Long Term Care Insurance and Paying for Elder Care

Page Reviewed / Updated - Feb. 2014

Definition

Long Term Care Insurance, sometimes called Nursing Home Insurance, is a policy that pays for some or all a senior’s long-term care costs in exchange for monthly premiums that typically range from $250-$1,000 / month. Depending on the policy, medical services at home, in adult day care, in assisted living and in nursing home communities can be included.

 

Introduction

 If one does not have long term care insurance but has an immediate need to pay for long term care, this option will not help.

Should a senior have long term care insurance already, then they are probably familiar with how it can help with the costs of long term care.  If one does not have long term care (LTC) insurance but has an immediate need to pay for long term care, this option will not help. Insurers typically do not accept new, elderly enrollees if they are already receiving or in need of care. Even seniors not requiring immediate care but in frail health are often rejected. If a senior is accepted, the insurance can be very expensive.

Rather than discuss the benefits of long term care insurance, this article will focus on what persons who are interested in purchasing long term care insurance should know.

 

Costs and Benefits

 Consumer Reports recommends not purchasing coverage before the age of 60.

LTC insurance is attractive because the monthly premiums are known in advance and therefore can be built into a budget. Plans are very flexible and can be structured to meet variety of needs.

Plans can cover the costs of in-home care, adult day care, assisted living, skilled nursing or all of them. One may choose a daily or monthly care allowance. For example, a plan can payout $50 / day if the individual resides at home and $150 / day if they are in a facility. Alternatively, one may choose coverage areas, like skilled nursing but not assisted living. In some rare cases, a family caregiver can even receive payments for the home care they provide.

For healthy seniors, Consumer Reports recommends not purchasing coverage before the age of 60. The older a senior is, the higher their monthly premiums with the expectation that the senior will be paying those premiums for a shorter period of time before they need benefits.  Other factors affecting cost include benefits covered, current age and the health of applicant. Younger seniors should expect to pay between at a minimum several hundred dollars per month. The cost could be as high as several thousand dollars per month for older seniors.

 

Tips and Questions for Buyers

In choosing a policy, there are a dizzying number of decisions, options and fine print legalese which can make selecting the right insurance a very tricky process. Follows is a list of some of the considerations of which potential buyers should be aware:

1) If selecting a care allowance plan, consider how the cost of care may change at some unknown point in the future when the care is required.

2) What is the appropriate deductible given consideration to the policyholder's other resources?  How might this change in the future?  

3) What monthly premium can the person afford?  Recognize that premiums will increase and it is likely the individual's income will decrease.  

4) The "elimination period” is the number of days the policyholder must require care before benefits begin.  What other coverage does the individual have (Medicare?) and will that coverage sustain them for the elimination period?

5) What duration of time should the policy cover? Many policies will pay for certain lengths of time.  The average stay in skilled nursing is 2.5 years and in assisted living, 22 months.

6) Is an indemnity / daily care allowance better for the senior then a policy that covers only the expenses incurred?

7) Should the individual include a non-forfeiture clause that enables a senior to receive money back if they cancel the policy?  At what cost?

8) Should the policy cover medications and/or home medical equipment? At what additional cost?

9) Is a tax-qualified plan that allows the senior to deduct their premiums appropriate?

10) Is a “partnership plan” that allows the senior to protect their assets appropriate?
 
It may be worthwhile to find a long term care advisor / broker that can help determine what one’s future care costs might be and choose a policy that will avoid unpleasant “gotchas” when it is actually needed. Alternatively, Amazon offers several long term care insurance guidebooks.

 

Qualifying for Long Term Care Insurance

There are no age requirements to purchase long term care insurance. While insurance companies may recommend an individual purchase the policy as young as 40 yrs old, Consumer Reports recommends waiting until the age of 60.  Waiting too long to purchase a policy can result in prohibitively expensive premiums.

Applicants for long term care insurance need to be in good health. Elderly individuals will likely be denied if they already require long-term care or need help with activities of daily living such as bathing and dressing or have any of the following conditions: AIDS, Alzheimer's, Parkinson’s, MS, any dementia or progressive neurological condition. Strokes or metastatic cancer.

Marital status typically does not affect eligibility for long term care insurance though it may affect premiums.

 

How the Benefits Work

Long term care insurance benefits depend entirely on the policy. Some plans will reimburse seniors and others will make payments directly to the service providers. Most plans require that a professional service take place to receive the benefit. For example, a family member won’t be compensated for the care they give.

There are plans with annual limits, total dollar limits as well as unlimited plans. One can also choose daily or monthly limits and align those to specific care situations. For example, $100 / day if the individual resides at home and $250 / day if they are in skilled nursing.

Most policies have “elimination periods”. This is the period of time after a policy becomes active before the senior is eligible for any benefits. Typically these are between 20 and 100 days, but some are even longer.

 

How to Apply

It is recommended that seniors use the services of a broker / advisor who is not tied to any one insurance provider. This eliminates some of the conflict of interest that long term care insurance salespersons may have. A salesperson might be tempted to sell a more expensive policy that does not necessarily suit a senior’s needs. Typically there are no fees to use a broker / advisor.