Just because your loved one’s long-term care insurance (LTCI) covers senior care doesn’t mean it will cover assisted living or memory care.
Find out what to look for in an effective LTCI policy so you don’t get caught out when it’s time to shop for care.
Long-term care insurance is a debated topic — do just a little delving and you’ll find well-meaning advice from both wary LTCI opponents and staunch advocates of such policies.
Whether you’re for it or against it, it’s out there, and plenty of senior Americans have chosen to hedge their bets and buy long-term care insurance in case they find themselves in need.
The problem is, not all LTCI policies are alike. They have specific stipulations about what they cover and don’t cover, when benefits are paid out and how long they will pay for care. If you’re not fully versed in what a policy covers, you might find yourself caught out when it comes to paying for care.
Researching long term care insurance is important as you don’t want an LTCI company telling you they won’t cover assisted living and you’ll have to pay out of pocket — even after decades of paying for a costly insurance policy.
Yet, this is the unfortunate case for many individuals who purchased their insurance in the late 1980s and early 1990s, before the idea of assisted living became widespread, and before insurance policies became more comprehensive in their coverage of different types of long-term care.
Now that many of those same people are claiming their LTCI benefits, they are finding that their coverage doesn’t meet their needs. Their claims might only be partly covered or even denied, says California Health Advocates, “because older policies contain out of date requirements for claiming benefits, and don’t reflect changes in long-term care services and providers.”
Here are just a few of the coverage dilemmas described byCalifornia Health Advocates in their report:
It is important to make sure that your policy is up to date. According to Allison Kern, Business Office Manager for Aegis of Issaquah:
“When most of our residents purchased their LTCI policies, assisted living communities were not as prevalent as they are today. Many were written for nursing homes, so I find that it is easier to approve someone for memory care than assisted living because of the services offered. Many have to meet a certain care requirement before they will be approved. You can also appeal the decision. I have done so twice and won both times. It does take time, effort and follow up from the Business Office Manager, however.”
So how can you make sure that your loved one is able to afford long-term care when the time comes? If he or she already has an LTCI policy, look carefully at the benefits covered.
What are the restrictions to coverage and payouts? It might be helpful to consult with an expert — you financial planner, an insurance professional, or a member of the American Association for Long-Term Care Insurance. That goes for those shopping for a new policy, too. If you or a loved one is considering buying one, make sure to do your homework. Do some comparison shopping, and ask important questions about what the policy covers:
Most experts seem to agree on two things: long-term care insurance is not necessarily suitable for everyone’s budget or care needs, but at the same time, if you do your research and select a policy that fits, LTCI can potentially be an enormous help when it comes time to pay for senior care. For more detailed information on what to look for, visit these websites:
We want to hear your experiences with buying long-term care insurance. Do you find yourself wishing you’d invested in a policy, or did you buy LTCI and then were disappointed with the coverage? Share your story with us in the comments below.
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