If you are fortunate to live to 83,

you will have lived 30,000 days on this beautiful blue planet.

The first 10,000 days, you grew from a child, dependent on parents, to an adult, striving for an education. The next 10,000 days, you worked hard to create a professional career, marriage, family, and community ties. The last 10,000 days are for you to fulfill heartfelt dreams; to master new goals; to protect your health;    to reflect on gratitude.

In the present moment, we often put aside concerns for future health.

Here’s an early warning:  Whether you’re the head a company or you’re a member of the C-suite, you could fall through a gaping hole in your executive benefit program those last 10,000 days unless you secure the safety nets available to you now.

An employer-paid benefit, executive long-term care insurance (LTCi) attracts, rewards, and strengthens retention of select executives for their contribution and loyalty to the business. If you don’t offer LTCi to your executives, we ask that you reconsider.

Executives play a crucial role in the larger corporate structure. Typically, their responsibilities are more demanding than those of the average employee. Also, the pressures on them are greater from innovating new products and expanding revenue to controlling costs and managing human capital. When companies fail to acknowledge these facts, they can lose coveted talent to other employers.

Self-insuring for long-term care demands a financial sacrifice many executives are unwilling to make. Consequently, an LTCi policy may be the only option available for executives to manage their lives after accidental injury or sudden health complications. Without LTC coverage, one misses a critical link to security in later life.

Look at the facts:

• One out of every two people (52.3%) turning 65 will experience a long-term care need during their lifetime.
• Those in the highest income quintile (22%) face a long-term care need of two years or longer.
• Median annual nursing-home cost for a semi-private to private room, $82,125 – $92, 378; however, if you’re a Manhattanite, you’ll need to pull together a whopping $164,250 per year in 2016 dollars.

What’s more, you need coverage to help you conserve assets for personal use; preserve an estate for children; ensure against becoming a burden to them; and, to minimize physical and emotional strain on a caregiver spouse

Without a robust LTCi policy, you will face other challenges.

Challenge Escalates

At least 15 percent of individuals turning 65 between 2015 and 2019 will spend more than $250,000 on long-term care, absent a policy. Can you save and set aside a quarter of a million dollars in time?

Without an LTC policy or substantial savings, your family is severely exposed in a long-term care event. Your spouse will be allowed to retain only $120,900 in assets for you to be eligible for long-term care benefits provided by Medicaid.

More than seven million Americans own long-term care insurance policies. As recently as 2002, a thousand or so insurers offered the product, Ray Farmer, director of South Carolina’s Department of Insurance explained in a CBS News interview. “Now there are probably a dozen left,” he said, due to the rising cost of care and claims.

So, you need it. Your executives need it. And soon.

Clearing the Hurdles

No doubt, we’ll all agree that executive turnover can be brutal on a small, mid-sized or major company. The cost of losing one key executive causes untold lost productivity. To replace the executive can cost the employer 2.5 times of the departing executive’s annual salary. One effective way to secure the executive ranks is the provision of a robust benefits program, the best of which include LTC coverage.

The employer buys a long-term care insurance policy for each member of the executive group. Let’s say a company employs 500 people, and a small group of executives directly drive the strategic growth of the business. Can an employer risk discrimination against the entire workforce if it only covers a small group of executives?  Isn’t LTCi prohibitively expensive? What about full medical underwriting?

We’ll answer these and other important questions in this post, the third in our services of executive benefits.

In our first post, we discussed the importance of disability insurance, when you cannot work due to an unexpected health setback. Then, we addressed the need for executive carve-out life insurance with death benefits commensurate with the highly compensated executive lifestyle.

Similarly, LTC coverage can be offered to a select few (an executive carve-out) with non-taxable premiums for the employer; job portability and control for the executive.

Unfortunately, few people are prepared to handle the costs of long-term care. On average, it costs

$46,000 a year for nursing home care in the United States.  In some regions, this figure can soar to

$100,000 and more. Further, costs will continue to rise.

As a result, 70 percent of all single employees who require long-term care can be wiped out financially within a year.  Half or more of married couples can face bankruptcy if one spouse enters a nursing facility for a year as their existing assets must be spent down to fund the care—without LTCi coverage.

Long-Term Care Defined

LTCi is business insurance that allows employers to insure a select group of their workers for the long term. With the increasing costs of semi-private and private rooms in nursing homes, protection from such long-term care costs makes good financial sense for both employers and executives.

