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Wife Did Not Expect This and LTCI Trigger Language
Jan L. Warner & Jan Collins

Question: My husband was 57 and I was 63 when we married last year. This was the second marriage for each of us. I have owned my home since my first husband died. I receive Social Security and a pension. Although he had been divorced for years, he still had rather large debts, child support obligations, and no assets. Several months after we married, he lost he job, started drinking, and began living off me. Then he was involved in an automobile accident -- in my car, and it was his fault. He was admitted to the hospital where, after several days in critical care, he died. He didn't have health insurance, and I did not sign him into the hospital; however, after getting several threatening letters from the hospital, I was sued for $85,000 because, they claimed, I was legally responsible for my deceased husband's medical expenses. I have gone to a lawyer who tells me that I will lose my house if we cannot negotiate a better deal with the hospital. He suggested bankruptcy as another option. I really got my goose cooked because I didn’t pay attention. Assuming that there is nothing else you can suggest, I would like for you to print my email to let your readers know that there are many, many pitfalls out there that few of us ever expect.

Answer: You're correct. Under what is known as the "necessaries doctrine," third parties that provide necessaries to one spouse have the right to bring suit against the other spouse to recover. Most state legislatures have enacted statutes that provide this remedy, and 29 have gone so far as to make children responsible for their parents' necessaries under certain circumstances. To make matters worse, a premarital agreement would not have benefited you one bit. We strongly urge seniors who plan to marry -- whether for the first or second time -- to make sure that planning for the exigencies you describe is accomplished before saying "I do."

Question: I have been concerned about buying long-term care insurance because a couple whom my wife and I have known for years bought a policy a number of years ago and, when she needed care because of dementia, the policy would not pay because she had not been put in the hospital first. I have stayed away from salesmen because my friend told me that he had been assured that the policy he bought was a “Cadillac”. My wife and I have refused to purchase a policy because of this. Is there a way we can be sure of what we are getting?

Answer: Because of problems like those encountered by your friends, Congress has stepped into the long-term care insurance arena. In addition to making part of the premiums for long-term care insurance tax-deductible as a medical expense, Congress has standardized certain policy language that triggers payment under the policies. For example, today’s policies require that an insured receive benefits if he or she will be unable to perform at least two of six activities of daily living (ADL's) for at least 90 days. And those whose cognitive impairment is so severe that it places the patient or others at risk will receive benefits even if he or she does not meet the ADL requirement.

In addition, policies can't require prior hospitalization as a prerequisite to receiving long-term-care benefits, and inflation coverage must be offered at an extra charge. There are many other protections for the consumer, and the language used by most companies today is similar based upon federal law. But that does not mean that you should rely on representations made to you and not read and understand your policy.

In making the decision to purchase or not purchase long-term care insurance, individuals should address both protection and economic issues because while the majority Americans who have enough assets to justify protection, many don’t have sufficient cash flow or assets to cover nursing home care for a long period of time. Some say that you should not consider long-term care insurance unless you have annual gross income of at least $30,000, can pay the premiums from that income, and have at least $75,000 in assets, excluding auto and home. Of late, Congress has been considering legislation that would make the premiums paid for tax qualified long-term care policies fully deductible to policyholders. In the final analysis, however, you and your wife should feel comfortable with your decision based upon your individual circumstances.

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