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Long Term Care Insurance [In-Depth Guide]

Peter Brissette • May 24, 2021

Have you thought about what you want your “golden years” to look like? You may already be planning your own retirement, or perhaps you have been researching long-term care for a parent or grandparent, and now you’re wondering how much this type of care will cost in the future. The simple truth is that no one can predict what the future will bring, and long-term care costs have been steadily increasing over the years. Most people aren’t sure of how they’ll pay for care, if/when they need it.

At Assured Assisted Living, we’re committed to providing support for those who need assistance with their Activities of Daily Living (ADLs) and their families. We also offer guidance regarding long-term care services, and this includes the financial aspects of caring for a loved one.

If you’re worrying about how to pay for the care of a loved one, or you’re thinking about your own retirement, long-term care insurance can be an extremely helpful tool.

Costs of Long-Term Care – Who Pays?

According to Genworth's Cost of Care Survey, between now and 2030, 10,000 baby boomers a day will celebrate their 65th birthday. Seven in 10 people require long-term care during their lifetime. The cost depends on the type of care facility, your geographic location the level of care needed and other factors.

What may surprise you is that your regular health insurance policy won’t cover long-term care. Medicare will cover temporary stays in a nursing home (after an illness or accident), as well as a limited amount of home health care for rehabilitation or skilled nursing. However, it doesn’t cover custodial care — non-medical care that assists people with ADLs such as dressing, bathing, eating and ambulating.

Medicaid will cover custodial care for lower income people, but only if it is provided in a nursing home. Not everyone who needs assistance with daily activities requires the medical care of a nursing facility—nor do they want to live in a large institutional setting. Medicare coverage for long-term care widely varies between states, and beneficiaries must first exhaust their savings before Medicaid will kick in.

The cost of long-term care, whether it’s provided in the person’s home, in an assisted living community or elsewhere, is most often the responsibility of that individual and their family.

Long-term care insurance is an attractive option for individuals and families who need help to pay for long-term health care. The primary benefit is that it will save you money since the monthly premiums will add up to be far less than the cost of care with no insurance. Having long-term care insurance provides you with more care options, expands the range of services, and relieves family members and friends from caregiving duties.

What is Long-Term Care Insurance?

A long-term care insurance policy covers a wide range of long term care services that aren’t covered by regular health insurance, Medicare or Medicaid. This includes supervision and assistance with daily activities like getting in and out of bed, bathing, dressing, eating and moving around. This type of insurance will cover your costs if you have a disability, chronic medical condition or a condition that may worsen over time, such as Alzheimer’s disease.

Most policies will cover care that’s provided in various types of facilities, making it extremely flexible. With long-term care insurance, you can protect your life savings from being quickly depleted with medical costs. In 2018, the annual median cost of long-term care was $48,000 for an assisted living facility and more than $89,000 for a nursing home.

Long-term care insurance may not be affordable for low-income individuals, but it is extremely helpful for those who don’t qualify for Medicaid but who don’t have enough money to pay out-of-pocket.

How Does Long-Term Care Insurance Work?

The process of applying for long-term care insurance is as follows:

Complete an application and answer health-related questions.
You may have to show the insurer your medical records and possibly speak by phone or in person for an interview.
Choose the desired insurance coverage. Policies will typically limit the amount that they’ll pay per day as well as a lifetime total.
Once you’re approved by the provider, you will begin to pay premiums.

Eligibility requirements may vary, but most policies say that you are eligible if you are unable to do at least two ADLs (activities of daily living) without help. You’re also eligible if you have Alzheimer’s or some other type of dementia or cognitive impairment. The six main activities of daily living are: dressing, bathing, caring for an incontinence problem, toileting, eating and getting in and out of a chair or bed.

To receive care, once you’re insured:

Your insurance company reviews your medical documents. A nurse may visit to conduct an evaluation.
The insurer approves your care plan and then approves the claim.
Most policies require that you pay for your care services for a certain length of time, usually for 30-90 days. This is known as the elimination period, similar to the deductible in other insurance policies.

The insurance company will begin to make payments once you are eligible and typically after you have received the paid care. Shared long-term care insurance is offered by certain providers. This allows a couple who have both purchased policies to “draw from” the spouse’s benefits if they reach their policy’s limit.

Is There Insurance That Covers Assisted Living?

