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Long
Term Care: Fact and Fiction
by Thomas M. Lilly, JD,
CLU Futurecare Associates, Inc., Pittsburgh, Pennsylvania
1-877-687-4700 (toll free)
412-687-4700 (local)
The cost of long term
care is the monster in the closet. To seriously evaluate the
pros and cons of how to pay for long term care, it is best to understand
the potential costs associated with long term care and understand
the fact and the fiction of alternatives for financing those costs.
Above all, you require reliable information
before you can make any decision and that is what this article intends
to provide. Then you need to evaluate long term care from
a personal perspective. How does it fit with your long term
objectives and aspirations? Decisions about long term care
are very personal and, I believe, of great consequence. If
you need help in understanding and interpreting the information,
my associates and I will be pleased to assist you. But you
must be the final judge of what makes the most sense for your circumstances.
THE COST OF LONG TERM CARE
Let's open the door. The cost
of long term care varies by both where you live when you receive
the care and the level of care you require. In Pennsylvania,
for example, as of January 2003, the average cost of skilled nursing
facility care is a little over $5,300 per month. Skilled care
is the highest degree of medical care, the patient is under the
supervision of a physician, the care is provided 24 hours a day
and the facility has a transfer arrangement with a hospital.
In New York State, the cost for similar care is much higher and
in other states it is lower. But, at $5,300 per month, the
expense comes to nearly $64,000 a year. That number comes
from the Department of Public Welfare and is revised yearly.
I use it here to give an indication of the average cost of the most
expensive level of long term care.
Please understand that your medical
insurance, including Medicare and Medigap, doesn't begin to cover
the cost for long term skilled nursing facility care and covers
very little, if any, home health care.
Medicaid does provide
long term care benefits, at a price. The price is that you
must qualify for welfare to qualify for Medicaid. How you
get there varies a little depending on the state in which you live,
but the bottom line is that Medicaid requires you to spend down
to the poverty level before you can receive long term care benefits
from the government. And that process may also have a significant
impact on the financial well being of your spouse.
As a rule of thumb, some financial
advisors say that, if you limit withdrawals from your retirement
savings to no more than 4% a year, the odds are good that you will
not outlive your savings. Consider that rule in terms of a
$64,000 average current annual cost for skilled long term care.
To be able to withdraw $64,000 a year at a 4% withdrawal rate without
diminishing your savings, you would need $1,600,000. Few of
us have such resources!
Then again, the Centers for Medicare
and Medicaid Services report that the average skilled care
Medicare claim is about 24 days.
So what's the worry? CMMS also
reports that the average long term care claim lasts about 21/2 years
or 30 months. If the care delivered during those
months is largely at a level less than skilled, it's reasonable
to assume that the cost would be lower. Let's assume that your care
costs $4,000 a month (my anecdotal estimate of the current average
cost of custodial facility care in the Pittsburgh area).
And let's further assume that you only needed that care for 30 months.
To finance your care, you would need an initial savings of approximately
$114,000 earning 4% on the declining balance. After 30 months
at $4,000 per month, you will have consumed your entire savings.
Before I
go any further, please remember the words used in defining these
costs . . . average and assume. They create
the danger. The average cost of care may not represent
the actual cost of care in a facility acceptable to you.
Most of us could handle several months of care in a crunch.
Could you handle the average of 30 months? What if you guess
wrong and the need continues? What if the need doesn't arise
for 15 or 20 years but the cost of care has grown from $4,000 a
month to $8,500 a month?
Unfortunately, my crystal ball broke
a long time ago and averages and estimates are all we have to go
on to reasonably anticipate long term needs. My point is that
the financial consequences of failing to plan for long term
care are substantial.
Let's look now at what I call the fact
and fiction of what many of us regard as alternative resources for
long term care.
MEDICARE AND MEDIGAP
Medicare simply does not pay
for long term care. Medicare will pay for skilled nursing
facility care for 20 days if you are transferred into such a facility
within 30 days of spending three days in the hospital for related
care. From the 21st through the 100th
day, Medicare subjects you to a daily copay of $105 if you still
require skilled nursing facility care. From day 101
on, you are on your own.
Medicare may provide a limited home
care benefit, which must be rehabilitative. Once your condition
plateaus, even if you have not recovered, the benefit ceases.
Medigap policies, Plan C or higher,
will pay the Medicare skilled nursing facility copay of $105 a day.
However, it is most important that you realize that Medigap only
pays for deductible and copay gaps in Medicare.
For further information on Medicare,
I recommend Medicare & You published each year
by the Centers for Medicare & Medicaid Services. You'll
find it at
www.medicare.gov or, upon request, I'd be happy to provide you
with a copy. It is a very useful web site because it also
includes links to other helpful government publications concerning
health care benefits.
MEDICAID
Medicaid long term care benefits are
a God send for individuals who are otherwise uninsured and without
assets to pay for their care. Medicaid is, in fact, the only
government program that provides long term facility care.
We would be happy to discuss the complicated Medicaid rules with
you should Medicaid appear to be an appropriate consideration in
your particular circumstances.
I am including this brief discussion
of Medicaid to provide a very basic outline of the means tests which
must be met to receive Medicaid long term care benefits. By
demonstrating the effective cost of qualifying for Medicaid, I hope
to emphasize the importance of incorporating provisions for long
term care in your planning.
To qualify for Medicaid in Pennsylvania,
an individual who is single or widowed cannot have more than $2,400
in assets. There are several exempt or non-countable assets,
including the Medical Assistance applicant's primary residence so
long as he or she is alive, but the bottom line is that you must
be indigent to qualify for Medicaid long term care.
If you are married, the same rules
apply except that you and your spouse can also shelter one half
of your jointly owned assets with a minimum protected amount of
$18,132 and a maximum of $90,660. If your jointly owned assets
total $200,000, you can shelter $90,660, not $100,000. If
your jointly owned assets total $1,000,000, you may shelter $90,660.
Your home is exempt so long as the healthy or “community” spouse
maintains it as his or her primary residence. Upon the death
of the second to die, however, the Department of Public Welfare
will recover from the proceeds of the sale of the house any Medicaid
Assistance benefits paid for nursing facility services for an individual
owner who was 55 or older at the time the benefits were paid.
Please understand that jointly owned
assets in excess of the protected amount must be spent for your
care before you can qualify for Medicaid benefits. Furthermore,
you must spend your pension benefits, if any, and your Social Security
benefits for your care regardless of whether you are single, widowed
or married.
If you give away countable assets,
Medicaid will declare you ineligible for Medical Assistance benefits
for a period of time running from the date you made the gifts.
That period is calculated by dividing the fair market value of the
gifted assets by the Medicaid divisor, currently $5,313.18.
The resulting number is the number of months for which you are ineligible
for benefits. You must pay for your care during those months
out of your own pocket.
LONG TERM CARE INSURANCE
LTC Underwriting.
Before I look at
the many different forms long term care insurance can take, please
note the word insurance. This is not something you
get by just signing up for it. You must show evidence of health
acceptable to the insurer. That process is called underwriting.
The outcome of it will determine whether or not the insurer will
agree to issue a policy covering you.
In some cases of employer-sponsored
LTC programs, the health questions may be reduced to just a few
“knockout” inquiries designed to eliminate applicants who would
immediately qualify for benefits. In some cases, there may
be no health questions.
However, an individual LTC insurance
application typically asks a lot of questions about your health
history and requires you to identify your physicians. You
should assume that the insurer will write to your physicians concerning
your health and that your physicians will fully disclose
their records to the insurer.
If your age is 70 or beyond, the insurer
will typically require a face-to-face meeting between you and a
nurse or social worker, paid for by the insurer, to provide a basic
evaluation of your physical and mental capacities. These are
not medical exams such as you may have experienced with life insurance,
though the insurer will reserve the right to require one at its
expense. Medical exams are rarely used in LTC underwriting.
It is also important to realize that
companies may underwrite the same health condition differently.
If you have any significant health history, be particularly careful
to speak with an LTC broker, an individual who does business regularly
with at least three different LTC insurers. Ask the broker
to discuss your health history with the insurer offering the policy
benefits most appropriate for you before you submit your
application. You'll have a better idea whether or not the
process will be favorable to you or whether you should consider
another insurer as well.
The booklet,
A Shopper's Guide to Long Term Care Insurance, published
by the National Association of Insurance Commissioners, provides
a useful introduction to LTC insurance. Insurance agents are
required by regulation to provide you with a copy at the first meeting
in which they discuss LTC insurance with you.
