Long Term Care Insurance Policies


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What kinds of long term care policies are available?

Group and Individual Long Term Care Insurance - Long term care insurance is available both as group plans and as individual polices. Group plans are most often available through employers. Almost 6,000 employers offered some kind of group long term care plan as of 2002. Plans are often available not only to employees, but to their immediate family and to retirees. Individual polices are good option for those who do not have access to group plans or those whose needs are better met through plans only available on an individual basis.

Partnership Plans - In some states special long term care insurance programs have been developed through an alliance between state governments and private insurance companies. These “Partnership” plans generally offer additional incentives and benefits related to the protection of assets from Medicaid spend-down requirements should benefits under private insurance be exhausted. These plans are available in California, Connecticut, Indiana and New York. If you live in one of these states, as you long term care insurance agent about these plans. More information is available at the following websites:

California - www.dhs.ca.gov/cpltc
Connecticut www.CTpartnership.org
Indiana www.IN.gov/fssa/iltcp
New York www.nyspltc.org

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What do long term care insurance polices cover?

Most long term care policies purchased today provide coverage for skilled, intermediate and custodial care provided in a variety to settings including at home, in the community or in a nursing facility.

Home and community care benefits: Policies generally provide benefits for a variety of care services provided at home or in the community. These include:

Home health care
Includes homemaker services, home health aids and skilled and non-skilled nursing care and physical therapy. Many policies also include benefits for medically necessary modifications to the home, like wheelchair ramps installation of grab bars and hand rails and bath or shower modifications.

Respite care
Provides for care by a third party to relieve family members a break from daily care giving responsibilities.

Adult day care
Provides health, social, and recreational activities in a supportive setting for adults who have functional and/or cognitive impairments that do not need 24-hour care.

Hospice care
For terminally ill patients, continuous care provided at home. Hospice care includes psychological and spiritual counseling help to dying patients and their family.

Facility care benefits: Policies generally provide benefits while receiving care in the following types of facilities:

Nursing home
Benefits for skilled, intermediate, and custodial care provided in a state licensed nursing home facility.

Residential care or assisted living facility
This group living arrangement provides help with activities of daily living such as eating, bathing, and using the bathroom, taking medicine, and getting to appointments as needed.

Hospice facility
For terminally ill patients, continuous care provided in a facility that can provide a home like setting. Hospice care includes psychological and spiritual counseling help to dying patients and their family.

What kinds of services are not covered by long term care policies?
Most long term care insurance polices will not provide coverage for the following:

Intentional or self inflicted injury or attempted suicide
Mental or nervous disorders or disease, other than Alzheimer’s disease or other dementia
Alcohol or drug addiction
Services payable by Medicare or any other Federal or State program, except Medicaid
Services covered by primary health insurance such as hospital or physician services, prescription drugs, x-rays, and lab work

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