Long-Term Care Insurance Basics

Long-term care is expensive, and this type of insurance can help you pay for some or all of the services provided by long–term care.

folder tabs with years

Statistics suggest the majority of us are going to need to be on the receiving end of what's usually called long-term care at one point or another during the "golden years" of our lives.

For example, information published by the US Department of Health and Human Services says that a person turning age 65 today has a 70 percent chance of needing some type of long-term care service or support late in life.

Which means, unfortunately, that a good portion of us are going to spend a lot of cash on health care after we reach, and then pass, a certain age.

After all, spending any amount of time in, say, a skilled-nursing facility these days costs a surprising amount of money. In fact, a trip to a "nursing home" last year would have set you back somewhere around $212 and $240 per day, depending on where it's located and whether you stayed in a private or semi-private room, according to the Genworth 2014 Cost of Care Survey.

Other long-term care situations aren't much, if any, better, with the national median monthly rate for an assisted living community coming in at $3,500 (about $116 a day), adult day health care centers charging an average of $65 per day, home health aides earning approximately $21 per hour, and homemaker services costing about $19 an hour.

What's Covered and How It's Covered

There are several ways you can pay for all of this care, of course. One option is to pay for it out of your own pocket, using current income or cash you've saved over the years. Two other options are Medicare, the federal program that provides hospital and medical insurance to people who are 65 or older, and Medicaid, which assists those with low incomes or limited resources.

Long-term care insurance is another possibility. Depending on the kind of policy you buy, or the policy options you choose when you make your purchase, this type of insurance can help you pay for all, or just some, of the forms of care mentioned earlier—as well as some or all of the costs associated with care coordination and home modification.

Benefits usually are paid by the day, week, or month. An example: your policy may pay up to $215 per day for skilled-nursing care, or $1,500 per week, or $5,000 per month. For home care, it might pay just a portion of the above—such as $100 or so a day.

These benefits don’t pay out forever, though—or at least most of them don't. The majority of long-term care insurance policies place limits on how much they'll cover (a maximum dollar amount), or how long (a specific number of years—up to a lifetime) they'll provide coverage.

It's important to carefully consider any limits or caps in a policy you may be considering, as well.

What's Not Covered

Something else you'll want to consider while shopping around for long-term care insurance: anything that isn't covered by an in-consideration policy.

For instance, a policy may not cover certain conditions or situations. In terms of conditions, a policy may not cover you--or you may not be able to buy the policy in the first place--if you had a stroke in the last couple of years or if you have a history of strokes.

A policy also may not cover you if you have AIDS or AIDS-Related Complex (ARC), Alzheimer’s Disease or some other form of dementia or cognitive dysfunction, or a progressive neurological condition like Parkinson’s Disease or multiple sclerosis.

Long-term care insurance policies may not cover care that's provided by family members either, although some will pay for family members to be trained as caregivers.

How Long-Term Care Insurance Works

Before your long-term care insurance policy will begin to pay out, you'll likely have to meet a couple of requirements.

One of those requirements revolves around something known as a benefit trigger. In most cases, these are tied to Activities of Daily Living (ADLs) or cognitive impairments—as in, you have to be unable to perform a certain number of ADLs (bathing, dressing, and eating are a few examples) without assistance before you "trigger" your benefits.

You and your loved ones don't determine if a benefit trigger has occurred, by the way. This is done by a nurse or social worker (who's often sponsored by the insurance company) after completing an assessment.

Once it's been decided that you have, in fact, triggered your benefits, you enter what's called the "elimination period." This refers to the number of days that must pass before your policy begins to pay. (In other words, your benefits begin on the day after your elimination period ends.)

Your elimination period could last anywhere from zero to more than 100 days. Shorter elimination periods usually mean higher premiums, while longer elimination periods usually mean lower premiums. Keep in mind, though, that going with a longer elimination period means you'll be paying for your health-care expenses out of pocket for a longer period of time before your policy starts paying for your care.

Something else to keep in mind regarding elimination periods: although some long-term care insurance policies only have one elimination period attached to them, others attach elimination periods to each separate incident that requires care.

Where to Buy Long-Term Care Insurance

There are a lot of options when it comes to where you can purchase a long-term care insurance policy. Here are some of the most common:

Employers

Depending on where you work, your employer may give you access to group long-term care insurance policies or even individual long-term care insurance policies. This is true even if you work for the federal government or some state governments.

There can be some real benefits to taking advantage of these kinds of offers, with one of them being that you may not have to meet particular medical requirements to qualify for some of the group plans that are made available to you in this way. Also, it's possible your family members will be allowed to take advantage as well, although they may need to pass certain medical screenings or tests first.

Insurance Agents or Brokers

Two things to keep in mind if you do what most people do and turn to an agent, broker, or financial planner when it's time to buy one of these policies:

  • Check to see if the agent, broker, or financial planner you're considering working with has been trained in long-term care insurance (this is required in some states)
  • Contact your state's Department of Insurance to make sure he or she is licensed to sell this kind of insurance

Organizations

It isn't unusual for professional or service organizations or associations to offer group long-term care insurance policies to their members.

If you decide to go this route, just make sure you read the fine print so you're fully aware as to what will happen if you stop being a member or if the coverage is terminated for some reason or another. (This same piece of advice should be followed for employer-sponsored policies, by the way.)

State Partnership Programs

People who live in certain states can buy special long-term care insurance policies that are linked to Medicaid. Specifically, these policies allow you to keep a set amount of assets while still qualifying for Medicaid. (For more information on State Partnership Programs, visit longtermcare.gov.)

Other Things to Consider Before Buying this Type of Insurance

Whether you should buy long–term care insurance depends on  your age and life expectancy, gender, family situation, health status, income  and assets.

  • The younger and healthier you are when you buy long-term care insurance, the less it will cost
  • On a related note, if you wait until you're older or you have a serious health issue, it could cost a lot more (if you can get it at all)
  • If you're a woman, you may want to give special consideration to this kind of insurance, as you're likely live past your 80th birthday (the life expectancy for men in the US is about 76), according to most statistics
  • Another reason you may want to strongly consider long-term care insurance: if your family has a history of chronic or debilitating health issues
  • If you have someone in your life (a spouse, children, other family members) who can care for you at home, it might make more sense for you to limit your choices to long-term care insurance policies that focus on skilled-nursing care
  • Although insurance companies can't increase rates on an individual basis, they can increase them on a broad level—such as on a class of similar policies in your state
  • Companies also can't cancel your long-term care policy unless you fail to pay your premiums, you used up all of your benefits, or you are found to have lied on your application
  • You, on the other hand, can cancel your policy at any time (and what you do, your insurer has to return to you any "unearned premium"—which refers to the amount you paid that hasn't been used to buy coverage)

References:

QuoteWizard.com LLC has made every effort to ensure that the information on this site is correct, but we cannot guarantee that it is free of inaccuracies, errors, or omissions. All content and services provided on or through this site are provided "as is" and "as available" for use. QuoteWizard.com LLC makes no representations or warranties of any kind, express or implied, as to the operation of this site or to the information, content, materials, or products included on this site. You expressly agree that your use of this site is at your sole risk.