Long Term Care Insurance FAQ
The Discover Insurance Center doesn't just offer insurance, it offers insurance education too. Get the answers to some of the most commonly asked insurance questions, so you can be empowered with information.
- What is long term care?
- In the event that you develop a prolonged physical illness, disability or a cognitive impairment like Alzheimer's disease, you may need long term care. Long term care is designed to help you manage limitations and help maintain your independence.
- How does the need for long term care come about?
- The need for long term care may develop gradually as we get older. When it first begins, we may only need care or help a few times a week, or one or two times a day — help bathing or dressing. Then as we get older, our care needs may progress or we may develop a chronic illness or disability which causes us to need care on a more regular basis — help getting into or out of bed or ongoing supervision because of a progressive condition such as Alzheimer's disease. Some of us may need long term care in a facility for a relatively short period of time while we are recovering from a sudden illness or injury, and then may be able to be cared for at home. Others of us may need long term care services on an ongoing basis, for example one who is disabled from a severe stroke.
- Do I need another insurance policy?
Long term care can be expensive without coverage. The average cost for one year of nursing home care, in a private room, is over $76,000. One year of care in your home (approximately 3 times a week) can cost about $16,000.
Some other average costs of care in the United States (in 2008) were:
- $187/day for a semi-private room in a nursing home
- $209/day for a private room in a nursing home
- $3,008/month for care in an Assisted Living Facility (1-bedroom unit)
- $29/hour for a Home Health Aide
- $18/hour for a Homemaker services
- $59/day for care in an Adult Day Health Care Center
Your health insurance is not designed to pay for long term care services; neither is Medicare under most circumstances. Having a Long Term Care insurance policy may help you pay for long term care services that arise unexpectedly due to a heart attack, stroke, a disabling accident or if you develop a chronic illness such as Parkinson’s disease. As long as the condition causes you to meet the benefit triggers listed in your policy, you could get the help you need when you need it. Having Long Term Care insurance could very well help you hold on to assets for which you have worked hard and set aside for retirement and may aid you in remaining independent for a much longer period of time.
- What kind of things will Long Term Care insurance pay for?
The answer to this question varies depending on what kind of policy you purchase but a lot of long term care services can actually be provided in your home. Long term care may also be available in the community through programs such as Adult Day Care Centers or in an Assisted Living Facility, a Nursing Home or a Hospice Facility. Services can be provided by Nurses, Physical Therapists, Occupational Therapists, Respiratory Therapists and Home Health Aides.
Generally, you would pay a provider for these services. Often families want to help but find the job beyond their capabilities. Family caregivers who are employed often have to make adjustments in their work schedules, including coming in late, leaving early, and taking time off or in some situations— quitting their jobs. It has been determined that they tend to suffer from more stress-related illnesses and to utilize their company-provided health plans more often.
- Does a Long Term Care insurance policy cover mental illness?
- If you have a pre-existing mental illness then no, you would not be able to get a policy. However, most policies do pay benefits for mental conditions as well as conditions such as Alzheimer’s disease and other forms of dementia if they develop after you already have your policy.
- How much Long Term Care insurance would I need?
- This is something very hard to predict. It is hard to know how much care any individual may need. On average, a person age 65 today will need some amount of long term care services at some point in their life. The service a person will need is unpredictable from one person to the next and the needs often change over time. Women may need care for a longer period of time (on average 3.7 years) than men (on average 2.2 years). While about one-third of today's 65-year-olds may never need long term care services, 20 percent of them will need care for more than five years.
- Are there breaks I can get on the premiums for good health; like if I don't smoke or drink, and are there health problems that could keep me from getting a policy?
- Your health and your health history will be looked at before the company will issue you a policy. Certain health factors could be considered when the company determines your premium. If you have pre-existing conditions, they can affect whether or not you will get a policy or what benefits you can purchase.
- How will my benefits be paid to me?
- Once you incur an expense for an eligible service, the benefit could be paid directly to you or to the service provider. The amount paid will be either for the exact cost of the expense or the dollar limit set in your policy, whichever is less.
- Why shouldn't I just use my retirement money to pay for any long term care I need? Or won't Medicaid/Medicare pay for it?
Long term care services can be expensive without coverage. You may want to conserve your assets for retirement and help maintain your independence.
As for Medicaid paying for long term care, you typically have to spend down your assets to a certain level before you qualify, and once you are on Medicaid your choices for nursing homes may be limited. Medicare has quite a few requirements and restrictions you must meet in order for it to pay for limited types of long term care. Also, the length of time you can receive benefits is limited.
- Is there a certain age or time in my life that is the best time to purchase Long Term Care Insurance? Can I wait until I'm 65 years old? After all I probably won't need long term care until after that!
- The younger you are when you purchase Long Term Care Insurance the better chance you have of qualifying. Your premiums will also be lower. And Long Term Care can be valuable for people of all ages. The need for this type of care can happen to anyone at any time.
- Can my spouse and I both get a policy? Would that save us money?
- Yes, you can both apply for a Long Term Care Policy and you could get a discount on your premium.
- What is the likelihood of me needing to use Long Term Care insurance?
- About 60 percent of individuals over age 65 will require at least some type of long term care services during their lifetime. Many will need care in a nursing home for some period of time. Factors that increase your risk of needing long term care are: age, marital status, gender, lifestyle, health and family history.
