Long Term Care
Long Term Care Insurance helps provide for the cost of long-term care beyond a predetermined period. Long-term care insurance covers care that is generally not covered by Health Insurance, Medicare, or Medicaid. Individuals who need long-term care are unable to perform the basic activities of daily living such as dressing, bathing, eating, toileting, continence, transferring (getting in and out of a bed or chair), and walking.
Long-term care insurance usually covers home care, assisted living, adult daycare, respite care, hospice care, nursing home and Alzheimer's facilities. If home care coverage is bought, long-term care insurance can even pay for home care. This would will pay for a visiting or live-in caregiver, companion, housekeeper, therapist or private duty nurse up to 7 days a week, 24 hours a day (up to the policy benefit maximum).
Policies
There are two types of long term care policies offered.
Tax qualified (TQ) policies are the most common policies that are offered. A TQ policy requires that a person 1) be expected to require care for at least 90 days, and be unable to perform 2 or more activities of daily living without assistance (hands on or standby); or 2) for at least 90 days, need substantial assistance because of a severe cognitive impairment. In both cases a doctor must provide a plan of care. Benefits from a TQ policy are non-taxable.
Non-tax qualified (NTQ) often comes with a medical necessity trigger. This means that the patient's doctor, or that doctor working with someone from the insurance company, can state that the patient needs care for any medical reason and the policy will pay. NTQ policies include walking as an activity of daily living and normally only require the inability to perform 1 or more activity of daily living. Fewer non-tax qualified policies are for sale.
Benefits and Deductibles
You qualify for covered benefits with most of the plans when you need any help with activities of daily living or when you need help because you have a severe cognitive impairment.
Most policies have a waiting period. This is the period of time that you pay for care before your benefits are paid. Elimination days might be anywhere from 20 to 120 days. Keep in mind the higher deductible period the lower the premium. Some policies do require intended claimants to provide proof of 20 to 120 service days of paid care before any benefits will be paid. Sometimes the option may be available to pick zero elimination days when the covered services are provided in the home in accordance with a Plan of Care. Some policies also require that the policy for long-term care be paid up to one year before becoming eligible to collect any benefits.
Affiliates
