How do I qualify for long term care insurance benefits?

Bathing: Ability to wash one's body by bathing in a shower or a bathtub and get in and out of the tub
Continence: Ability to control and check bowel and urination and wash there after
Dressing: Ability to put on and take off clothes, braces or items like artificial limbs
Eating: Ability to take in food
Toileting: Ability to get in and out of toilet and do necessary washing
Transferring: Ability to move and change positions from sitting to standing etc

Exactly how this is defined varies from policy to policy but is generally defined as the inability to perform without assistance two or more ADL's due to sickness or injury or because you need substantial supervision due to an dementia or Alzheimer's disease.

There are differences in how you qualify for benefits under tax-qualified and non-tax-qualified plans . In general, it may be more difficult to qualify for benefits under a tax qualified than a non-tax-qualified plan. Some key differences include:

Medical necessity – Tax qualified plans must cover those who are “chronically ill” and cannot without “substantial assistance” perform at least 2 Activities of Daily living for a period expected to last at least 90 days. Non-tax qualified plans may allow benefits when “medically necessary”, providing greater discretion on the part of the policy holder's physician.

Activities of daily living - Tax qualified plans must include at least 5 activities of daily living. Non-tax qualified plans may include more activities of daily living, making it easier to meet the two activity standard. Further, tax-qualified plans refer to the inability without “substantial assistance” whereas non-tax qualified plan require a lower level of “regular human assistance or supervision”.

Cognitive impairment - Cognitive impairment is defined as “severe” in a tax-qualified plan and not in its non-tax qualified counterpart.

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What other benefits are generally included in long term care insurance policies?

Care coordinator: Pay for services of a professional care coordinator, generally a registered nurse or a licensed social worker, that provides information, advice, and arranging of long term care services.

Home modification benefit: Pays for medically necessary modifications to the home, like wheelchair ramps installation of grab bars and hand rails and bath or shower modifications Enables renovations and adaptations of the home setup for better living;

Caregiver training: Pays for training informal caregivers in the proper procedures for caring for the policyholder while at the policyholder's home.

Waiver of premium: Premiums are waived once the policyholder qualifies for benefits under the policy and the elimination period has been satisfied.

Bed reservation benefit: Pays for room and board charges in a nursing facility on a temporary basis while the policyholder is absent, for example, because they are receiving care in a hospital.

Restoration of benefits: If the policyholder qualifies for benefits under the policy and then stops receiving care before the maximum benefits are exhausted and then does not require qualify again for benefit for a certain period, then the maximum benefit amount is restored to its original amount.

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What are other benefits available on an optional basis?

Inflation protection: See discussion above.

Joint waiver of premiums: Premiums on a joint policy is suspended as soon as any one of the couple enters a claim period.

Surviving spouse waiver of premium: When both spouses are covered and one qualifies for a waiver of premium because they are receiving care the premiums for the spouse not receiving care is also waived.

Non-forfeiture of premium: Provides for coverage to remain in force as paid up coverage if you stop paying premiums and lapse your policy. Coverage remains in force but at a reduced benefit amount.

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How are premiums paid for long term care policies?
Premiums can be paid on a monthly, quarterly or annual basis. Most policies are paid on a lifetime basis, meaning the premiums continue for a long as the policyholder owns the policy. Some companies now offer what are referred to as 10-pay or limited pay products. Under these plans, you pay premiums for a certain period of time, generally 10 years, after which the policy is paid in full for the remainder of your life.

Can premiums be increased by the carrier?
Premiums may not be increased for you individually once you have purchased your policy because of changes in your age or health. However, carriers may, with the approval of the state insurance commissioner, increase rates for a class of policyholders. A class of policy holders generally refers to a group of policyholders who purchased the same plan and where in the same age group at the time of purchase.

Can my coverage be cancelled?
You can choose to cancel your policy or the carrier will cancel your policy if you fail to pay the premiums when they are due. However, the carrier my not cancel your policy because of changes in your age or health.

Are premiums tax deductible?
Premiums for federally tax qualified plans are tax deductible, subject to certain limitations, and benefits paid under federally tax qualified plans are not taxable when received. Premiums for federally tax qualified plans are tax deductible along with other non-reimbursed medical expenses to the extent they exceed 7.5% of adjusted gross income, subject to the following limitations based upon age:

Age	Maximum Tax Dedictable Premium
Under 41	$260
41-50	$490
51-60	$980
61-70	$2,600
Over 70	$3,250

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