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Long Term Care Insurance Definition

How Do I Buy Long

Compare Long Term Care Insurance Options, Traditional versus Hybrid LTC

Since long-term care insurance is medically underwritten, some people with certain underlying health conditions, unfortunately, cannot buy it. This is one way it differs from health insurance.

It is critical that you deal only with an insurance agent or broker who is licensed in your state to sell life and health insurance. If you want to confirm licensure, contact your state insurance department. Many states require those agents and brokers who sell long-term care insurance to take special courses to be able to do so. Therefore, ask if the agent or broker you hope to use is current on their continuing education requirements, including those concerning long-term care insurance.

Long-term care is underwritten based on morbidity, which is the likelihood of suffering from a debilitating disease or medical condition. It differs from life insurance, which is underwritten based on mortality, or the likelihood of dying. It is possible to be approved for life insurance and still be declined for long-term care insurance and vice versa.

Where To Buy Long

Federal and US Postal Service employees and retirees are eligible for special long-term care coverage. Find out more here.

Non-government workers can compare several private long-term care insurance policies to find the best rates. These are the top 10 long-term care insurers by market share in 2022, according to the American Association for Long-Term Care Insurance:

Quick tip: Traditional long-term care insurance policies are “use it or lose it,” meaning you or your heirs won’t get a refund of premiums if you wind up not needing the coverage. If you’re interested in more flexible terms with the option of a death benefit, consider a hybrid life insurance policy.

Here are the most important things to consider when shopping for a long-term care policy:

Insurance company credit rating: Financial strength ratings of insurance companies indicate their ability to withstand future economic hardship. In other words, is the company stable and likely to make good on its contracts? Check each insurer’s rating with agencies like A.M. Best Company, Moody’s, and Demotech.

Benefits coverage: Dig into the scope of coverage. Do family members qualify as caregivers? What are the benefit triggers? Which types of care or care facilities are covered? Is there a daily or weekly benefit and how much is it?

What Qualifies As Long

Long-term care insurance, according to Washington state law , is an insurance policy, contract or rider that provides coverage for at least 12 consecutive months to an insured person if they experience a debilitating prolonged illness or disability. LTC insurance typically covers the following types of services if theyre provided in a setting other than a hospitals acute care unit:

LTC insurance typically pays benefits when an insured person can no longer independently do two or more of the following activities of daily living :

  • Control their bladder or bowels

LTC insurance may be included as a rider on some life insurance and annuity policies. However, some life insurance policy riders dont qualify as long-term care insurance in our state according to the definition of LTC insurance as defined in RCW 48.83.020 . See a list of companies approved to sell long-term care insurance in Washington state.

If you have questions about benefits or exemptions regarding the new WA Cares Fund , visit the WA Cares Fund website .

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Who Pays The Costs Of Long

At present, most long-term care is paid for from:

  • an individuals own resources,
  • his or her familys resources or
  • Medicaid, the federal-state government program designed to cover the health care costs of a mostly indigent population.
  • Contrary to popular belief, traditional health insurance and Medicare usually provide little or no coverage for long-term care. Currently, most people who need long-term care services must pay for it on their own unless:

    • they have long-term care insurance policies with benefits for the services they need or
    • they are or become eligible for Medicaid or other government assistance.

    Private Insurance Plans: Life Insurance Vs Long

    The Best Long

    Long-Term Care Insurance Plans

    Long-term care insurance is a type of private health insurance that provides benefits to cover some of the costs of services you might need if you develop a chronic illness or cognitive impairment.

    Government Programs

    In Massachusetts, the state’s Medicaid program, known as MassHealth, currently provides assistance for 65% of all nursing home residents.8 In addition, the Executive Office of Elder Affairs spends 70% of its budget on long-term care services provided in Massachusetts, but pays almost entirely for home and community-based services. To qualify for Medicaid or Elder Affairs assistance, a person may not have income or assets above a certain level.


    Many individuals incorrectly assume that Medicare will cover most of their long-term care costs. In fact, Medicare pays very little of all long-term care costs. IT IS NOT RECOMMENDED THAT YOU RELY ON MEDICARE TO PAY FOR YOUR LONG-TERM CARE NEEDS.

    Medicare covers only the following long-term care services:

    Veterans Benefits

    If you are a veteran, you may be eligible for some long-term care services in a Veterans Administration facility. To find out whether you would be eligible for assistance, contact your city/town governments Veterans Agent or the Massachusetts Department of Veterans Services.