While there are different coverage options, many long-term care insurance policies will cover the costs of assisted living. This type of insurance may also pay for in-home care, a nursing home, adult day care and other care services.

How Much Does Assisted Living Insurance Cost?

Long-term care insurance cost is based on several factors, including the provider, amount of coverage, and your geographical region, gender, age, health and marital status. It ranges from approximately $2,000 to $2,700 a year for singles and about $3,000 for a married couple.

What Does Medicare Cover for Assisted Living?

Medicare only covers medical expenses and prescriptions, but not long-term care such as help with daily activities (eating, bathing, dressing, etc.) and supervision. It may cover a short-term stay in a nursing facility, but only after an illness or accident.

Is It Worth It to Buy Long Term Care Insurance?

If you’re worried about paying for non-medical care and you know you won’t be eligible for Medicaid, long-term care coverage may be a great option. However, for it to be cost-effective, you should purchase the policy before retirement and while you’re still in good health.

What Long-Term Care Insurance Pays For

This type of insurance can cover costs associated with in-home care, an assisted living facility, respite care, hospice care, adult daycare, a nursing home, memory care facility and even home modifications that are made to accommodate disabilities.

Long-Term Care Insurance Considerations

There are certain things you should keep in mind if you’re thinking about purchasing a long-term care insurance policy.

All long-term care is not the same. A nursing home isn’t your only choice. There are different options, depending on your needs and preferences. Long-term care refers to a wide variety of services to meet the needs (medical or non-medical) of someone with a disability or chronic illness who can’t care for themselves. Long-term care insurance gives you more flexibility regarding the type of care you receive.

Plan your aging experience as you plan for your retirement. Start to define your aging wants, needs and desires early on, well before the time when you think you should. Life events can be unpredictable, and costs continue to rise. Planning early ensures that you have options later in life.

Buy the policy when you’re still young. Don’t wait until you’re older to think about buying long-term care insurance. That’s the worst time. In fact, some companies may not even offer policies to seniors, or if they do, premiums will be high. The best cost savings are if you purchase it in your 20s or 30s.

There are different ways to purchase your policy. You can buy directly from an insurance company or through an agent, and some employers offer group rates to their employees. Most states offer partnership plans with insurance companies that provide certain benefits. Compare quotes from different agencies. Rates can vary widely.

You may be turned down due to preexisting conditions. If they do agree to sell you the policy, they may withhold payment for care that’s related to the conditions for a certain length of time. This is another reason why it’s smart to purchase the policy when you’re young.

There may be policy exclusions. Ask the insurance company for a list of these exclusions. They may include alcohol and drug abuse, self-inflicted injuries and mental disorders. Make sure that Alzheimer’s disease and other common medical conditions like heart disease and cancer are not excluded.

Your premiums may go up. The cost of your policy is not guaranteed to remain the same throughout your lifetime. Companies may raise rates if they can show that the cost of claims were higher than they anticipated.

Examine your life insurance plan. Some life insurance policies may have long-term care (LTC) riders or options. An LTC allows you to receive part of the death benefit while you’re still living, which can be used to pay for care expenses. If you add an LTC rider to your existing policy, your cost will increase.

Take advantage of tax benefits. If you itemize your deductions, long-term care insurance can be included as an expense. This is especially useful in later years. Federal tax codes and some states let you write off some or all your long-term care insurance premiums as tax deductible medical expenses. Premiums must be “tax-qualified.”

Why Get Long-Term Care Insurance?

In weighing the pros and cons of long-term care insurance, you’ll find that there are many benefits and just one drawback, which is the cost of the premiums. Advantages include greater freedom as you age, with more available options for assistance, from home care and adult day care services to an assisted living community or nursing home. Having a safety net reduces financial and psychological stress on your family. The only “con” is that you must keep up payments on your policy. If you want options as you age and know that you won’t qualify for Medicaid, consider long-term care insurance.

Assured Assisted Living – Your Long-Term Care Experts

At Assured, we specialize in dementia and memory care, and are committed to proving our residents with the best possible care so that they can live dignified lives with as much independence as possible.

Our highly-trained staff provides 24-hour protective supervision, with a high staff-to-resident ratio for personalized care. We work with most if not all long-term care insurance providers, and our team assists in processing insurance claims.

Contact us today for more information about our unique approach to senior living. We can also help answer your questions about long-term care insurance. Everyone is aging; take control of your aging experience today.

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