I have developed the review which you
are now reading to provide greater depth and perspective on the
complicated subject of governmental and privately insured long term
care benefits, but I also encourage you to read the Shopper's
Guide.
Qualified LTC Policies.
The Health Insurance Portability and Accountability Act of 1996
(“HIPAA”) created “qualified” LTC policies. If policies incorporate
certain provisions specified in HIPAA and exclude certain other
provisions, they are said to be qualified under HIPAA.
HIPAA also “grandfathered” LTC policies
issued prior to 1/1/97. The policies are considered qualified
so long as material changes aren't made to them after 12/31/96.
If you have an LTC policy issued prior to 1/1/97, be sure to let
your advisor know.
One value of having a qualified
LTC policy is that you may receive an income tax benefit for some
or all of your premium. More importantly, you are guaranteed
that any benefit you receive from the policy will be exempt from
federal income taxes.
Benefits received from non-qualified
LTC policies are not exempted from federal income taxes by
HIPAA. However, non-qualified policies are permitted
to have a benefit trigger not allowed in qualified policies.
That trigger is medical necessity. A “trigger” is a condition
that may cause you to be eligible for policy benefits. Non-qualified
policies may also allow you to be eligible for benefits by needing
assistance with just one activity of daily living (ADL). Qualified
policies require you to need assistance with two of six ADLs (eating,
bathing, dressing, toileting, continence or transferring) in order
to be eligible for benefits. Thus non-qualified LTC policies
appear to be somewhat more liberal in how you may become eligible
for benefits.
I note that both types of policies
also provide that you are eligible for benefits if you have cognitive
impairment, the most common example of which is Alzheimer's Disease.
It is my opinion that the HIPAA
guarantee of federal income tax exemption for benefits paid
from a qualified LTC policy outweighs the possibility that you could
develop a long term health care need which would involve
a deficit in only one activity of daily living or that would be
sufficiently medically serious as to cause you to require long term
care services but not need assistance with two activities of daily
living.
Which type of policy you select is,
of course, your decision - just be aware of the pros and cons of
each type.
Policy Provisions.
Your eligibility for benefits will depend on the terms of your LTC
policy. Before you apply for a policy, review a specimen
policy that stipulates the provisions for each of the terms that
you want included in your coverage. Be sure that you understand
the terms before signing on the dotted line.
The following provides an overview
of the basic provisions that appear in all policies. But be
warned, companies do differ in how even these provisions are applied.
I will note some of the variations.
- The Elimination Period.
This is the time between the onset of your claim and when you
are actually eligible to accrue policy benefits. It is a
built in delay between the time you need care and when they start
to pay for it. Prior to satisfying the elimination period
requirement, you will be responsible for the cost of services.
You select the elimination period at the time you apply for coverage.
Companies may offer a variety of choices such as 30, 50, 60, 90,
100, 180 days or even longer.
For example, if you elect a 30-day elimination period when you
buy your policy, the policy will not pay for expenses otherwise
eligible for coverage between the onset of the claim (the day
you first needed care) and the end of the 30th day.
Companies, however, can differ in how they credit the days required
to fulfill the elimination period. Some policies credit
one day of care for one day toward satisfying your elimination
period. Other policies may credit one week (seven days) toward
the elimination period if you require otherwise covered services
during just one day of a given week. Still other policies
may vary the theme crediting seven days if you require otherwise
covered services on three days during a given calendar week.
The more liberal the crediting of days toward the elimination
period, the sooner you will receive coverage for expenses you
incur because of health care services you require.
“One time only” is also an important point to keep in mind.
Many policies today provide that you need only satisfy the elimination
period once in your lifetime. You may have surgery that
requires several weeks of rehab. If, for example, you need
assistance with bathing and dressing during that rehab period,
you may earn days in permanent satisfaction of the elimination
period which could be most important later on if you develop a
truly long term health care need. Your policy benefits will
be available to you sooner.
The elimination period will have an impact on your premium.
A policy with a 30 day elimination period will have a higher premium
than one with a 60 or 90 day period. Remember that the insurance
company will not pay benefits for expenses you incur during the
elimination period. Be sure to compare the premium you save
against the potentially higher out of pocket expense you will
incur should you have a long term care claim.
Don't count on Medicare to help pay expenses during the elimination
period. Remember that Medicare only pays for skilled nursing
facility care and then only under certain conditions and Medicare
benefits are subject to a $105 a day co-pay after the first 20
days.
