (in the US). People often pick coverage based on what they had before Medicare if they were comfortable with it and it worked for them. If someone used a Blue Cross/Blue Shield type plan they'll be familiar with the paperwork that a Medigap plan will involve. If someone favored the seamless healthcare experience that an HMO provides that HMO likely offers a Medicare Advantage continuation plan.
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dbr
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Re: Planning for parent's retirement health coverage

Post by dbr »

johnaltabc wrote: Sun Jun 04, 2023 1:35 pm So even long-term policy will likely not cover their needs fully; that's unfortunate.
Almost no one has their needs covered so well as your parents do. I don't understand where the unfortunate is coming from. Are we missing something about how that $6M is getting used up and won't be there in some substantial degree for end of life care? By all odds they could be spending $200k or something from that money every year and end up 25 years from now with more money than they have now even after inflation.
Topic Author
johnaltabc
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Re: Planning for parent's retirement health coverage

Post by johnaltabc »

dbr wrote: Sun Jun 04, 2023 1:21 pm Long term care insurance that can offset some costs of in-home care exists.

You don't say what your parents annual spending looks like nor what their income sources other than spending wealth might be, but a first take in this would be that $6M in assets is already more than sufficient self-insurance for in-home care. A first step would be to investigate the resources available and cost of such care. For example, one could probably hire live in multi-person staff for maybe $300k/year and afford 20 years of that for $6M. But it depends on how much other income needs to be supported here.

Government coverage for in-home care is not under Medigap but under Medicaid, for which someone with $6M does not qualify, nor should they.
Thanks for the info. I know their annual spending is very small but I know small varies from person to person; I will have to determine that amount. They have rental properties and 401k which I know we have to plan around since it's not liquid.

I suppose I need to do a lot more research, but how to go about that research is the difficult part. If I were to search for "Long term care insurance" to offset the cost, is there a particular term/phrase I should search in google for 24/7 care coverage?

And for searching multi-person staff medical care, is there a particular term/phrase would I enter for that?
livesoft
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Re: Planning for parent's retirement health coverage

Post by livesoft »

I think signing up for Medicare A,B, D, and G is orthogonal to not going to nursing home, so that was all good to get done.

Then it is just a matter of converting a room in their home to a hospital room and hiring 7 x 24 / 40 = 4.2 full-time qualified medical personnel and maybe some more to cover vacations for these people. And a supervisor for these folks who can also do the bookkeeping, manage medical supplies, etc.

Oh, if they will not be able to shop and cook for themselves, then they will need people to do that as well. Maybe they already pay for maids and yard work?
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Topic Author
johnaltabc
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Re: Planning for parent's retirement health coverage

Post by johnaltabc »

dbr wrote: Sun Jun 04, 2023 1:52 pm
johnaltabc wrote: Sun Jun 04, 2023 1:35 pm So even long-term policy will likely not cover their needs fully; that's unfortunate.
Almost no one has their needs covered so well as your parents do. I don't understand where the unfortunate is coming from. Are we missing something about how that $6M is getting used up and won't be there in some substantial degree for end of life care? By all odds they could be spending $200k or something from that money every year and end up 25 years from now with more money than they have now even after inflation.
All of this is very new to me and I just don't have a good grasp on the medical cost that could potentially occur. I was just hoping that there was a simple/effective solution; like buying X insurance to meet everyone's needs, which is what I meant by unfortunate. I understand that they are in an extremely good place compared to majority of people. Apologies if that came across badly.
dbr
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Re: Planning for parent's retirement health coverage

Post by dbr »

johnaltabc wrote: Sun Jun 04, 2023 1:54 pm
dbr wrote: Sun Jun 04, 2023 1:21 pm Long term care insurance that can offset some costs of in-home care exists.

You don't say what your parents annual spending looks like nor what their income sources other than spending wealth might be, but a first take in this would be that $6M in assets is already more than sufficient self-insurance for in-home care. A first step would be to investigate the resources available and cost of such care. For example, one could probably hire live in multi-person staff for maybe $300k/year and afford 20 years of that for $6M. But it depends on how much other income needs to be supported here.

