Long-Term Care (LTC) is different from medical care, because it generally helps you to live as you live now instead of improving or correcting medical problems. People often think of long-term care as strictly nursing home care. LTC services may include help with activities of daily living, home care, respite care, hospice care or adult day care. This care maybe given in your own home, an adult day care facility, assisted living facility, nursing home or hospice facility. Medicare does not cover long-term care. However, Medicare Part A does cover skilled nursing facility care, nursing home care (as long as custodial care isn’t the only care you need), hospice care and limited home care. You should not count on Medicare for Long Term care costs.
Policy Review
Range of Care/Covered Services
Coverage for different levels of care in different care settings specific to your policy:
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Daily Benefit
The amount of coverage provided (typical options range from $50 to $350).
Duration of Benefits
Any limitations placed on the benefits you can receive (e.g. dollar amount caps, time limits, etc.)
Waiting and Elimination Period
The period of time before the insurance policy will begin to pay out benefits, if applicable
Qualify for Benefits (“Benefit Triggers”)
Benefit triggers are the conditions that must occur before you start receiving your LTC benefit. Most companies look to your inability to perform certain “activities of daily living” (ADLs) or “instrumental activities of daily living” (IDLs) to qualify for benefits.
ADLs include: bathing, dressing, using the toilet, transferring (to or from bed or chair), caring for incontinence, eating
IDLs include: housework, managing money, taking medication, preparing meals, shopping for groceries, responding to emergency alerts such as fire alarms.
Coverage Exclusions (if applicable)
Conditions for which policy excludes coverage
- Pre-existing conditions: The waiting period (e.g. six months) imposed before coverage will go into effect regarding treatment for pre-existing conditions.
- Other exclusions: Whether or not certain conditions are covered (e.g. Alzheimer’s or Parkinson’s disease, etc.)
- Prior hospitalization: Whether or not a hospital stay is required before you can qualify for LTC benefits
- Other: