Learn More About Long Term Care Insurance With Frequently Asked Questions (FAQ)
Long-term care services may not be covered by health insurance or Medicare, leaving individuals responsible for their own care in the event of a chronic illness or disability. To address this, today’s products focus on how to help individuals age in place. Below you will find answers to common questions about long-term care insurance to help individuals decide if it's the right choice for them.
01
Why LTC
Long-term care insurance can be a valuable investment for an aging population that is living longer than ever. With statistics indicating that 69% of people will use long-term care services at some point1, it's important to understand why long-term care insurance is worth it. It’s also worth noting that care won’t come cheap: long-term care costs average at $61,936 per year for home health care and $113,530 per year for a private room in a nursing home.² Long-term care insurance can:
- Protect your assets: Many states have long-term care partnership programs to help protect assets as an incentive to purchase a traditional long-term care plan.
- Take pressure off your family: Becoming a caregiver is physically, emotionally and often financially burdensome. Many people are not able or willing to make such a huge sacrifice. This is especially true when the caregiver is a spouse or partner also facing their own aging health issues.
- Give you care options: Long-term care insurance gives you flexible options when it comes to deciding where to receive care.
- May even come with life insurance protection: Today, many long-term care insurance policies are hybrid policies that bundle long-term care coverage with life insurance coverage (or an annuity).
- Puts you in control and gives you peace of mind: With many companies, your family will have access to professional care coordination who can help you with better understanding necessary equipment or home modifications to be able to maintain living at home. They can help provide training for family members or help you find providers if needed.
Some states have long-term care partnership programs that help protect assets that are tied to some traditional long term care policies. Public health programs such as Medicare and Medicaid only cover a limited amount of long-term care expenses, and private health insurance is not a reliable option either. With the help of a licensed agent, individuals can find the right long-term care insurance policy that works within their budget and may even be eligible for tax deductions.
Long-term care insurance may be worth considering as 69% of people are likely to require long-term care services at some point in their lives1. The average person needs long-term care for three years, with women needing care for 3.7 years and men needing it for 2.2 years1. Costs for long-term care services are high and can vary depending on location and type of care required. The national average cost of care for a private room in a nursing home is $113,530, while a year of home health care would cost you $61,9362.
Medicare and Medicaid do not cover all long-term care expenses, and relying on family members for care can be emotionally and financially stressful. Medicare only covers nursing home care for a maximum of 100 days. It only covers other long-term care expenses like skilled home health care for a short period of time, while non-skilled assistance with activities of daily living like bathing and eating are not covered at all. Meanwhile, Medicaid only kicks in after you spend down most of your own savings. Relying on family members for care also has pitfalls since it can take a severe emotional and financial toll on them.
Long-term care insurance can protect savings and assets while also sparing family members from stress. Working with a licensed agent can help you find the right long-term care insurance option within your budget, and premiums may be deductible on federal and state taxes.
You can also learn more about long term care insurance here.
When it comes to long-term care coverage there are three main options:
- Traditional long-term care insurance - exclusively cover long-term care expenses in your home or a facility and inflation protection is available.
- Hybrid long-term care insurance - pair long-term care with life insurance or an annuity. These types of policies provide coverage for both extended care in your home or a facility along with a death benefit. While a great solution for some, they can be more costly upfront. These products can offer inflation protection.
- Life insurance with a long-term care rider – some life insurance policies let you add a long-term care rider, which lets you use some of the life insurance policy’s death benefit to pay for long-term care needs while you’re still alive. These policies do not typically include inflation protection.
The best policy for an individual depends on their goals and circumstances, such as how they want to pay their premiums, whether they want the option of locking in their premium, their health status, and tax advantages. A licensed insurance professional can help you find the right long-term care insurance policy for your needs and budget.
Long-term care insurance covers a range of care services provided in either a home or a specialized facility. It can include:
- Home health care: skilled in-home nursing care; occupational, speech, physical and rehabilitation therapy; and help with activities of daily living like bathing and eating. On occasion, some policies may also include homemaker services like meal preparation and house cleaning services.
- Respite care: temporary care at home, adult day care or nursing home. This type of care is meant to relieve a primary caregiver of responsibilities for a span of a few weeks per year.
- Adult day care centers
- Assisted living facilities
- Nursing homes
- Alzheimer’s special care facilities
A few policies also cover short-term hospice care. Long-term care insurance does not usually cover care by family members, and it does not cover medical care costs, which are typically covered by private health insurance and/or Medicare. Learn more about what long term care insurance covers.
02
Purchasing and Costs
Determining how much long-term care insurance you need depends on various factors:
- Your age
- The cost of care in your region
- Personal and family health history
- Kind and extent of care you want
- Period of time you want the policy to cover
- Your budget
Working with a licensed insurance agent can help you determine the amount of coverage you require.
Long-term care insurance rates are based on age and health, so insurance professionals recommend purchasing it in your 40s or 50s. This guarantees lower rates, locked-in coverage, and peace of mind that your loved ones will be covered. If you are over 60, you can still get coverage, but it may be more expensive. A licensed insurance agent can help you find a policy that fits your budget, and you may be able to deduct long-term care insurance premiums from your taxes or use HSA dollars to pay premiums.