Government coverage for in-home care is not under Medigap but under Medicaid, for which someone with $6M does not qualify, nor should they.
Thanks for the info. I know their annual spending is very small but I know small varies from person to person; I will have to determine that amount. They have rental properties and 401k which I know we have to plan around since it's not liquid.

I suppose I need to do a lot more research, but how to go about that research is the difficult part. If I were to search for "Long term care insurance" to offset the cost, is there a particular term/phrase I should search in google for 24/7 care coverage?

And for searching multi-person staff medical care, is there a particular term/phrase would I enter for that?
As with anything on Google you will want to try various options for home health care, long term care, hospice care, home health aides, etc.

For some perspective for a few years I directly hired in home care for an elderly relative. Eventually the care burden got high enough that person went to a nursing home with dementia and that facility was better than attempting care at home. Another relative developed Alzheimers but was able to stay at home with a live-in caretaker supplied through a local agency placing recently arrive immigrants needing employment. The care taker was beyond outstanding up to hospice care at the end. I have another family member with bipolar/addiction issues who is well cared for under Medicaid in a local assisted living facility.

Hiring home care staff is a job in itself as is navigating insurance and public support. Good luck.
Katietsu
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Re: Planning for parent's retirement health coverage

Post by Katietsu »

Medicare plus medigap covers mostly the same stuff as, presumably, your own health insurance like doctors, hospitals, physical therapists and MRIs.

There are times when medicare can also cover a nursing home stay. For instance, if Mom breaks her hip, she would likely need skilled nursing care for a time period between the hospital and home. Maybe you can look into the nursing homes in their area that offer this type of rehab care. Identify a couple of nice ones with good food in case they need that type of care. There is a large variation in facilities so their perception of a nursing home might not be accurate.

Here is a government site that discusses the basics of long term care:
https://www.nia.nih.gov/health/what-long-term-care

Long term care insurance is available. There is a great deal of discussion as to whether or not it is a useful insurance to have. Sometimes it only covers care in a nursing home but there are also policies that include coverage for care in the home. However, you are not going to find a policy that provides 24/7 at home coverage indefinitely. Your parents are still young enough to get a long term care policy if they do not have any disqualifying medical issues.

There are companies that provide in home elder care services. The individuals provided are usually called home health aides or certified nurse assistants. The duties that they are allowed to perform will vary by state. For instance, they might not be able to administer medication if the patient is unable to do so themselves.

I would not try to address everything related to elder care all at once. First address medicare and medigap. How is their health now? It is unclear where your focus should be.
BarbBrooklyn
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Re: Planning for parent's retirement health coverage

Post by BarbBrooklyn »

johnaltabc wrote: Sun Jun 04, 2023 1:23 pm
BarbBrooklyn wrote: Sun Jun 04, 2023 1:07 pm How old are your parents?

Are they willing to move to someplace that is on one level and ADL compliant?

Or they insisting that they remain something akin to a 150 year old home with one bathroom, not on the entry level? In other words, is their "plan" within realistic boundaries?

My aunt and uncle, with your parents'l evel of assets and in a single level ranch house were able to stay at home until "the end". At least Aunt was. She only had medical issues

Uncle had dementia and no level of in-home care was feasible.

I would not 'promise" anything other than doing what is best for their needs.
Thanks for the reply.

They are about 65 years old and they specifically told me they want care at home (I'm assuming one of their current properties). They don't want to go into nursing home because I guess they heard stories about bad nursing homes -- I don't really know what nursing homes are like. I also don't really know what's within realistic or not yet because I'm still very new to this and doing all the research myself.

So your uncle ended up being sent to a 24/7 care nursing home? Do you happen to know what kind of health coverage he had or did they just pay for all of the expense their assets?
Sorry, I meant ADA compliant.

