LGBT Issues Regarding LTCi Presented by Claude Thau

LGBT Issues Regarding LTCi Presented by: Claude Thau LGBT rights are stabilizing, but unique aspects of this market remain.

Same-Sex Marriage Approved by Supreme Court Obergefell v. Hodges, June 26, 2015, 5 -4 decision States must: Permit same-gender marriages Recognize same-gender marriages performed in other states Claude’s comment: what about foreign marriages? Far-reaching: inheritance (including intestacy); adoption; contract rights; property rights; immigration; guardianship priority; ability not to testify; prison visits; etc. Apparently does not address any transexual issues

To Do List for Such Couples Decide whether/when to marry Might expose different expectations Who to invite May need to divorce other-gender partner first?

To Do List for Married Couples 1. Register marriage 2. Inform employer Add coverage under er-paid acute health, exec carve-out LTCi Change beneficiaries etc. 3. Which assets should be shared? Bank & CU accounts; investment accounts; home; etc. 4. Estate-planning: trusts, wills, etc. LTCi to protect kids? 5. Pensions, SSA? 6. Home-owners ins. : non-owner no longer needs renter’s insurance 7. Decide how to file taxes: several considerations 8. Health Care Directives, Durable Powers of Attorney, DNRs, etc.

Possibly Unanticipated Consequences 1. 2. 3. 4. Liability for spouse’s debts; bankruptcy Liability for spouse’s LTC needs Higher taxes if both have high income Medicare Part B price might change Your income might affect spouse’s child’s 5. a. Scholarship b. Ability to get subsidy under ACA

All Levels of Government Must Implement Federal, state, county, city Must reviews practices and also documentation 6

Employers Must Implement Also 1. 2. 3. 4. 5. 6. 7. Acute health plans Beneficiaries for life insurance, pensions Family Medical Leave policy Employee assistance programs Employee child scholarship grants Executive carve-out programs Events to which spouses are invited

Employer Risks State differences as to proof of marriage Risks of treating people differently. For example: If require proof of marriage for same-gender, must do so for opposite-gender marriages If ask about children, must do so for each type of marriage Any risk in not recognizing adopted children for health benefits, scholarship programs, etc. ?

Businesses Must Implement Financial: insurers, banks, etc. Membership organizations: museums, zoos, country clubs, etc. 9

Size of the Market May become easier to determine? More than twice as many report having had same-gender sexual involvement than report as LGBT. Growing, up to 4. 3% in mid-2013 Earlier 2011 report: 3. 8% of USA population (more than NJ population) identify as: 1. 1% women who are bisexual 1. 1% men who are gay 0. 7% men who are bisexual 0. 6% women who are lesbian 0. 3% are transsexuals 10

Unique LTC Issues for the LGBT Market – may change 1. Entire population: women are 50% more likely to need LTC than men. Does gender incidence & length of claim vary in LGBT market? 2. 3. 4. 5. 6. 7. Twice as likely to be single when aged Less likely to have children as caregivers May still have less support from blood relatives. Many plan to grow old with friends, not families. Same-sex divorce rate = half the % 2 -sex couples Bad experience in institutions encourages more desire for informal home care. 11

US HHS Video LGBT Training for LTC Providers HHS’s Administration for Community Living (ACL) released online learning tool: Building Respect for LGBT Older Adults to increase awareness of the issues faced by lesbian, gay, bisexual, and transgender (LGBT) individuals living in long term care (LTC) facilities. ACL funds Services and Advocacy for Gay, Lesbian, Bisexual and Transgender Elders (SAGE) to develop and operate the National Resource Center on LGBT Aging 12

LGBT LTC Statistics. 1. LGBT men & women more likely to have provided care to an adult in past 6 months. a) Males: 20% LGBT vs. 17% general population. b) Females: 22% LGBT vs. 18% general population. Women provide similar amounts of caregiving whether LGBT (20 hours/week) or not (22 hours/wk) 3. But LGBT men give more care than other men (41 hours/week vs. 29 hours/week) 4. % of people who provide care > 150 hours/week: Gay men (14%); Lesbians (3%); Bisexual (2%) 2. 13

LTC Insurers Generally Treat All Couples Equally Both-buy discounts are the same regardless of gender or marital status But non-married (any gender) generally must have lived together and shared finances for 3 years (varies by insurer) Med. America: 1 yr (GA: 6 mos; TX: must be married) Transamerica: 2 yrs (ID, LA, VA: must be married) Shared Care is generally available if bothbuy discount is available. 14

Possible In Force LTCi Issue Some same-gender couples may not have gotten couples’ discount because had not been living together long enough. Now marry Will the insurer allow them the both-buy discount going forward? Argument that they had been discriminated against because of lack of right to marry. Might be worthwhile to re-issue policies if not inforce very long What if they had unrecognized marriage? 15

Don’t shy away due to these Underwriting Issues Some reports of higher % of: AIDS: 50 x as high % of new cases among gay men, but still much less than 1% (2007) Cancer, especially breast cancer (due to smoking, alcohol, BMI) May improve due to SCOTUS decision Depression & anxiety (lesbians particularly) May improve due to SCOTUS decision Syphilis 16

Favorable Characteristics More educated (46% have college degrees) Higher discretionary expenditures Partly because fewer children Partly due to high education level Appreciative of non-judgmental service Well-networked. A fairly easy market to connect to and get referrals. Young age distribution yet more aware 17

Age Distribution 18

Other Insurance Issues Obviously the age distribution suggests a DI market General population: more than 25% of 20 year-olds will be disabled before they retire 19

ASSI “True Freedom” Guarantee Issue non-medical home care services Can pay companion of your choice to provide care Very attractive in LGBT market Must buy prior to receiving LTC services 20

Help + Care Discounts on LTC services, prescriptions, dental, hearing, vision, podiatric, chiropractic, vitamins, nurse helpline, imaging services, diabetes management, etc. Covers entire household. 3, 000 have accessed 20 -yr-old network. Care. Scout provides services. 236, 000 providers. Sell in 44 states; $30/month Can save $17, 280 for ave. NH stay & cost 21

Gender-Specific Pricing Women pay 50%-60% more than men. In most states, we have only 1 insurer still using unisex prices for single people (none in MO) Especially valuable for lesbian couples to get unisex pricing. Now possible with Genworth if both buy. Multi-life LTCi attractive to lesbians, but not gays. 22

Cash Features May Be Attractive in LGBT Market “Cash” benefits pay if you need LTC, as opposed to reimbursing commercial costs “Cash” benefits can be used to pay an informal caregiver. Mutual of Omaha and Transamerica allow 30%-40% of the benefit to be used in such fashion. Life. Secure allows 50% of unused benefit if in plan of care. Genworth allows 50% but only for homemaker & chore services. 23

Thank You for Your Attention Lots of issues regarding providing LTC to LGBT market. (If interested, ask us for booklet on Principles of LGBT Elder Care, written for LTC providers) We can also provide: Link to LGBT consumer marketing article Other links used in putting this together 24

Medicaid/Social Security Issues Easier for less affluent partner to qualify Harder for affluent care recipient to provide income or assets for less affluent. Minimum Monthly Maintenance Needs Allowance Spouse ability to retain house Survivor (in non-Recognition State or not married) may have less social security & pension benefits than a married survivor. Young may presume normal rules will apply by time they need care, especially if married or intending to marry and willing to relocate. 25