Long-term care is provided to people who are unable to perform the basic tasks of everyday living on their own for an extended period due to chronic medical, physical or cognitive conditions, or disabling injuries. Medicare, Medicare supplemental insurance (Medigap), and traditional health and disability insurance plans typically do not cover long-term care services. Long-Term Care Insurance covers long-term care services provided in a nursing home, at home, in an assisted living facility, or in other community-based settings.
“Long term” cannot be uniquely defined. In 1996, the federal government effectively defined a “long-term” need for assistance as one that lasts at least 90 days. Some policies provide coverage on the first day that the insured person meets the criteria for benefits. Others require 30, 60, 90, or 120 days of assistance before benefits become payable.
This is an individual decision, based on many factors. Premiums are much lower for people in their 40s and 50s. After age 60, premiums for LTC insurance begin to rise steeply. An additional consideration is that as people age, they are more likely to develop health conditions that may make them uninsurable.
Medicare will only provide for some skilled care in very limited situations. Medicare generally covers acute care or skilled care such as that provided during a short hospital stay. Medicare typically does not provide coverage for assistance with the activities of daily living. Long-term care insurance is designed to cover activities of daily living.
Yes, but in very limited situations. Medicaid will generally apply only to those with very low incomes and very few assets. Even then, there is only limited choice of what and where benefits will be provided. For example, there might be limited choice of physician and facility, no control over the number of people sharing a room, or no ability for the family to pay for any extras.
Although medical insurance has some aspects of long-term care, they are not the same thing. For example, some medical plans may pay for the services of a nurse while you are recovering from an illness or an injury that requires medical attention. This medical benefit is very limited. Once you are better or reach the maximum benefit for nursing services, this benefit would cease to be available. Medical insurance is not designed to cover activities of daily living. Long-term care is designed to cover activities of daily living.
The benefits and amount of coverage an individual or couple needs depends on their unique circumstances. Your local insurance agent is the best resource to help you identify your needs and assist you with selecting a plan that best meets those needs.
Having an LTC insurance policy may not keep you out of a nursing home if that is the only place that can provide the appropriate care.