Uncle went first to a Memory Care unit (this was after Aunt died; his children had no patience with him calling the police several times a week to report WWII-related incidents). After he became unmanageable there, the was transferred to a VA nursing home where, with good meds and lots of Vet company, he lived more happily than he had in a long while. He died at the age of 96.
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HomeStretch
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Re: Planning for parent's retirement health coverage

Post by HomeStretch »

johnaltabc wrote: Sun Jun 04, 2023 2:03 pm All of this is very new to me and I just don't have a good grasp on the medical cost that could potentially occur. …
That’s understandable… Based on my recent experience with parents/in-laws in a HCOL state:
1) Original Medicare including good Medigap/Part D (UHC AARP plans) covered all medical expenses so there was no out-of-pocket expenses aside from premiums. This included hospitalizations, chemo, specialists, rehab facility, PT/OT and hospice. All premiums combined were ~$550/month for each.
2) Expenses for RX (patient portion), vision, dental, hearing were 100% out-of-pocket. As veterans, they were able to receive hearing, vision, some RX/vitamins for free at a local VA hospital. Your parent(s), if a veteran, needs to get registered at the VA website and then get an ID/be seen by a VA doctor.
3) Parents who needed an in-home aide - cost was $35/hour through an agency, minimum 4 hours per day. Good aides are hard to find, they do not provide medical care and there is a shortage of workers.
4) Parent who needed Assisted Living then Memory Care - cost ranged from $10k/mo to $18.5k/mo. Private pay. No facilities in the area accept Medicaid reimbursement. If you can’t pay, you can’t stay.
5) Parent who needed Skilled Nursing Facility - $20k/mo for a semi-private room. Private pay of 1 year was required to jump the 2-3 year admissions list after which Medicaid assignment was accepted. Medicaid (which is means and income tested) LTC application for one parent took 8 months to be approved (benefits are retroactive) and the elder law attorney fee for application assistance was $10k.
6) If your parent(s) is a veteran, look into VA Aide & Attendance which, if approved, will provide a benefit for in-home or in-facility care + monthly stipend. This program is means and income tested. Approval can take a year but benefits are retroactive. A widow/er of a veteran is entitled to these benefits.

For the some of these costs (such as an aide), your parent will need an annual Care Plan (documenting assistance needed with daily living activities and prescribing the services) signed by their primary care doctor in order to deduct the costs on their tax return as qualified medical expenses.
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Mullins
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Re: Planning for parent's retirement health coverage

Post by Mullins »

If they simply age and not much happens with their health until their final breath, that would be wonderful. But things happen. Big changes can come just like that.

Having had parents in nursing facilities I can tell you that it may turn out that home care isn't recommended because it may be a parent's condition needs more (doctors, aides, nurses, equipment) than what can be provided for immediately at home. Especially when the patient is progressively declining or experiences medical emergencies. It also falls on the family member to be the primary caregiver, the one coordinating everything, overseeing everything, and lending a hand, jumping in to do what's needed (change the colostomy bags, cook the special diet meals, for instance), tending to the parent even if it's the middle of the night. That can be overwhelming and cause burn out.

My sister was under the notion that she'd be off in another room without a care while a dutiful staff rotated 24 hours round the clock but that's not the way it worked.

You may promise your parents you'll do your best to honor their request. But when and if you must, do what's best for them.

A LTC policy might be an idea. Though they typically have an elimination period where you pay out of pocket before benefits kick in.
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livesoft
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Re: Planning for parent's retirement health coverage

Post by livesoft »

Also people will change their minds as they age.

When my father died, my mother sold the house and bought a home in another state near the most grandchildren. As she got older, she sold that house and moved herself into a nearby CCRC apartment. At that time she was still driving and sharp as a tack. She basically aged in place for a few more years and eventually died peacefully in her sleep.

