As people age, they may require care to ensure their health, safety, and well-being. Making a plan for future care can greatly reduce stress and increase the quality of life of an older adult. Long-term care insurance is a tool that can ease the financial burden of paying for care. If you have long-term care insurance, you may wonder if it pays for nursing home care. Here, we go over the details of long-term care insurance’s coverage of nursing home care.
What is long-term care insurance?
Long-term care insurance is an insurance policy that covers some types of care that older adults may need, including home health care, personal care, adult day care, and nursing home care. If a person has a policy and meets the health criteria, long-term care insurance can help cover the cost of care.
What is a nursing home?
Nursing homes are residential care facilities for people who need significant, around-the-clock care. They provide care for people who can no longer care for themselves independently and who often live with chronic conditions or cognitive impairment. Whether the individual requires assistance with day-to-day tasks or medication and physical care management, nursing homes can help.
Nursing home services can benefit seniors requiring 24-hour supervision and essential care but not hospital care. Nurses and aides are on staff to offer skilled nursing and personal care assistance. Other services are also provided, like meal preparation and housekeeping.
Nursing homes have supportive and trained staff and medical professionals 24 hours a day, offering services such as:
- Skilled nursing care.
- Medication management.
- Three meals a day.
- Rehabilitation.
- Assistance with activities of daily living, like bathing and toileting.
- Attention to one’s overall general well-being.
- Social activities.
According to the Genworth Cost of Care Survey, the national median monthly cost for a shared room in a nursing home is over $8,000. The cost of a private room is even more.
Does long-term care insurance pay for nursing home care?
Although long-term care insurance does cover some expenses, specific eligibility requirements and factors may be considered. Here are the facts about long-term care insurance and nursing home care coverage.
When does long-term care insurance coverage begin?
The terms and conditions of your coverage depend on your long-term care insurance policy. Before you can receive any benefits, an insurance agent may require you to meet a set of eligibility requirements known as “benefits triggers.”
You must need a certain amount of daily living assistance or have a serious cognitive impairment that causes you to require assistance. Typically, to trigger LTCi benefits, you must need assistance with at least two activities of daily living or have significant cognitive impairment. When the benefits are approved, your insurance carrier will begin reimbursing you or your loved one for nursing home care expenses based on the terms of your policy.
Does long-term care insurance pay for nursing home costs during the elimination period?
An elimination period is the amount of time that a person must wait between triggering coverage and receiving benefits. If your policy has a calendar-day elimination period, you are responsible for paying out of pocket for the care you received during that time. For example, with a 90-day elimination period, you will be responsible for everything in those 90 days.
Policyholders must allow the elimination or a waiting period to pass before using their benefits. The elimination period varies depending on your policy; it may be 30 days, 60 days, 90 days, or another length of time. It’s a good idea to confirm your policy’s elimination period or discuss with your provider the best option when selecting a policy.
What nursing home costs are covered by long-term care insurance?
In general, long-term care insurance can cover and reimburse the costs of nursing home care. Depending on your policy, this type of insurance can cover the following nursing home services:
- Room and board.
- Help with personal care.
- Skilled nursing care.
Your insurance policy will determine exactly how much to reimburse you for each service. Each policy will have a daily benefit amount, and most have lifetime caps. The amount of care that the policy will cover depends on the daily cost of care you require and the daily benefit amount of your policy. Contact your insurance provider to find out which services your policy covers and how much you will receive. A reputable agent will discuss the terms and conditions of your specific policy and coverage.
Does the policy adjust for inflation?
You have the option of buying inflation protection with your long-term care insurance. If you choose this option, the daily benefit amount will increase regularly to reflect the rising costs of care associated with inflation.
Many nursing home care expenses are covered by long-term care insurance, depending on your specific policy. To learn more about how much coverage and what types of care are covered, contact your insurance provider to discuss the terms and conditions of your policy.