    The Home Care Program


    Life Insurance Plans

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    Emergency Medical Alert Systems

    Emergency response systems automatically respond to medical and other emergencies via electronic monitors. The user wears a necklace or bracelet with a button to push in an emergency. Pushing the button summons emergency help to the home. This type of service is especially useful for people who live alone or are at risk of falling. A monthly fee is charged.

    What Is Long Term Care

    When you think about long-term care, you may think about care in a nursing home. But long- term care includes an ever-changing array of services aimed at helping people compensate for limitations in their ability to live independently. Long-term care should meet your medical needs, as well as your social, financial and housing needs. It can range from assistance with household chores to assistance with activities of daily living to highly skilled medical care.

    Long-term care services may be provided in a variety of settings such as the home, community sites or nursing homes. The type and setting of long-term care services depend upon your particular needs. Those with physical illnesses or disabilities often need hands-on help with basic activities of daily living including bathing, eating, dressing, toileting, continence and transferring. Those who are cognitively impaired usually require supervision or verbal reminders to perform routine activities or to stay out of harms way. Skilled care is provided on a doctors order by medical personnel such as registered nurses or professional therapists. Although it can be provided in a nursing home, skilled care may be provided in the home by visiting nurses or therapists. Personal care is provided to help people perform ADLs but is less intensive than skilled care and does not require the services of a medical professional. Personal care may be provided in many settings, including a persons home or adult day care center.

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    Talking With Your Parents About Long

    It can be difficult to make the decision about whether you or a loved one needs to leave home. Sometimes, decisions about where to care for a family member need to be made quickly, for example, when a sudden injury requires a new care plan. Other times, a family has a while to look for the best place to care for an elderly relative.

    You may have had a conversation with a loved one where they asked you not to put them in a nursing home. Many of us want to stay in our own homes. Agreeing that you will not put someone in a nursing home may close the door to the right care option for your family. The fact is that for some illnesses and for some people, professional health care in a long-term care facility is the only reasonable choice.

    How Popular Is Long

    Identify the tax benefits associated with long-term care insurance.

    The number of insurance companies selling long-term care insurance has plummeted since 2000. Slightly more than 100 insurers were selling policies in 2004, according to 2020 data from the National Association of Insurance Commissioners. About a dozen are selling policies today.

    The uncertain cost of paying future claims as well as low interest rates since the 2008 recession led to the mass exodus from the market. Low interest rates hurt because insurers invest the premiums their customers pay and rely on the returns to make money.

    The market is continuing to change. Genworth, one of the largest remaining carriers, suspended sales of individual long-term care insurance through agents and brokers in March 2019. The company sells policies to groups and directly to individual consumers through its own sales department.

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    Glossary Of Long Term Care Terms

    Accelerated Death BenefitA life insurance policy feature that lets you use some of the policys death benefit before you die.

    Activities of Daily Living Everyday functions and activities individuals usually do without help. ADLs include bathing, continence, dressing, eating, toileting, and transferring. Many policies determine benefit eligibility based on being unable to do two of six ADLs.

    Adult Day CareCare given during the day at a community-based center for adults who need help or supervision. This includes help with daily personal care, but does not include around-the-clock care.

    Alzheimers DiseaseA progressive, degenerative form of cognitive impairment causing severe intellectual deterioration.

    Assisted Living FacilityA residential living arrangement that provides personal care and health services. Assisted living is for people who need assistance with activities of daily living, but dont need the level of care a nursing home provides. These facilities can range from small homes to large apartment-style complexes and may offer different levels of care and services.

    BathingWashing oneself in either a tub or shower. This activity includes getting in or out of the tub or shower.

    Benefit TriggersThe criteria an insurer uses to decide when a policy pays benefits. This often includes being unable to do two or more activities of daily living or needing substantial supervision due to a cognitive impairment such as dementia or Alzheimers.


    How Is The Cost Of Long

    Your premium amount will be determined by your length of coverage, your age/gender, your current health, the elimination period and the maximum dollar amount you can be reimbursed for covered expenses. Qualifying for coverage can become more difficult as you agethe best time to apply is while you’re still in good health.

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    Making Housing Decisions: Aging In Place

    In thinking about long-term care, it is important to consider where you will live as you age and how your place of residence can best support your needs if you can no longer fully care for yourself.

    Most people prefer to stay in their own home for as long as possible. Learn about services, products, and resources that can help older adults stay in their homes.

    Types Of Ltc Insurance Policies

    The Advisors Guide to LTC Insurance Options

    Three types of LTC policies are available in California, named according to where benefits are paid. They are:

  • Nursing Home & Residential Care Facility Only
  • Note: When life insurance or annuity policies include benefits or riders for LTC, they must generally meet the same requirements for each of the types of benefits described below.