However, days covered by Medicare may count toward satisfying
the elimination period - another
reason to check out specimen policies before you buy.
- The
Benefit Amount. LTC insurance
policies usually express the basic benefit in terms of a maximum
daily benefit amount. Thus you may buy a policy with a $150
a day maximum benefit. Some companies express the benefit
amount in monthly terms (e.g., $4,500 a month), but the daily
benefit is the most common benefit description.
You select a maximum daily benefit when you apply for a policy.
I think that today a $150 daily or a $4,500 monthly benefit is
a reasonable starting point. Remember the $5,313.18 “Medicaid
divisor” to which I referred earlier? That's the current
average cost of skilled nursing facility care in Pennsylvania
according to the Department of Public Welfare. It works
out to about $177 a day.
The statistics suggest that most long term care claims, with the
emphasis on long, don't require constant skilled nursing care.
You'll often see $100 a day referred to in media articles on long
term care. In my experience, that number, at least in Pennsylvania,
is an underestimate even for quality custodial care.
Your needs and resources will be the ultimate arbiter of the basic
benefit appropriate for you, but I recommend that your competitive
evaluation require $150 a day as a constant for each insurer's
quote.
Note the word basic. Every company offers riders,
extra benefits for extra costs, which can enhance your coverage.
When comparing costs, be careful to first examine the basic, no
frills, benefit cost of each insurer you want to consider.
One more basic point. Be sure to ask how the “daily” benefit
is actually paid out in the event of a claim. Some companies
limit what they will pay to the stated daily amount. If
your daily care costs more, the excess cost over the daily benefit
is your responsibility.
The trend, however, appears to be for companies to provide for
the stated daily benefit to be accessible at claim time as a weekly
or even a monthly multiple. For example, your daily benefit
may be $150 but the company will allow you to access during a
seven day period (or a calendar week) $1,050 (7 x $150) without
limiting the payout to a daily maximum. Thus if you need
physical therapy but only three times a week and the therapy costs
$250 each time, the LTC policy will cover you for the full amount
each time because the total covered expense didn't exceed
$1,050 during the seven day period.
Incidentally, if your benefit is paid on a reimbursement basis
(the structure used by the majority of LTC policies,) the left
over $300 ($1,050-$750) is kept in reserve for you and could extend
your maximum benefit period.
- The
Benefit Period. This is the
number of years for which the full daily benefit is payable once
you are eligible for benefits.
You select the benefit period when you apply for your policy.
Companies typically offer 2, 3, 4, 5, 6 and even 10 year benefit
periods called “limited” because the number of years for which
benefits are payable is limited. You can also elect an unlimited
or lifetime benefit period.
As I mentioned above, if you have a limited benefit period
and the cost of your covered expenses does not use up the full
amount of your daily, weekly or monthly benefit amount, the balance
is kept in reserve for you and will extend the maximum duration
of your benefit period.
There are a few policies on the market called indemnity
policies for which the last statement is not applicable.
Indemnity policies pay the full amount of your daily benefit to
you if you incur covered expenses even though the expenses don't
add up to your maximum daily benefit amount. Most policies,
however, are structured on a reimbursement basis and pay, up to
your policy maximum, only to the extent you actually incur covered
expenses.
Your premium cost is affected by the length of elimination period
and by the benefit period you select. Because the
average long term care claim is about two and one-half years,
I encourage you to consider at least a three-year benefit period.
For greater planning flexibility, I think that a four-year benefit
period is a prudent minimum. However, your financial
circumstances now and for the foreseeable future will guide you
to the appropriate, manageable premium level. It is certainly
better to have even a two-year benefit period in force than no
coverage at all.
- Shared Benefits.
This is a relatively new concept in LTC benefits and may take
the form of a rider added to a policy or of an entirely separate
type of policy. The benefit can work in two very different
ways.
Typically a shared benefit provision is a rider that you elect
to add to your policy at the time you apply for coverage.
The rider may provide that you and your spouse (or, with some
companies, your life partner) can “piggyback” on the other's policy
benefit if one person uses up his or her benefit. Using
this option would reduce the maximum benefit available to the
healthy individual should she or he need long term care at a later
date. However, policies which structure the shared benefit
in this manner usually provide a floor or minimum benefit which
will be available to the healthy spouse in the future, although
it will not be as great as the benefit they originally purchased.