My point is that your parents can say what they want now, but I expect them to modify their plans as they get older.
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fourwheelcycle
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Re: Planning for parent's retirement health coverage

Post by fourwheelcycle »

If your parents are 65 now, they may not need assisted living, memory care, or long-term care for many years. Do they have current or known health conditions that will lead to a need for long-term care now, or sooner than age 80 or 85? It is possible your parents may never need long-term care. They might not even need in-home assistance until 80, 85, or 90. That assistance might start with home health aides who arrive to help them get up, washed, and dressed in the morning and then come back in the evening to help them go to bed. It might progress to 12 or 16 hours per day of in-home assistance (two aides, each for one eight hour shift).

My wife's parents ultimately did need 24 hour in-home care. It could have been provided by one reliable agency that provided one aide at a time for three eight hour shifts per day, but my wife and her sister fortunately found an extended family with two mothers and three adult daughters. Three of them covered one shift each for most 24 hour days. If one of them was sick or on vacation, they arranged for the 4th or 5th person to step in. It cost about $260K per year, ultimately for three and a half years, until my wife's parents died one year apart at ages 96 and 97. They were both on Medicare Hospice care at the end. The Hospice nurses came to their home regularly to evaluate their needs and prescribe and manage necessary medication.

You do need a plan to liquidate a sufficient portion of your parents' assets as they get older in order to provide cash flow for the care they might need. If you read this forum, I would say most people recommend against buying long-term care insurance if your parents can afford to self-insure. The long-term care industry started out very optimistically, with reasonable premiums, many years ago. Now, unfortunately, due to past underestimation of eventual utilizations rates, premiums are much higher and many/most policies do not guarantee level or limited increase premiums. Your parents may be able to afford increasing premiums, but it may not be the best way to go.
rich126
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Re: Planning for parent's retirement health coverage

Post by rich126 »

Getting parents to sell a house that isn't suited to aging can be very difficult. A friend of mine has a mother that is in her 90s and they took her to visit 4 retirement places (not sure what level of care but since she is still living at home by herself, I don't think she needs a ton of help now) and she wants to stay where she is although she realizes getting around is getting more difficult (in terms of walking). I think the places they were looking at ranged from $6-8K a month.

Unfortunately wanting to stay at home and being able to can be very difficult unless family is willing to help take care of them unless you have tons of money and can find proper employees. And even that may be difficult if they require significant medical attention.

Good luck.
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johnaltabc
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Re: Planning for parent's retirement health coverage

Post by johnaltabc »

fourwheelcycle wrote: Sun Jun 04, 2023 5:16 pm If your parents are 65 now, they may not need assisted living, memory care, or long-term care for many years. Do they have current or known health conditions that will lead to a need for long-term care now, or sooner than age 80 or 85? It is possible your parents may never need long-term care. They might not even need in-home assistance until 80, 85, or 90. That assistance might start with home health aides who arrive to help them get up, washed, and dressed in the morning and then come back in the evening to help them go to bed. It might progress to 12 or 16 hours per day of in-home assistance (two aides, each for one eight hour shift).

My wife's parents ultimately did need 24 hour in-home care. It could have been provided by one reliable agency that provided one aide at a time for three eight hour shifts per day, but my wife and her sister fortunately found an extended family with two mothers and three adult daughters. Three of them covered one shift each for most 24 hour days. If one of them was sick or on vacation, they arranged for the 4th or 5th person to step in. It cost about $260K per year, ultimately for three and a half years, until my wife's parents died one year apart at ages 96 and 97. They were both on Medicare Hospice care at the end. The Hospice nurses came to their home regularly to evaluate their needs and prescribe and manage necessary medication.

You do need a plan to liquidate a sufficient portion of your parents' assets as they get older in order to provide cash flow for the care they might need. If you read this forum, I would say most people recommend against buying long-term care insurance if your parents can afford to self-insure. The long-term care industry started out very optimistically, with reasonable premiums, many years ago. Now, unfortunately, due to past underestimation of eventual utilizations rates, premiums are much higher and many/most policies do not guarantee level or limited increase premiums. Your parents may be able to afford increasing premiums, but it may not be the best way to go.
The only known medical condition that I know of is high blood pressure/cholestrol, and dad having to use inhaler. But I understand that trying to over cover everything can also be ineffective.

