Long-Term Care insurance helps pay for care in your own home, in a nursing home, and in an assisted living facility. Your policy will pay you a certain amount per day or per month for a certain duration of time.
To qualify for benefits, you need to require standby assistance performing two of six activities of daily living as defined below. You can also qualify for benefits if you have a severe cognitive impairment and need standby supervision to protection yourself and others.
Activities of Daily Living:
Bathing – washing oneself by sponge bath; or in either a tub or shower, including the task of getting into or out of the tub or shower with or without equipment or adaptive devices.
Dressing – putting on and taking off all items of clothing and any necessary braces, fasteners, or artificial limbs
Toileting – getting to and from the toilet, getting on and off the toilet, and performing associated personal hygiene.
Transferring – moving into or out of a bed, chair, or wheelchair with or without equipment such as canes, quad canes, walkers, crutches or grab bars or other supportive devices including mechanical or motorized devices.
Continence – the ability to maintain control of bowel or bladder function; or, when unable to maintain control of bowel or bladder functions, the ability to perform associated personal hygiene (including caring for catheter or colostomy bag)
Eating – feeding oneself by getting food into the body from a receptacle (such as a plate, cup, or table) or by a feeding tube or intravenously.
There are two types of Benefit Payment Methods
Indemnity Policies: These are the most liberal policies. They will pay your entire monthly or daily benefit regardless of the expenses you incur during that day or month. Benefits are paid solely on the existence of a disability. However, you must incur some expense.
Reimbursement Policies: These are more restrictive policies. You must submit your expenses to the insurance company who will reimburse you for the expenses. If you only have $100 worth of expenses for the day and your daily benefit is $200 per day; you will only receive $100 for the day. However, your benefit will last longer; your benefit duration will be increased.
Professional Home care or Total Homecare:
Elimination Period: This is your deductible. It is the number of consecutive days or service days during which you must have qualified benefits and be under the regular care of a Physician before benefits are paid. Typical elimination periods are 30, 60, 90, or 180 days.
Shared Care: This is a joint policy where you can access your partner’s benefit and vice versa.
Survivorship: With this feature, if a husband or wife passes away, the surviving spouse’s premium can be waived permanently. Usually the policy must be in force for 10 years with no claims paid.
Cash Benefit: With this feature, once you qualify for benefits, you receive a portion of the full cash benefit of your monthly or daily benefit amount even if you incur no long-term care expenses. An example of this would be if you receive care from a family member or a friend.
Return of Premium: With this feature, all paid premiums (minus any benefits paid) are returned to the estate or beneficiary of your choice.
Waiver of Elimination Period for Homecare: With this feature, your elimination period is waived for home care. You receive benefits for home care as soon as you qualify for benefits.
Waiver of Premium: Premiums are waived once you qualify for benefits and your elimination period is satisfied.
Cash Benefit with no Elimination Period: If you have a Cash Benefit option, the Elimination Period could be waived.
Premium rates for Long-Term Care insurance vary greatly and are affected by such factors as the amount and length of coverage selected, your age on the effective date of the policy, your gender, and the optional benefits you select. Premiums for females are higher than premiums for males, but premiums for long-term care insurance policies purchased through a group are gender neutral.
Factors to Consider When Designing a Long-Term Care insurance policy:
- The cost of long-term care facilities and home care support in your area or the area where you intend to retire.
- Your family history (longevity, Alzheimer’s Disease, Parkinson’s Disease, Arthritis, etc.).
- The availability of family and friend support. Are you concerned about being a burden on your loved ones?
- How much of the long-term care risk do you want to insure?