An alternative and, I believe, more favorable shared benefit structure
creates a third pool of money which either individual or both
can access after their individual policy benefits are exhausted
until that pool is also used up. This format assures each
individual that they will always have their own policy benefits
for their own use in the event of a long term care claim.
The advantage of such a rider is clear where a limited duration
benefit is purchased. You could effectively double the maximum
number of years for which benefits would be payable for one of
two individuals or substantially increase the benefit duration
for both persons depending on how the future unfolds.
As with any additional benefit, the shared benefit rider adds
a cost to each policy. You should examine that cost and
the potential benefit in terms of your long term budget and the
needs for which you are most concerned.
- Inflation
Riders. This
benefit is intended to provide some protection against the future
cost of long term care. It can take several different forms;
an automatic annual fixed percentage increase in your benefit
or a periodic option for you to purchase an increase in your benefit.
The increases can vary in at least three ways; they can be simple
or compound or they can be by a varying dollar amount based
on an index (often called a COLI rider). The cost
of the benefit increase may be included in the cost of the rider
itself or it may be a charge based on your age at the time you
exercise an option over and above the cost of the option rider.
No one said this subject is simple!
Which rider, if any, is appropriate for you is more than anything
else a function of your age at the time you first apply for long
term care insurance. In my opinion, if you are younger than
age 70 at the time you apply for a policy, you should elect an
automatic annual compound benefit increase provision.
If you are 70 or more senior, you should consider a simple
benefit increase rider or, at least, the COLI rider.
An inflation rider is likely the single most expensive additional
benefit you can include in a long term care policy. The
longer the interval between the policy issue date and a claim
on the policy, the more critical in hindsight the decision to
purchase the rider becomes. An annual benefit increase of
5% compounded will double the policy benefit in about 15
years. A 5% simple increase will double the benefit
in 20 years. Think about what the cost of long term care
may be in 15 or 20 years.
- Premiums.
There can be a significant difference
between the premiums charged by one LTC insurer compared to another
for very similar benefits. It does pay to shop. However,
I believe that you should first determine the most appropriate
basic benefit structure for your needs before you shop.
If you heed the advice to work with a broker who is not the agent
of just one or two companies, that individual should be able to
provide you with competitive quotes from a number of well established
long term care insurers for the benefits important to you.
Most LTC insurers do not guarantee that the premium will not change.
What is guaranteed is that the policy cannot be cancelled by the
insurer so long as you pay the premium. Neither can an insurer
single you out for a premium increase. The company
must apply to the insurance commissioner for permission to change
the rates charged for a class of insureds and show cause
why the rate change is needed.
There are, however, a few companies today who do offer a guarantee
that their premiums will not change for a number of years.
You should make it a point to discuss with your broker quotes
for the benefits you need including quotes in which the premium
is guaranteed for a period of years. The cost may be higher
than for an equally strong company and product without a premium
guarantee. The point is to examine the options.
You should also examine the history of the insurer in terms of
rate increases. In Pennsylvania and a number of other states,
companies are now required to disclose to you whether they have
raised the rates in the past on the policy for which you are applying
or on any similar policy.
I have prepared a cost/benefit matrix. The Matrix offers
a perspective on how premiums can vary depending on your age at
the time you purchase coverage, on the duration of the benefit
period you select for your coverage, and depending on whether
or not you are in really good health (receive the best rate offered
by the insurer) or good health (receive the standard rate for
the coverage you request.)
The matrix also addresses the “time value of money” issue -
what if I didn't buy the insurance
and, instead, saved the premium dollars for, let's say, 20 years.
How long would my savings cover my expenses if I had a claim that
started in 20 years? You may be surprised at the answer.
The matrix assumes for each issue age a benefit of $150 a day
and, with the exception of issue ages 75 and 80, the cost of a
5% compound automatic annual increase in the benefit is included
in the premium. The benefit is 100% available for care wherever
it is delivered to you, whether in a skilled nursing or assisted
living or adult day care facility or at your home.
I think that the matrix also provides a perspective on value for
individuals who may, because they do have substantial assets,
be thinking about self-insuring against long term care.
Since the premium outlay wouldn't be a significant budget issue,
I submit that the value of the insured benefit is in the fact
that it frees those dollars for family or charitable purposes.
