Long term care insurance can help cover the costs of extended medical care and support that you may need while living at home, in an assisted living facility or in a nursing home. Traditional employer based health insurance typically doesn’t pay for daily, extended care. Even Medicare only offers help in very specific instances. For those with a disability or chronic illness that requires help on a daily basis, long-term care insurance is a smart, practical way to get the care you need without worrying about expenses.

Qualifying for Long Term Care Insurance

To qualify, you must show an inability to perform certain activities of daily living (ADL’s). Benefits typically start when an individual needs help with 2 or 3 ADL’s such as walking, bathing or dressing. Benefit triggers are different between policies. For instance, sometimes benefits begin when supervision is needed to perform an activity. In other cases, benefits do not begin until someone must do the activity for you.

Factors to Consider About Long Term Care Insurance

Cost. Age and health play an important role in determining how much you will pay for coverage, with younger applicants in good overall health typically able to secure less expensive policies. Since many people purchase long-term care insurance 10, 20, even 30 years before ever needing benefits, inflation protection is available to ensure benefits will be able to keep up with the increasing cost of care.

Once benefits begin, most policies waive the monthly premium, but there is often a waiting period before the insurance pays for services. Policies with short waiting periods typically cost more than those with long waiting periods.

Availability. Most long-term care insurance is sold through an agent or broker licensed to sell insurance in the state. Sometimes policies are available at discounted rates as part of group coverage offered through an employer. Often, group policies do not include medical underwriting, meaning there is no medical requirement necessary to qualify. With some group plans, benefits are available to family members.

Joint Policies. Long-term care insurance can be purchased as a single plan that covers more than one person, as in a husband and wife. Joint policies split benefits between recipients, and there is always the risk that one person depletes funds before the other person needs them.

Pre-existing conditions. Applicants with pre-existing conditions are often turned down for long-term care insurance. However, when policies are made available, it’s not unusual for a withholding period to be included, with expenses related to a pre-existing condition not covered for a pre-determined amount of time.

Covered Services

1. Nursing home care. Skilled nursing care that is provided 24/7, including rehabilitation, personal care, and assistance with daily activities. Not all policies cover the cost of room and board.
2. Assisted living. Care provided at a residence designed to support individualized needs, such as meal delivery.
3. Adult day care. Care provided outside the home in a supervised setting for adults in need of help during the day.
4. In-home care. Care provided in the home to help with daily activities, housework or errands.
5. Home modifications. Long-term care insurance may pay for the cost of modifying your home so you can keep living in it safely.  

“Future service options” allow you to receive new services as part of your coverage—services that were not available when you first purchased your policy. “Future purchase options” allow you to increase your coverage at a later date as you see fit. For young policyholders, securing the option to expand a policy in the future ensures coverage is available when you need it most.