Have you heard of Long Term Care (LTC) Insurance and wondered what it was? Unlike traditional health insurance, long-term care covers long-term services and supports. Coverage includes personal and custodial care in various settings, such as your home, a community organization, or other facilities. Health insurance covers doctor’s appointments, hospital treatment, home health, and skilled nursing facilities (SNFs). Additionally, depending upon your health plan, it covers medications, durable medical equipment, and rehabilitation treatment (i.e., physical therapy).
How does LTC pay, and what does it cover?
Private insurance companies provide LTC policies that reimburse policyholders per the pre-agreed daily amount up to a pre-selected limit. Limits are selected using daily amount times the number of years chosen (typically 2 to 5 years). A few old policies do not have limits, but this is rare. Most Long-Term Care policies limit how long or how much they will pay.
Generally, Medicare will cover skilled in-home services (home health aide from a home health provider) for a short time. Medicare does not pay someone to help a person with their Activities of Daily Living, which is most of the services needed. Those services must be paid out of pocket unless you have a Long-Term Care policy.
Will Medicaid pay for Long-Term Care?
Medicaid will pay for the largest share of long-term care services, but only to qualifying low-income individuals that meet minimum state eligibility requirements. They also factor in the amount of assistance needed with ADLs.
Gender is another factor. Women generally live longer and are more likely to file a claim, so they pay more than men.
Marital status is looked at since single people pay more than married couples.
Coverage options affect the premiums. Factors include daily or lifetime benefits, a cost-of-living adjustment for inflation, shorter elimination periods (waiting periods), and fewer coverage restrictions affect premiums.
Talk to a long-term care specialist, life insurance broker, or financial advisor to learn more. STAGES is here to educate people about the options out there.