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Daniel T. Murray Blog: life

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The mortality rate in Massachusetts declined substantially in the four years after the state enacted a law in 2006 mandating universal health care coverage, providing the model for the Affordable Care Act.

In a study released last week, Harvard School of Public Health professors Benjamin Sommers, Sharon Long and Katherine Baicker conclude that "health reform in Massachusetts was associated with a significant decrease in all-cause mortality."

The authors caution that their conclusions, published in Annals of Internal Medicine, may not apply to all states, and other studies have shown little correlation between having insurance and living longer. Nevertheless, the Harvard study adds to a growing body of evidence that having health insurance increases a person's life expectancy.

Mortality rates – in this case, the number of deaths per 100,000 adults between the ages of 20 and 64 that occur in a given year – vary widely among states. Mississippi, Alabama, West Virginia, Oklahoma, Kentucky and Louisiana have the highest age-adjusted rates (which recognize that some states have older or younger populations). Hawaii, California, Connecticut, Minnesota, New York and Massachusetts have the lowest mortality rates, according to 2010 data (the most recent available) from the U.S. Centers for Disease Control and Prevention (CDC).

Uninsured rates also vary widely. Between 2011 and 2012 Massachusetts had the lowest uninsured rate in the nation at 4 percent of its population, compared to a national average of 15 percent, according to a Kaiser Family Foundation analysis of U.S. Census data. Texas had the highest rate at 25 percent, followed by Nevada (24 percent) and New Mexico and Florida (both 22 percent).

Massachusetts is also among the most affluent states in the nation, and it has one of the highest average education levels and ratios of physicians to residents, all of which lower mortality rates. Many other factors also affect the death rate of a state or regional population, including the prevalence of chronic diseases, obesity, climate and environmental hazards, smoking and drug and alcohol abuse, gun violence and occupational safety.

"It is difficult to compare one state to another when it comes to mortality rates," said Alison Cuellar, a health economist at George Mason University. "All the evidence points in the direction of health insurance increasing longevity," she said. "We just don't know the magnitude of the effect."

In 2002, the Institute of Medicine estimated that the death rate of the uninsured is 25 percent higher than for otherwise similar people who have health insurance. According to the study, 18,000 excess deaths occurred each year because 40 million Americans lacked insurance.

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Policies for children represent a small fraction of the life insurance market, but they made the news this week after a court hearing for a Georgia man accused of killing his young son by leaving him in a hot car.

Testimony and court documents revealed that Justin Ross Harris and his wife had two life insurance policies for 22-month-old Cooper Harris, one for $2,000 and one for $25,000.

Prosecutors have portrayed the 33-year-old Harris as an unhappy husband who was exchanging nude photos with several women. Defense attorneys say the death was a tragic accident. Harris remains in jail charged with murder and child cruelty.

The insurance policies were mentioned among numerous details from the evidence against Harris and weren't singled out by prosecutors in their arguments.

Still, the case has drawn attention to policies that families sometimes purchase for children. Here are five things to know about the children's life insurance market.

— HOW DO THE POLICIES FOR CHILDREN WORK? The policies are typically purchased by parents, grandparents or anyone directly related to the child, according to Steve Weisbart, chief economist for the Insurance Information Institute.

Premiums paid into the policies vary according to the terms. Generally, the higher the death benefit — what's paid out to beneficiaries if the insured person dies — the greater the premium. Insurers require that anyone buying the policy have an "insurable interest" in the person covered, meaning the buyer wants the person covered to actually live.

— INSURERS ATTACH CONDITIONS TO THE DEATH BENEFIT. Insurers require documentation of how a covered individual dies, and the policies will not pay out if the beneficiary is convicted of murdering the person covered.

— POLICIES CAN BE SAVINGS DEVICES. Life insurance policies typically have a cash value while the covered person is still living, with the amount based on premiums that have been paid over time. Often, a parent or grandparent buys a policy with the intention of giving the child the option later in life of using the policy as a cash source.

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Health care costs are a big concern for people going into retirement, but the costs of long-term care can still be a shock.

Here are a few facts:

• 70% of people over 65 will need some form of long-term care at some point.

• For married couples, the chance that one spouse will need long-term care rises to 91%.

• People living alone are more likely to need some sort of home health care.

• Women outlive men, and thus, are more likely to live alone and need some sort of home health care.

So, while some financial planners previously were on the fence about long-term care insurance, they were still encouraging people to at least have a plan for long-term care.