Simply put, a long-term care policy makes it possible to deliver care in the home or in a facility (semi-private or private room) to individuals who need assistance with the activities of daily living such as feeding, bathing, dressing, or handling personal hygiene, defined as toileting, transferring, and incontinence.  

Specifically, you meet the definition of long-term care when the individual is unable to perform any two of these six activities. What’s more, if the person suffers severe cognitive impairment as in Alzheimer’s disease, he or she is a candidate for long-term care.

Apart from nursing home care, alternatives are limited to an adult day care center; home health care; an assisted living facility, which enable people to live in an apartment-like setting; or hospice care, which is purely for the terminally ill.  

Compared to traditional medical care, long-term care is designed to assist someone to live as comfortably as possible, although it may not help improve or correct underlying medical problems. Long-term care may also include care management services that evaluate a person’s needs while coordinating or monitoring the delivery of services.

An employer-sponsored LTCi group plan can provide significant advantages like discounts and streamlined health underwriting and remain 100 percent voluntary with the employee paying the whole premium. But you need a better package for executives. And, importantly for employers, coverage can pinpoint select employee groups, the arena for an executive carve-out plan, and offered to spouses, partners, parents and parents-in-law, retirees and even spouses of retirees.

Employers—Don’t Look Away

Unfortunately, many employers overlook the need for LTCi coverage, believing their executive benefit plans adequate to cover retirement goals, making little or no provision for long-term care.

This oversight surprises me because employers conscientiously invest in benefit plans designed to assist highly compensated executives meet retirement goals yet stop short of protecting that retirement against the erosive nature of long-term care costs.

These costs can devastate a person’s lifetime savings and cost corporate America double-digit billions in lost time, lost executive talent, and lost productivity.

Of the 30.2 million small businesses in the U.S., most with fewer than 100 employees, and the 18,500 corporations with 500 or more employees, only about 25,000 (LIMRA 2010) offer long-term care to their employees. This tiny fraction indicates the true width of the needs gap.

Further exacerbating the situation, we cannot depend on the government to help cover long-term care cost; it is the largest unfunded liability facing Americans today. Neither Medicare nor Medicaid is set up to cover long-term care.

Employer Options for Executive Carve-Outs

As the employer, you are not required to offer coverage to lower-level employees because long-term care insurance is not subject to “discrimination testing.” An employer can “carve out” selected key executives for LTCi from the pool covered under the group plan and still confer the group cost-savings to the executive. Premiums for group coverage typically are lower than premiums for individual policies.

What’s more, underwriting is more lenient when policies cover more than 15 executives. Insurance providers lower adverse selection risks when more are covered, and lapse rates are lower because employers pay the premiums.

Of course, if your employer does not offer any form on LTCi, you can (and should) buy an individual policy.

Here’s a brief discussion on the preferred policy features available for these immensely valuable plans:

Preferred Policy Features

As you study the LTCi options, look for policy features to complement your personal situation and include them in your or your executives’ carve-out policy:

Front-end underwriting

If you’re in good health, you should get coverage. Try to avoid back-end underwriting because the insurer may subject your application to more scrutiny before a claim approval.

Guaranteed Issuance and Renewal
Need help here Joe. Is there guaranteed issuance and renewability with an exec carve-out?

ADL Benefits Trigger

Consider a policy that triggers benefits based on the insured’s inability to perform two of six activities of daily living (ADL).

Elimination Period

The time a policyholder must wait before becoming eligible for benefits matters. Best to select between 0, 30 or 90 days.

Daily Benefit Rider

Daily benefit amounts vary. Be sure to understand the full daily cost of care for a nursing home, assisted living facility, or home and community-based care in your state. One easy way to calculate a daily benefit: Take the average cost of care where you live (or likely to live when need care) and subtract from that your daily income. For instance, nursing homes cost $300 a day, and your income is $3,000 a month, or $100 a day, then your daily benefit should be $200 a day.

COL Adjustments
Cost-of-living adjustments built into your policy can keep pace with the rising cost of nursing home care.

Return-of-Premium Rider

If you end up not using your policy, your premium amounts return to you. This benefit can cost you about half or more of a non-return policy.

