Long-term care insurance provides coverage for those who need assistance managing daily activities. It may also cover some of the costs of a care facility or a caregiver following an accident or illness. Many long-term care facilities and home-care services receive public funding. However, most also charge extra fees for additional services that are not covered by health plans.

Coverage 

• Long-term care insurance may cover in-home care, adult day programs, assisted living, residential care, and nursing homes on a short or long-term basis.  

• Most policies require a plan of care from a medical provider documenting the need for assistance with at least 2 of the following activities: bathing, dressing, transferring, eating, toileting, and continence care or a terminal diagnosis. 

Premiums

• As with any insurance, it is important to stay current on monthly premiums so that the policy is not cancelled. 

• Premiums are usually waived once insurance coverage begins.

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Policy Limits

• Policyholders are reimbursed a daily amount up to a preselected limit or the daily maximum benefit.

• Most policies also have a maximum lifetime benefit.

Waiting Periods

• Most policies have a Waiting, Elimination, or Deductible Period - a period of time after qualifying for care and before the insurance company will begin paying for the covered care. 

• The most common options are 30, 90, or 100 days.

• Some policies waive the waiting period if the beneficiary has a terminal diagnosis.

• Some policies require that the waiting period is met only once during the life of the policy, while others apply it again after a certain period of time without needing care has passed. 

• Some policies require that care is received each day of the waiting period, whereas others may only require it once per week. For example: If a person receives homecare twice per week, it may be counted as 2 days towards the waiting period, or the entire week of 7 days may be counted depending on the policy.

Purchasing and Cost

• People in poor health or already receiving long-term care services may not qualify for long-term care insurance as most individual policies require medical underwriting. 

• Policies are usually purchased by people between the ages of 50 and 65.

• The cost of a policy will depend on age, the maximum payments, and the optional benefits.

• This Guide can assist in understanding insurance options.