Thanks everyone for all the info and sharing your experiences. Definitely gives me some things to think about.
RudyS
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Re: Planning for parent's retirement health coverage

Post by RudyS »

With those assets, and the level of health you mentioned, they seem like good candidates for a CCRC (Continuing Care Retirement Community.) One starts in independent living, and assuming a Type A (lifecare plan) community, you progress as needed to assisted living, then skilled nursing, should those levels become necessary. All at substantially the same cost. Several recent threads have discussed this in more detail.
dbr
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Re: Planning for parent's retirement health coverage

Post by dbr »

A relevant consideration is how much of that $6M in assets is tied up in the home(s) your parents would like to stay in through old age? Related to that is what are their sources of retirement income?

A case like this is probably one of self-insuring, but the financial plan needs to be laid out not just for health care spending.
valleyrock
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Re: Planning for parent's retirement health coverage

Post by valleyrock »

Lots of on-point advice above.

You might look around/ask around and find a local healthcare advisor who has experience in helping people at various stages. That could include a social worker with experience, and who's struck out on their own to help with these very navigations. It's probably worth it to pay now for some frank discussions with a knowledgeable local third party.

It's important to understand that situations evolve. So, one never knows exactly what will come up and what the options will be at the time.

The other thing I've learned from experience is that this stuff can get expensive, so there's a need to be OK with making those expenditures as necessary. It's part of the end-game, as it were. Fortunately, the funds are there for your folks.
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Watty
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Re: Planning for parent's retirement health coverage

Post by Watty »

johnaltabc wrote: Sun Jun 04, 2023 12:41 pm Any advice or things I can look into would greatly be appreciated.
They need to have their wills and related documents in order while they are able to do that. Without the right paperwork their doctors will not talk to you and you will have a hard time managing their finances. Some brokerages, notably Vanguard, want things like a power of attorney document to be done on their form and people have posted that they can be very difficult to deal with even when you have a valid POA that is not on their form. Be sure to get all their paperwork in order while your parents are able to sign things.

There a various important dates for signing up for Medicare and supplements so be sure to not delay doing that.

Every year in December you will need to review their Medicare Part "D" plans for their drugs and maybe change it. The problem is that rates can change and different plans will cover different drugs differently and even the plan they are in may change the drug coverage going into a new year. In some cases changing your Part "D" plan can result in substantial savings. One "gotcha" with some Part "D" plans is that not all pharmacies that take the plan will be "preferred" pharmacies. You can ask their pharmacy if they take their Part "D" plan and the answer might be yeas, but it may cost them more than at a preferred pharmacy.

An important choice is when they will start Social Security. See this web site for suggestions.
https://opensocialsecurity.com/

There are lots of threads about long term care insurance that you can look up. My take on it is that the policies you can buy today and not anywhere near as good as some of the policies that were sold 20+ years ago so it is harder to find a policy that makes sense especially when you are already 65. With many policies they can and will raise the rates even after you have paid into it for a long time. Most(or may all) policies that are sold now have a limited about of payout and at most might pay out something like $300K to $500K in benefits in the most extreme cases. They have $6 million in investments so that is not a life changing amount for them.

You can look into long term care insurance but I would be surprised if you find anything that is worth buying that will make a difference to lives.

Medicare in general does not pay for a nursing home except for very limited cases like for a limited time after surgery. It is easy to get that confused with Medicaid which can help pay for a persons care when they run out of money.
johnaltabc wrote: Sun Jun 04, 2023 12:41 pm Then they told me they do not want to be in a nursing home and want 24/7 care at home should need arise.
They can afford a lot of in home care but in some situations they may need to be moved into some other sort of facility. Don't let them guilt into promising never to move them into a nursing home since that is not a realistic option in all situations. At most promise them it would be a last resort.
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