Out-of-Control Premium Hikes for Long-Term Care Insurance

Some people with long-term care insurance started 2016 with unpleasant news. Premiums are rising, and the media reported policyholders, such as customers in Pennsylvania, could be paying as much as 130 percent more for their coverage this year.

However, the headlines only tell part of the story. "Unfortunately, no one in the financial press has taken the time to inform consumers about rate stability regulation," says Scott Olson, an independent insurance agent and co-owner of LTCShop.com.

[See: 10 Things You Need to Know About Medicare .]

All but nine states have adopted a long-term care insurance rate stability regulation, and in most cases, it's based on a model recommended by the National Association of Insurance Commissioners. Some people in the industry, like Olson, say these state regulations are key to leveling out the big bumps in premiums some consumers are experiencing.

State rules limit company profits. The NAIC long-term care insurance model regulation was first modified to include rate stabilization provisions in 2000. An updated model was developed in 2014. While 41 states have adopted a rate stability regulation, only 11 have published the most recent amendment.

Even in states that don't have the recent updates suggested by the NAIC, Olson says the regulations should provide peace of mind. While policies issued before the adoption may have raised premiums with little oversight, long-term care insurance plans issued today must meet strict requirements if they want to charge customers more.

"The most important part of the rate stability regulation is how it addresses the insurance company's profits," Olson says. "If an insurance company requests a rate increase, they must first reduce the profit levels in their original pricing. Secondly …100 percent of the rate increase must go towards claims and customer service, not profits." In other words, insurance companies can't raise premiums simply to pad their bottom line.

Unintended consequences to state regulations. Some experts say the new regulations could have unintended effects on the industry. "The states are trying to protect consumers, which is noble," says Steve Cain, national sales leader for LTCI Partners in Los Angeles. "They've built some actuarial safeguards and some hoops carriers have to jump through."

Those hoops may discourage some insurance companies from choosing to do business in states where a rate stability regulation has been adopted. What's more, the fact that newer policies are insulated from arbitrary premium increases may be contributing to massive rate hikes applied to older policies.

"What these carriers are trying to do is break even," Cain says. In order to do that, they may be raising rates for old blocks of business which, according to Cain, are "bleeding" money from a company. If newer policies weren't protected from increases, those losses could be spread over a larger group of customers, which may cost newer policyholders more but reduce increases for older plans.

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States try other tactics to help those with pre-regulation policies. Olson says most recent rate hikes enacted by the top long-term care insurers in California and Florida were for policies issued before the adoption of rate stability regulations. However, those with older policies aren't entirely out of luck. Some state insurance commissioners are working with companies to reduce rate increases for these plan holders as well.

When Pennsylvania residents were hit with rate increases earlier this year, Insurance Commissioner Teresa Miller worked with four insurance providers in the state to address rising rates. A plan was developed to allow consumers to minimize their premium increase in exchange for changes to their policy terms or benefits.

As a result, Genworth customers who were facing premium increases that averaged 80 percent and were as high as 130 percent were able to significantly reduce their costs. Premium increases were limited 20 or 30 percent, depending on the type of policy, and customers who agree to concessions such as lowering their daily benefit or shortening their benefit period can further reduce their premium increase.

Uncertainty and optimism for the future. Despite the creation and adoption of the NAIC model rule, the question of how best to regulate long-term care insurance may be far from answered. "It's too early to tell how the revised rate stabilization rules will impact long-term care insurance because very few states have adopted the new standards," says Jesse Slome, executive director of the American Association for Long-Term Care Insurance. He adds that the issue may not be a priority in some states where policy sales have lagged.

Only 100,000 traditional long-term care insurance policies were sold in 2015, compared to 700,000 in 2000. With relatively few consumers making purchases, state insurance commissions may be focused on more far-reaching topics such as health care affordability .

However, many experts are optimistic the current regulations will have a positive impact. "The industry feels as though the current products will be much more price stable," Cain says. "With today's products, you're looking at 10 percent rate increases."

[See: 10 Medical Services Medicare Doesn't Cover .]

If that prediction doesn't hold true, it may be back to the drawing board for states. Even with the limited number of policies being sold today, Cain says states should be highly motivated to find a solution to rising long-term care insurance premiums . "If there's not a private insurance marketplace, it's all on the state [to pay for long-term care]."

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