    Home Care Only

    Home Care Only policies only cover care in your home or a community setting, but not in an assisted living facility or nursing home. These policies must include benefits for home health, adult day health care , hospice, respite care, personal care and homemaker services.

    Nursing Home & Residential Care Facility Only

    Nursing Home & Residential Care Facility Only policies only cover care in a nursing home or a place licensed as a Residential Care Facility for the Elderly that provides assisted living care. The benefits of these policies must include the cost of all LTC services you receive in the facility not just the charge for room and board up to the policys maximum daily benefit amount.

    Assisted living benefits in this type of policy issued after 1998 must be paid when you are in any RCFE-licensed facility, including small neighborhood homes , retirement homes and specialized community facilities for Alzheimers patients. In addition, the assisted living benefits in these policies must equal at least 70% of the nursing home care benefit.


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    What Ltc Insurance Covers

    Policies may limit what conditions they cover. For example, its not unusual to deny care for alcoholism, drug addiction or war injuries. And while a preexisting condition, such as heart disease or a past cancer diagnosis, may not stop you from getting a policy, the policy may not cover care related to that condition for some period after it goes into effect.

    Generally, though, you become eligible for benefits once you can no longer perform a set number of the so-called activities of daily living such as bathing, dressing, eating, using the toilet, getting in and out of beds and chairs, and managing incontinence or become cognitively impaired. At that point, premiums typically are waived while you receive benefits.

    But if you stop paying the premiums before the need arises, you usually lose the coverage. And if you never use the coverage, the insurance company keeps and invests your money to pay for other peoples claims and reaps a profit.

    Its use it or lose it, Graham says.

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    Still Not Sure If Your Policy Or Contract Qualifies As Ltc Insurance

    Contact your insurance company to find out if the product youve bought or want to buy complies with the Washington Insurance Code , Washington Administrative Code and is an approved company through the OIC or Insurance Interstate Product Regulation Commission .

    Riders filed with the IIPRC under the Individual Standards for Accelerated Death Benefits standards are not long-term care insurance products.

    Riders filed with the IIPRC under Individual Long Term Care Uniform Standards are long term care insurance products.

    There Are Several Type Of Long

    Long Term Care Insurance Rate Increases Your Options

    A typical, traditional LTCI policy will pay a predetermined amount for each service â for instance, $100 a day for nursing home care. There generally will be a limit to the benefits you receive, either based on a number of years or a dollar amount. A plan that offers pooled benefits will set a total dollar amount for the various services you receive.

    New types of LTCI policies are growing in popularity, extending beyond the traditional âuse it or lose itâ type, many of which have experienced premium increases.

    One alternative is hybrid life and long-term care insurance. This type of policy combines long-term care insurance with permanent life insurance and provides more options:

    • If you need long-term care, you can tap the policy benefit.
    • If you die before needing long-term care, the policy has a life insurance benefit.
    • If you decide you need the money for something else, you can typically receive a cash value that can be roughly equal to or less than the total premiums paid.
    • Contract terms and premiums are guaranteed not to change.

    Another alternative is a universal life insurance policy with a LTCI rider. This option might be right for you if youâre interested in a meaningful death benefit for your beneficiaries in the event LTCI isnât needed.

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    How Do I Know If Im Eligible For Long

    Step one in obtaining long-term care insurance is meeting with an experienced, Bankers Life licensed insurance agent/producer to determine the right plan for you. Most individual long-term care insurance policies require medical underwriting and may require a medical exam. Our underwriters will review your medical history to determine if your application is acceptable and to identify your risk classification.

    Making Decisions About Long

    Begin by thinking about what would happen if you became seriously ill or disabled. Talk with your family, friends, and lawyer about who would provide care if you needed help for a long time. Read about how to prepare healthcare advance directives.

    You might delay or prevent the need for long-term care by staying healthy and independent. Talk to your doctor about your medical and family history and lifestyle. He or she may suggest actions you can take to improve your health.

    Healthy eating, regular physical activity, not smoking, and limited drinking of alcohol can help you stay healthy. So can an active social life, a safe home, and regular health care.

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    Does Social Security Pay Ltc Benefits

    No. The purpose of Social Security is to ensure some level of monthly income to elderly or disabled Americans. It is funded by payroll taxes. The amount of benefits you receive are based on your earnings.

    The closest approximation to long-term care insurance within Social Security is the disability benefit, called Social Security Disability Benefits . But it does not provide for the kind of custodial care that long-term-care insurance covers. You may be entitled to SSDI if you worked in jobs covered by Social Security and have a medical condition that meets Social Security’s definition of disability.


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