All You Need to Know About Long-Term Care Insurance

Most families don’t think about long-term care until they need it. By then, the cost of help at home, assisted living or memory care can come as a shock. Long-term care insurance is one of the few ways to plan for those costs ahead of time. Here is a plain-language guide to how it works.

What long-term care insurance pays for

Long-term care insurance helps pay for care when a person can no longer manage everyday life safely on their own. Depending on the policy, that can include:

• Home care, such as an aide who helps with bathing, dressing or meals
• Adult day programs
• Assisted living, including memory care in an assisted living home
• Nursing home care

Regular health insurance and Medicare generally do not pay for this kind of ongoing personal care, which is why a separate policy exists.

When benefits start

Most policies begin paying when a doctor or nurse certifies that the person either needs help with at least two “activities of daily living” (bathing, dressing, eating, toileting, continence and moving from a bed or chair) or has a cognitive impairment such as Alzheimer’s disease or another dementia. For families facing dementia, the cognitive-impairment trigger is often the one that matters most.

Many policies also have an elimination period, a waiting period (often 30, 60 or 90 days) during which the family pays for care before benefits begin. Read this part of the policy carefully.

Key terms in a policy

• Daily or monthly benefit: the most the policy pays per day or month.
• Benefit period or pool: how long, or how many total dollars, the policy will pay.
• Inflation protection: raises the benefit over time so it keeps up with rising care costs.
• Covered settings: check that assisted living and memory care are included, not only nursing homes.
• Hybrid policies: life insurance or annuities with a long-term care rider, which pay a benefit even if care is never needed.

When to buy

Premiums are lower and approval is easier when you are younger and healthy. Many people shop in their 50s or early 60s. Once someone has a dementia diagnosis, buying a new policy is usually no longer possible, so the time to plan is before symptoms appear.

Using a policy you already have

If your loved one already has a policy, gather the paperwork early and call the insurance company to ask how to file a claim, what documents they need and whether the home you are considering qualifies. Keep copies of everything you send. Families who move a loved one into memory care can often begin the claim right away so the elimination period starts counting.

Generations Senior Living accepts long-term care insurance and can help families with the claims paperwork.

Other ways families pay for care

Long-term care insurance is only one piece. Veterans and surviving spouses may qualify for the VA Aid and Attendance benefit, and some families qualify for Florida Medicaid’s long-term care program. Many families combine savings, insurance and benefits.

Have questions about memory care for someone you love? Call Generations Senior Living at (352) 474-2696 or schedule a tour of one of our three homes near The Villages.