Long Term Care
Long-term care insurance (LTCI), an insurance product sold in the United States and United Kingdom, helps provide for the cost of long-term care beyond a predetermined period. Long-term care insurance covers care generally not covered by health insurance, Medicare, or Medicaid.
Individuals who require long-term care are generally not sick in the traditional sense, but instead, are unable to perform two or more of the basic activities of daily living (ADLs) such as dressing, bathing, eating, toileting, getting in and out of a bed or chair, and walking.
Long-term care isn't necessarily long term. A person may need care for only a few months to recover from surgery or illness.
As an individual ages, there is an increased risk of needing long-term care. In the United States, Medicare will not cover the expenses of long-term care, but Medicaid will for those who can not afford to pay.
Age is not a determining factor in needing long-term care. About 40% of those receiving long-term care are between 18 and 64. The late actor Christopher Reeve, who in 1995 at age 42 became paralyzed following an equestrian accident, required 9 years of long-term care. Once a health condition occurs, long-term care insurance may not be available. Early onset (before age 65) Alzheimer's and Parkinson's disease are rare but do occur. Michael J. Fox was 30 when diagnosed with Parkinson's.
In the United States, Medicaid generally does not cover long-term care provided in a home setting; in most cases, Medicaid does not pay for assisted living. However, Medicaid does provide medically necessary services for people with low income or limited resources who "need nursing home care but can stay at home with special community care services." People who need long-term care traditionally prefer care in the home or in a private room in an assisted living facility.
If home care coverage is purchased, long-term care insurance can pay for home care, often from the first day it is needed. It will pay for a live-in caregiver, companion, housekeeper, therapist or private duty nurse up to 7 days a week, 24 hours a day. Assisted living is paid for by long-term care insurance as is adult daycare, respite care, hospice care and more.
Long-term care insurance can also help pay expenses for caring for an individual who suffers from Alzheimer's disease or other forms of dementia.
Eligibility and Deductibles
Many policies have a waiting period (deductible period), or elimination days that may differ from 20 to 120 actual calendar days. Many policies require intended claimants to provide proof of 20 to 120 service days of paid care before any benefits will be paid. In some cases the option may be available to select zero elimination days when covered services are provided in the home in accordance with a Plan of Care. Some may even require that the policy for long-term care be paid up to one year before becoming eligible to collect benefits. The reason to choose a higher deductible period is for a lower cost premium.