Fully Paid-Up Coverage

Employers can purchase coverage that becomes fully paid in ten years, an attractive benefit for executives given policy portability. New policy riders let the insured expand the total dollar amount coverage if long-term care is necessary early in life. 

Other options include premium payment (typically made on an annual, semiannual and quarterly basis); choice in waiver of premium, professional services, home care services, respite care, alternative plan of care, restoration of benefits, and more. These complex choices warrant your working with a long-term care expert who can assist in key decisions with sound analysis.

Kimberly Lankford, author of The Insurance Maze: How You Can Save Money on Insurance-and Still Get the Coverage You Need suggests anyone interested in LTCi should do their homework:

“Examine waiting periods in relation to cost. The longer the waiting period before coverage kicks in, the lower the premium. A 60-day waiting period, she says, typically is the best balance.

Consider the length of the benefit period. The shorter the period, the lower the cost. The average nursing home stay is about two and a half years . . . coverage can be purchased for several years or for a lifetime. Most, she says, select the three-year period.

Buy coverage while the insured is in his or her 40s or 50s, when premiums are lower. A policy with a $200-a-day benefit and five percent annual inflation protection may cost a 45 year-old $1,824 per year. At age 55, that cost jumps to $2,227. At age 65, the cost becomes $3,427.

Stick with a large insurer that has a history of not raising premiums. Long-term care insurance premiums may rise over the years based on the claims paid on the block of people that are insured.”

LTCi Tax Advantages to Both Employer and Executive

Under the Health Insurance Portability and Accountability Act of 1996, LTCi policies that meet certain requirements may be eligible for federal income tax advantages, known as “qualified” LTC insurance. Those that do not meet these requirements are “non-qualified” LTCi policies. When deciding whether to purchase a qualified or non-qualified policy, tax consequences should be one of many factors you consider.

In an executive carve-out policy, employers can deduct the cost of an executive’s LTCi premiums. A C- corporation can deduct 100 percent of the executive’s premiums. For Subchapter S corporations, limited liability partnerships and partnerships, however, the IRS rules limit income tax deductions, based on the insured’s age.

These policies are “tax-qualified.” Benefits are not considered taxable income to the insured. Executives pay no income tax on employer-paid premiums. Even though some companies prefer to let employees purchase policies themselves, executives can still receive a premium discount if the company offers the policy.

If an employer offers coverage and the employee pays premiums, the policy is tax-qualified (policyholders won’t pay taxes on their benefits). Also, employees with medical expenses, including dental, exceeding 7.5 percent of their adjusted gross incomes, can deduct long-term care premiums. A person’s age determines the deductible amount.

The LTCi contract must also meet the requirement of Consumer Protection Provisions. A contract may be considered a qualified LTCi contract even if benefit payments are made on a per diem or other periodic basis, and even if the expenses happen during the period to which the payments relate.  Non-tax-

qualified LTCi policies exist. However, the premiums are not eligible for the favored tax treatment that tax-

qualified policies receive. If your tax situation calls for a qualified LTCi plan, consider these requirements:

1. only protection provided in the contract must be qualified long-term care services
2. contractdoes not pay for expenses covered by Medicare
3. contractis guaranteed renewable
4. contractdoes not provide for a cash surrender value or other money pledged, assigned, or borrowed

From a tax standpoint, participants in an employer-paid LTCi plan for a C-corporation may exclude from income any premiums the employer pays (IRC Sec. 106).  Employer expenses for LTCi premiums paid on behalf of employees, their spouses, retirees, and their spouses are deductible as a business expense.

Even if the plan is discriminatory in favor of highly compensated employees, the employee’s exclusion of the premium paid by the employer, and the employer’s deduction for such premiums, are permitted. The IRS allows you to deduct qualified medical expenses that exceed 7.5 percent of your adjusted gross income for 2018.

Other essential tax issues apply specifically to partnerships, S-corporations, and limited liability companies. Review these different issues with a benefits consultant or tax accountant.

Will you be the one out of every two people who need long-term care in your lifetime?

Can you afford the risk of no insurance?

I cannot overstate the value of an experienced and knowledgeable professional to guide you through the complexities of planning a suitable long-term care benefit plan. By planning for this life stage now, you will determine the level of comfort you will enjoy in Act Three of your life’s play.

To your well-being in health, wealth, and life

Joe

Joseph E. Henehan, president and chief executive officer

The Henehan Company