Long-term care insurance costs vary based on several factors, including:
- Age
- Health
- Benefits chosen
It is recommended to start shopping for long-term care insurance in your 40s or 50s to secure lower rates and protect against the possibility of not obtaining coverage later due to health issues. The cost of long-term care is high, the national average cost of care for a private room in a nursing home is $113,530, while a year of home health care would cost you $61,9362.
The U.S. Department of Health and Human Services reports that 69% of people will use long-term care services at some point.1 Medicare and Medicaid only provide limited coverage for long-term care, and relying on family members for care can be emotionally and financially exhausting, especially if it is your spouse or partner who is also facing their own aging health issues. Long-term care insurance can protect your assets, spare your family from the toll of caregiving, and provide peace of mind. Today, long-term care insurance can also be bundled with life insurance coverage. This means you get two important coverages in one policy: life insurance coverage that offers your loved ones financial support if you were to pass away or long-term care coverage if a chronic illness or disability requires you to need long-term care.
There are three main ways to buy long-term care insurance:
- Through an insurance professional
- Offers flexibility: your specialist can shop for the best policy among several of the top long term care insurance companies.
- Provides a personalized experience: you will have one point person to educate you along the way and provide custom quotes specific to your unique needs.
- Gives a customized coverage solution: this type of customization is often times not available with the other two options.
- Potential good health discount: your policy will be individually underwritten, meaning the insurance company will base its price on your personal health history rather than on a broad group rate.
- Through an employer
- Easy process: there are typically just a few preselected plan designs to choose from. This saves you time and effort because your employer has already done that for you. On the other hand, this gives you less customization.
- Convenient billing: your premiums can be billed through easy and convenient payroll deduction or direct billing.
- No gender-based pricing: LTCI is typically more expensive for women, so buying through an employer could be a good move if you’re female.
- Easier to qualify for coverage: employer coverage may require fewer health-related questions, simplifying the process and potentially reducing costs for obtaining long-term care insurance. However, it's important to note that healthy individuals typically pay the same price as others in their age group, missing out on potential discounts available through individual policies specifically designed for good health.
- Through an association (alumni group, professional organization, trade group)
- Discounted pricing
Long-term care insurance may also come bundled with life insurance coverage or an annuity.
In today’s consumer driven market, when it comes time to buy a new car, people like to shop around for the best deals. Comparing products, accessories, warranties, and prices, they hunt for bargains. They know if they search wisely, they can save money. So when these same consumers go to purchase long term care insurance, they have similar expectations. However, shopping for long term care insurance is not like shopping for a car due to several key differences – the most important being insurance regulation.
Learn more about why shopping for long term care insurance is different than shopping for a new car.
03
General
If you have long-term care insurance, it's important to manage it properly. Long-term care insurance may come bundled with other policies, and it's recommended to review your policy after major life events such as marriage, divorce, buying a house, or becoming disabled. You should also review your policy if you have a change in health. If your policy includes an inflation rate, you may need to adjust your coverage to reduce premium charges. If your policy has a purchase option, you may want to review it to determine if you should buy more coverage. It's a good idea to review any form of insurance annually to ensure that you have the right level of coverage and to learn about new coverage options.
A long-term care insurance policy pays benefits when someone suffers from cognitive impairment and/or is unable to perform two of the six activities of daily living, which are:
- Control your bladder and bowel movements
- Dress yourself
- Use the toilet and attend to your personal hygiene
- Feed yourself
- Bathe yourself
- Move yourself into and out of a bed and chair
Policyholders must first meet the elimination period, which is a waiting period (similar to a deductible) between when an illness or disability begins and when they start receiving benefits. Most policies have an elimination period that lasts 30, 60, or 90 days, and by choosing a longer elimination period, the premium costs may be lower. Long-term care policies sold today start to pay when the elimination period is met, and the policyholder meets either severe cognitive impairment or inability to perform two of the six activities of daily living. It is always best to read over you individual long-term care policy to understand the exact conditions that trigger long-term care benefits. Learn more about filing a claim here.
To file a claim for long-term care insurance benefits, you must first meet your policy's elimination period and at least one of its benefits triggers, such as severe cognitive impairment or being unable to perform two activities of daily living. Once you meet the requirements, contact your insurance company to request a claim packet, which typically includes various forms, such as policyholder statement, attending physician statement, nursing assessment and plan of care, provider statement, and authorization to release information. Fill out the packet and attend a phone interview with the insurer. You can expect a response within 30 days. If your claim is approved, the insurer will pay the care facility or provider directly or reimburse you for covered expenses. Learn more about filing a claim here.
Health insurance pays for hospital and medical care, but it does not pay for extended health care services. For example, you need surgery due to an injury. Health insurance will pay for the surgery, hospital stay, and doctor’s bill. But if you need help with your activities of daily living while you recover, this is not covered by health insurance. Long term care insurance will pay for the additional care you may need.
There are many benefits to purchasing long term care insurance through your employer. These benefits include:
- Additional discounts
- Streamlined Underwriting – This means you may answer only a few health questions and medical records may not be required
- Portability – If you buy a policy through your employer, by law, you can take it with you when you retire or change jobs
- Family Benefit – your spouse/partner and extended family may be eligible for group rates
Recommended Reading
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