Long Term Care
Are You Covered?
Long-term care (LTC) insurance is coverage that provides nursing-home care, home-health care, and personal or adult daycare for individuals age 65 or older or with a chronic or disabling condition that needs constant supervision.
What Is Long-Term Care (LTC) Insurance?
Long-term care (LTC) insurance is coverage that provides nursing-home care, home-health care, and personal or adult daycare for individuals age 65 or older or with a chronic or disabling condition that needs constant supervision. LTC insurance offers more flexibility and options than many public assistance programs, such as medicaid.
Understanding Long-Term Care (LTC) Insurance
A long-term care insurance policy helps cover the costs of that care when you have a chronic medical condition, a disability or a disorder such as Alzheimer’s disease. Most policies will reimburse you for care given in a variety of places, such as:
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Your home.
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A nursing home.
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An assisted living facility.
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An adult day care center.
Considering long-term care costs is an important part of any long-range financial plan, especially in your 50s and beyond. Waiting until you need care to buy coverage isn’t an option. You won’t qualify for long-term care insurance if you already have a debilitating condition, and long-term care insurance carriers won’t approve most applicants over the age of 75. The majority of people with long-term care insurance buy it in their mid-50s to mid-60s.
Whether long-term care insurance is the right choice depends on your situation and preferences.
Many people are unable to rely on children or family members for support and buy long-term care insurance to help cover out-of-pocket expenses. Otherwise, long-term care expenses would quickly deplete the savings of an individual and/or their family.
While the costs of long-term care differ by region, it is usually very expensive. In 2020, for example, the average cost of a private room in a skilled nursing facility or nursing home was $105,850 a year, according to a report on long-term care by Genworth. A home health aide costs an average of $54,912 annually.
In the United States, Medicaid provides for low-income individuals or those who spend down savings and investments because of care and exhaust their assets. Each state has its own guidelines and eligibility requirements. In most states, you can keep up to $2,000 as an individual and $3,000 for a married couple outside of your countable assets, which include checking and savings account balances, CDs, stocks, and bonds. Your home, car, personal belongings, or savings for funeral expenses don’t count as assets.
Why buy long-term care insurance?
Nearly 70% of 65-year-old people will need long-term care services or support, according to 2020 data from the Administration for Community Living, part of the U.S. Department of Health and Human Services. Women typically need care for an average of 3.7 years, while men require it for 2.2 years.
Regular health insurance doesn’t cover long-term care. And Medicare won’t come to the rescue, either; it covers short nursing home stays or limited amounts of home health care when you require skilled nursing or rehab only. It doesn’t pay for custodial care, which includes supervision and help with day-to-day tasks.
If you don’t have insurance to cover long-term care, you’ll have to pay for it yourself in most states. You can get help through Medicaid, the federal and state health insurance program for those with low incomes, but only after you’ve exhausted most of your savings.
How long-term care insurance works
To buy a long-term care insurance policy, you fill out an application and answer health questions. The insurer may ask to see medical records and interview you by phone or face to face.
You choose the amount of coverage you want. The policies usually cap the amount paid out per day and the amount paid during your lifetime.
Once you’re approved for coverage and the policy is issued, you begin paying premiums.
Under most long-term care policies, you’re eligible for benefits when you can’t do at least two out of six “activities of daily living,” called ADLs, on your own or you suffer from dementia or other cognitive impairment.
The activities of daily living are:
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Bathing.
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Caring for incontinence.
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Dressing.
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Eating.
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Toileting (getting on or off the toilet).
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Transferring (getting in or out of a bed or a chair).
When you need care and want to make a claim, the insurance company will review medical documents from your doctor and may send a nurse to do an evaluation. Before approving a claim, the insurer must approve your plan of care.
Under most policies, you’ll have to pay for long-term care services out of pocket for a certain amount of time, such as 30, 60 or 90 days, before the insurer starts reimbursing you for any care. This is called the “elimination period.”
The policy starts paying out after you’re eligible for benefits and usually after you receive paid care for that period. Most policies pay up to a daily limit for care until you reach the lifetime maximum.
Some companies offer a shared care option for couples when both spouses buy policies. This lets you share the total amount of coverage, so you can draw from your spouse’s pool of benefits if you reach the limit on your policy.