$64,000 or more a year today, $128,000 or more in just fifteen
years - those are dollars which could mean a great deal to a charitable
organization and create a tax benefit to boot for the insured
while he or she receives tax free benefits from the qualified
LTC policy.
Finally, while the matrix focuses on what you may receive in dollar
benefits for what you pay, don't forget the human side of the
equation. The greatest protection afforded by LTC insurance
is for the community spouse, the healthy spouse. Elder law
attorneys, CPAs and financial advisors often tell me about how
the cost of caring for an uninsured spouse left the otherwise
healthy spouse near poverty after the death of their loved one.
If you would like a copy of my cost/benefit matrix, please call.
- Extras.
Most companies offer a selection of enhancements that you can
add to your policy at the time of application. My purpose
in this discussion has been to help you sort out the basics so
that you can reasonably decide whether insured LTC coverage is
appropriate for you and, if so, to provide you with some guidelines
on how you can objectively evaluate the underwriting practices,
fundamental benefits and costs of various insurers.
Don't get caught up in extras until you reach a sound decision
on your needs and the basic policy which fits you best.
- Combo
policies. The long term care
insurance marketplace offers not only “stand-alone” LTC policies
but also policies in which long term care benefits are coupled
with universal life, whole life and even variable life policies.
These policies may be appropriate for the individual who has significant
liquid assets, who needs additional life insurance, and who needs
insured long term care protection. You should understand
that they are not primarily marketed as long term care contracts.
Rather, basic long term care benefits can be added to them by
riders. Typically, however, the use of the long term care
benefit directly impacts the life insurance benefit and the investment
value of the product.
You should also know that, at least in the current state of their
development, the LTC benefits offered by these products are not
as comprehensive as you will find in stand-alone policies.
The question I think you need to ask yourself if you are presented
with such a policy is why, if you need life insurance, would you
place value on a rider (an LTC benefit) which, by using it in
a long term care claim, would potentially reduce your death benefit
to a nominal amount?
At least part of the answer to that question is in the willingness
of some individuals to hedge the LTC risk if they can accomplish
other purposes at the same time such as the conservative growth
of a portion of their assets or the provision of some additional
death benefit. If you fit that profile, you may want to
consider such products but be sure to do so in comparison to stand-alone
LTC contracts so that you understand the benefits offered by each
approach.
- Financials.
Financials are fundamental. You should require the broker
to provide the financial ratings of each insurer under your consideration.
I strongly recommend that you only consider insurers with financial
ratings of “A” or higher from at least two of the following five
rating firms: A. M. Best Company, Fitch Ratings, Moody's
Investors Service, Standard & Poor's, and Weiss Ratings.
CONCLUSION
I hope that this article provides you
with a basic understanding of the realities of long term care benefits,
both governmental and those available through private insurance.
The consequences of failing to incorporate
long term care in your planning, at least as you approach retirement,
can be financially catastrophic. I encourage you to discuss
your needs, concerns and resources with a qualified LTC broker so
that appropriate measures can be taken to reasonably protect you
and your family as the future unfolds.
© 2003 by Thomas M. Lilly, JD
CLU
All rights reserved.
Jim's Lange's Comments
I hope you found Tom's discussion of
long term care options useful in your own decision making process.
There is no person I trust more than Tom to provide appropriate
advice and service in the long term health care area. As I
mentioned at the beginning, I urge you to stop procrastinating and
address the long term care issue one way or the other.
We recommend that unless you have an
excellent long term care insurance provider with whom you are happy,
that you take advantage of Tom's offer for consultation.
Tom is President of Futurecare Associates,
Inc, a long term care brokerage firm located in the Shadyside district
of Pittsburgh, PA. Tom represents a large number of LTC insurers,
which facilitates matching the appropriate long term care insurance
solution with an individual's long term care needs. Tom is
licensed to practice in Pennsylvania, New York, Massachusetts, Ohio,
Kentucky, Virginia, Washington D.C., Nevada and California.
If you are a resident of a different state, Tom can easily become
licensed in your state to serve you. As many of my out of
town clients have found with my services, it is often more important
to have a true expert do the work remotely than to take a chance
with a local practitioner who might not have Tom's expertise, education,
judgment or experience in the long term health care area.
Tom is offering consultations to readers
interested in long term care insurance issues and can be reach by
calling toll free 1-877-687-4700, locally at 412-687-4700, or by
e-mail at tom_lilly@msn.com.
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