Frequently Asked Questions

Do I Need Long Term Care Insurance?

Before applying for long-term care insurance for yourself or for a family member you should thoroughly examine your or your family member’s life and needs. If the individual considering long-term care insurance has certain chronic illnesses or a certain family health history, he/she may not qualify for coverage. The following is an introduction to the factors that you should consider before applying for or purchasing long-term care insurance.

Your lifestyle

  • You live alone or you have no family to care for you.
  • You’re unwilling to ask your children to pay for long-term care.
  • You want freedom of choice regarding where you live and receive care.
  • You’re female (women tend to live longer and use more long-term care than men).
  • You’ve had family members live into their 80’s and beyond.
  • If you do require long-term care, you do not want to receive public assistance and go on welfare.
  • It’s important for you to leave your estate to your spouse or children.
  • You have a family history of chronic health problems.

Your assets and income

Consider buying long-term care insurance if:

  • You have significant assets and income
  • You want to protect some of your assets and income
  • You want to pay for your own care
  • You want to stay independent of the support of others

Do not consider buying long-term care insurance if:

  • You can’t afford the premiums
  • You have limited assets
  • Your only source of income is a Social Security benefit or Supplemental Security Income (SSI)
  • You often have trouble paying for utilities, food, medicine, or other important needs

How much does Long Term Care Insurance Cost?

Companies that sell long-term care insurance “underwrite” their coverage. They look at your health and health history before they decide to issue you a policy.

Insurance companies’ underwriting practices affect the premiums they charge you now and in the future. They ask you to answer questions on the insurance application about your health. For example, they may want to know if you:

  • Have been in the hospital in the last 12 months.
  • Have Alzheimer’s disease, dementia, or organic brain syndrome.
  • Have Multiple Sclerosis, Muscular Dystrophy, ALS (Lou Gehrig’s disease) or Parkinson’s Disease.
  • Use mechanical devices such as a wheelchair, walker, crutches, hospital bed, dialysis machine, oxygen or stair lift.
  • Need or receive help in doing any of the following: bathing, eating, dressing, going to the bathroom, transferring from the bed to chair or maintaining continence.

Having certain conditions that are likely to mean you’ll soon need long-term care (Parkinson’s disease, for example) probably will mean you can’t buy coverage from these companies. No matter how the company underwrites the insurance, you must answer certain questions that the company uses to decide if it will insure you.

Doesn’t Medical Insurance Cover the Cost?

Most medical insurance does not cover the costs of long term care.

  • These major medical plans only cover skilled medical care provided by a doctor or hospital while you are an inpatient.
  • Medicare provides limited benefits following hospital confinement.
  • Medicaid provides broader benefits, but you must be nearly impoverished to qualify.

Today, 4 out of 10 people pay nursing home costs out-of-pocket. Will you be one of them?

Won’t the Government Pay?

Medicare and Supplemental Insurance

Medicare’s skilled nursing facility (SNF) benefit does not cover most nursing home care. Medicare will pay the cost of some skilled care in an approved nursing home or in your home but only in some situations. The SNF benefit only covers you if a medical professional says you need daily skilled care after you have been in the hospital for at least three days. You should not rely on Medicare to pay for your long term needs.

Medicare does not cover homemaker services. Medicare does not pay for home health aides to give you personal care unless you are homebound and are also getting skilled care such as nursing or therapy. The personal care must also relate to the treatment of an illness or injury and you can only get a limited amount of care in any week.

Medicare supplement insurance is private insurance that helps pay for some of the gaps in Medicare coverage, such as hospital deductibles and excess physicians’ charges above what Medicare approves. Generally, Medicare supplement policies do not cover long term care.

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The purpose of Medicaid is to provide medical care for those with low incomes; it is not meant for everyone. To get Medicaid help, you must meet federal and state guidelines for income and assets. Many people start paying for nursing home care out of their own funds and “spend down” their financial resources until they are eligible for Medicaid. Medicaid may then pay part or all of their nursing home costs. You may have to spend down or use up most of your assets on health care before Medicaid is able to help. Some assets and income can be protected for a spouse who remains at home.

State laws differ about how much money and assets you can keep and be eligible for Medicaid. Contact your state Medicaid office, office on aging, or state department of social services to learn about the rules in your state.

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