Long-Term Care FAQ
The federal government says about two-thirds of us will need
long-term care. This care is very expensive, and is not usually covered by
health insurance, disability insurance, or Medicare. So how will you pay for this care if you need
One option is to purchase long-term care insurance. This
coverage pays for your care when you can no longer perform normal activities of
daily living like bathing, dressing, feeding yourself, getting from a bed to a
chair, and using the toilet or if you develop cognitive impairment. If you are
eligible for the home health or community care services of long-term care
insurance, it will also pay for services like helping with household tasks,
meal preparation, and grocery shopping.
If you meet the eligibility requirements, the cost of an
assisted-living facility is covered by long-term care insurance. However, some assisted-living
facilities require residents be able to perform most of the daily living
activities noted above. This requirement would not allow the costs of those
facilities to be covered by long-term care insurance.
Long-term care insurance itself can be very expensive, and
the number of companies providing this insurance has dropped over the past
several years as the cost of paying for the care has risen. Policy holders have sometimes been hit with
large premium increases.
On the other hand, paying nursing home expenses can quickly
deplete your life savings, leaving you dependent on Medicaid and leaving
nothing to your heirs.
Here are some other
questions to ask if you are thinking about buying long-term care insurance:
What types of care
does long term care insurance cover, and what doesn’t it cover?
Comprehensive long-term care policies typically cover skilled nursing care,
intermediate care, custodial care, adult daycare, and hospice care. Policies
will cover care performed in facilities such as nursing homes, assisted living
facilities, and hospice facilities as well as care performed in the insured’s
home. Policies do not cover pre-existing conditions, mental or emotional
disorders (except for clinically diagnosed Alzheimer's disease or related degenerative
or dementing illnesses), alcoholism and drug addiction, or self-inflicted
What is the typical
cost of a year in a skilled care nursing home?
Will my insurance cover all of these costs?
The 2013 Genworth Cost of Care Study reported that the cost of a
semi-private nursing home room in Pennsylvania in 2012 was about $95,000, the
cost of a one-bedroom assisted living facility was about $38,000, and the cost
of a home health aid was about $46,000. These costs must be paid by the
policyholder during the policy’s elimination period (typically, the first 90
days of care). The policyholder will also be liable for costs that exceed the
policy’s daily or monthly payment limit.
How much does long-term
care insurance cost at my age?
The cost of a policy varies greatly depending upon the insured’s age,
gender, marital status, elimination period, benefit period, daily policy limit,
and inflation protection options. Please see an insurance agent for more
Can my policy be
cancelled if I pay my premiums on time and can my premiums increase?
Your policy cannot be cancelled if you pay your premium on time but your
premium may go up in the future. Long term care insurance is designed to be a
level premium product but the insurer can raise premiums if losses are greater
than anticipated. Click on the link at
the end of this Q&A to see the latest approved rate increases for long term
care insurers in Pennsylvania. Any rate
increases will affect all insureds in your policy class – you cannot be singled
out for an increase based upon an adverse change in your health.
If fewer companies
are selling long term care insurance, how can I tell if the company I’m
considering has the money needed to pay my bills if I need it to?
You can learn more about the financial strength of insurance companies
What is a long-term
care partnership policy?
example, say a Pennsylvania resident buys a Long-Term Care Partnership policy
from a private company, uses the insurance, and exhausts the policy’s $300,000
in benefits and then qualifies for Medicaid. The policyholder will then be able
to bequeath $300,000 of his assets to his heirs without fear of Medicaid asset
The Long-Term Care Partnership Program is a joint federal-state policy
initiative designed to promote the purchase of private long-term care
insurance, minimize the costs of the Medicaid program, and allow policyholders
to pass assets to their heirs. The asset protection offered by the program is
dollar-for-dollar -- every dollar of coverage that your long-term care policy
provides allows you to keep a dollar in assets that normally would have to be
spent down to qualify for Medicaid.