Many people wonder what is covered by Long Term Care Insurance for services that you or a loved one might need to use in the future.
Policies may cover the following:
- Nursing home care
- Home health care
- Respite care
- Hospice care
- Personal care in your home
- Services in assisted living facilities
- Services in adult day care centers
- Services in other community facilities
There are several ways policies may cover home health care. Some long term care insurance policies only pay for care in your home from licensed home health agencies.
Some will pay for care from licensed health care providers not from a licensed agency. These include licensed practical nurses; occupational, speech, or physical therapists; or licensed home health care aides. Other policies may pay for services from home health care aides who may not be licensed or are not from licensed agencies. Home health care aides help with personal care. You may find a policy that pays for homemaker or chore worker services. This type of benefit, though not available in all long term care policies, would pay for someone to come to your home to do some of the basic necessities; such as, cook meals and run errands. Generally, adding home care benefits to a policy also adds to the cost of the policy.
NOTE: Some policies pay benefits directly to family members who provide care in the home.
Where Services Are Covered
You need to know what types of facilities are covered by your long-term care insurance policy. If you’re not in the right type of facility, the insurance company may (has the right to) refuse to pay for eligible services. New kinds of facilities may be developed in the future, and it is important to know whether your policy will cover them. Some policies may pay for care in any state-licensed facility. Others only pay for care in some state-licensed facilities, such as a licensed nursing facility. Still others list the types of facilities where services will not be covered, which may include state licensed facilities. (For example, some places that care for elderly people are referred to as homes for the aged, rest homes or personal care homes, and are often not covered by long-term care policies). Some policies may list specific points about the kinds of facilities they will cover. Some will say the facilities must care for a certain number of patients or give a certain kind of care. When shopping for a long-term care policy, check these points carefully and compare the types of services and facilities covered in the policy. Also, be aware that many states, companies and policies define assisted living facilities differently. Policies that cover assisted living facilities in one state may not cover services provided in an assisted living facility in another state. Before you move or retire to another state, ask if your policy covers the types of services and facilities available in your new state. Also, if your policy lists kinds of facilities, be sure to check if your policy requires the facility to have a license or certification from a government agency.
NOTE: If you do NOT reside in the kind of facility specified by your policy, the insurance company may not pay for the services you require.