"For Baby Boomers, long-term care insurance is a must," says Manhattan attorney Ann-Margaret Carrozza. "We can no longer rely upon Medicaid to cover custodial type care. We see over the course of the past few years that eligibility for Medicaid has gotten tougher. In 2006 the so-called look-back period was extended from three years to five years," she says. During that period, the government can check, or look back, to see if you have sheltered or given away assets — and if you have, it triggers a penalty period when you're ineligible for government aid.

"There are now proposals in Congress to increase it to 10 years," Carrozza says. And, she warns, Medicare only covers up to 100 days of rehabilitation following hospitalization. "Beyond that — nothing!"

The Employee Benefit Research Institute says the average retirement shortfall for Baby Boomers and Gen Xers is nearly $50,000. But that rises dramatically when expenses for home health care or nursing homes are added: for married households by $25,317; single males, an average increase of $32,433; and by $46,425 for single females.

No wonder so many people are worried that they won't have enough money to even cover health care costs in retirement, let alone make it through retirement in the lifestyle they are accustomed to.

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Financial needs change with change in one's life stage. Whether it's your marriage, children's education or retirement years, you need money to get through the various stages of life comfortably. Life insurance helps you meet these requirements and prepares you for unforeseen expenses. Insurance provides you with financial security that helps you take care of your loved one.

In order to reap the benefits that insurance has to offer, you must factor in insurance early in life.

When it comes to insurance, be an early bird

Ideally, it makes sense to buy at least one life insurance policy when you have just started to earn. Doing so has its own advantages. Not only do you add a crucial instrument to your financial portfolio, but it also helps ensure that your family's financial situation does not debilitate should anything untoward happen to you. Besides, when you start young, the premium amounts too are lower.

At a later stage in life, you can always revisit your insurance portfolio and add another policy keeping with your changing financial needs. This process is called a life insurance review and is extremely important.

Review your insurance plan from time to time

Life insurance is not a one-size-fits-all solution. It is therefore important to review your insurance plan at regular intervals. It will prepare you for life's various milestones and the associated expenses. One of the biggest advantages of a life insurance review is that you do not stay underinsured. As age advances, your responsibilities increase and lifestyle undergoes changes. Based on timely reviews, you can revise your life insurance cover from time to time.

It is only with constant reviewing of your insurance plan can you start building a corpus for your old age.

Planning for the future

You start working, get married, have kids and soon enough, your kids grow up. Even before you realize it, you find yourself standing with a farewell bouquet at the threshold of a new phase of life - the post-retirement period. To ensure that you don't take a financial hit in your older age, you must plan for it in advance. Taking a life insurance policy at a young age will simplify things for you as you approach the golden years of your life.
There are varied options of retirement plans that one can choose from. You can choose to go with monthly income or annual payouts as per your requirements. If you choose to buy a monthly income plan, you will be entitled to a monthly income during your post-retirement years.

How your retirement plan will help you in your old age

On various occasions, people are under the impression that savings accrued over a lifetime are sufficient to see them through old age. This is perhaps one of the biggest misconceptions. Life is unpredictable and sometimes all it takes is a bout of critical illness to wipe out all that you had saved. You can avoid such a situation by opting for a retirement plan early in life (preferable in late 20s or early 30s). It supplies you with an income every month, almost similar to the salary that you used to receive when you were employed. You can use this money for your routine expenses as also for health emergencies.

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If you're co-signing big student loans for your child, you may want to buy a life insurance policy while you're at it.

While no one wants to imagine the death of their child, taking out insurance on your son or daughter -- or asking them to purchase their own plan -- will protect you from being hit with mountains of debt should tragedy strike.

And the policies are pretty cheap. A basic plan with up to $250,000 in coverage can cost as little as $15 a month for a young, healthy college student or recent graduate. That's a whole lot less than the loan payments you could be stuck with -- which average more than $200 a month.

Such a move would have been life altering to Steve and Darnelle Mason, who lost their daughter Lisa five years ago.

Trying to pay back the $100,000 in private student loans they co-signed for their daughter has been a financial nightmare.

"I absolutely wish we had [a life insurance] policy," said Steve Mason. "We would not have struggled financially for the past four years with these private student loans, and our credit would not have been ruined."

Federal student loans are forgiven by the lender when a borrower dies, but private lenders aren't required to provide any such relief.

That's one reason it's important to get as much federal aid as possible before turning to private lenders. And for parents, it means not co-signing on a loan unless you have the means to repay it.

Another reason for caution: student loans can rarely be discharged in bankruptcy.

But for many parents, getting their child a good college education is non-negotiable -- and that's when life insurance can provide a little peace of mind, says Eleanor Blayney, a certified financial planner and consumer advocate for CFP Board.

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