Where Is Long-Term Care Covered By My Policy?

Shown below are the four locations where care may be covered. Many policies cover all four.

·      Nursing home

·      Adult day care center

·      Your home

·      Assisted living facility

Important: Even if your health qualifies you for long-term care, the policy will pay only if you use the type of professional care the policy specifies.

 

What Are Typical Nursing Home Requirements?

Is Adult Day Care Covered By Long-Term Care Insurance?

Some policies cover services you receive from an adult day care center. The policy pays when you continue to live at home but spend part of your day at the center. Purely social visits to your neighborhood senior center do not count!

Typical adult day care benefits

· Nursing care

· Therapeutic, educational and social activities

· Help with activities of daily living

· Constant supervision because of Alzheimer's, senility or similar diseases

Will I Be Covered For Care I Receive In My Home?

Many policies now pay for care in your own home. Some policies that cover nursing homes automatically include home care; others offer it as an additional option. A few policies cover nothing but home health care.

Since it costs less to take care of you in your own home, policies usually pay lower benefits for home health care.

Getting your care at home can be appealing; however, the home health professional may not be available around the clock!

Typical home care requirements

·    Services may be performed by a home health aide, but must be prescribed by your doctor.

·    Care must be to assist you with activities of daily living.

·    Provider must supervise or protect you if you have Cognitive Impairments (such as Alzheimer's or senility).

·    Therapy, nursing services or other medically necessary services must be provided.

Will Assisted Living Facility Care Be Covered?

Some policies cover care in an assisted living facility. Assisted living facilities provide residential living for those who need help with activities of daily living (ADL's).

Typical assisted living benefits

·    Provides meals.

·    Provides assistance with personal care, such as bathing.

·    Provides prescription management (such as reminding you to take your medicine).

When Will My Benefits Start?

Each policy has its own triggers for determining when your physical or mental condition has reached a point that you are entitled to benefits from the policy.

Do Long-Term Care Policies Cover Pre-Existing Conditions?

Health problems that were diagnosed or treated within six months before you boughtthe policy may not be covered if you need care beginning in the first six months after you buy the policy.

· If a pre-existing condition causes a nursing home stay within the first six months, the policy may pay nothing.

· Some policies will cover any pre-existing condition that you disclosed on your application. However, chances are your application won't be approved if you have a serious health problem.

What Is An Exclusion?

Exclusions are specific services and care that will not be covered under your long-term care insurance policy. Every insurance policy has a list of things it doesn't cover. Before you purchase any insurance policy, check for a list of exclusions.

Will My Long-Term Care Insurance Pay Expenses Covered By Other Insurance?

LTC policies will not pay any expenses that are covered by other insurance policies, or government programs.

Do I Have To Stay In The Hospital Before My Long-Term Care Policy Will Cover Additional Care?

Policies sold today do not have a prior stay restriction for nursing home care. However, some policies might require a prior stay in a hospital or nursing home before paying for home health care or adult day care.

A good policy should:

· Provide equal coverage for skilled, intermediate and custodial care

· Include some form of inflation protection

· Include any of the 'modern' features that you feel you need - home health care, adult day care, respite care, etc.

A good policy should NOT:

· Require prior hospitalization before paying for nursing home care

· Exclude care for Alzheimer's, Parkinson's or similar nervous disorders