As we gear up for a busy holiday season filled with loved ones, laughter, and festive gatherings, it’s also important to know that November is Long-Term Care Awareness Month. It’s the perfect time to start thinking ahead. Being informed and prepared can make all the difference, and exploring long-term care insurance is one way to get ahead of the game. Just keep in mind that not everyone may qualify.
As we explain the ins and outs of long-term care policies using helpful information from the AARP, please be mindful that every insurance policy is individualized. Each long-term care insurance company offers different coverage, and the time frames for using benefits will vary. If you’re shopping, contact a reputable long-term care insurance carrier near you for the best policy information. If you’re issued a policy, stay informed about what it includes.
Interested in a Tour of Senior Living?
Frequently Asked Questions About Long-Term Care Policies:
When should I buy long-term care insurance?
The earlier, the better! Participants can be denied coverage due to advanced age. A health exam and a true health history report are required to be issued a policy. Because age-related conditions can worsen over time and health catches up with people, exploring policies sooner rather than later is best.
Does a long-term care insurance policy start automatically?
Policyholders may be required to pay for services out of pocket for up to 180 days before benefits kick in, a period similar to a grace period but often called an “elimination period.” Each policy will offer a different elimination period before benefits can be used.
What has to happen before I qualify to use my policy?
Before benefits are approved, policyholders need to require some help with several activities of daily living, or “ADLs.” ADLs include eating, bathing, dressing, using the restroom, and getting in and out of bed and chairs. Once you can no longer perform these activities due to a physical or cognitive decline, long-term care policies may take effect after the policy’s elimination period.
Will the policy cover me for the whole time I need long-term care?
There are limited and unlimited policies available. Limited may cover policyholders for a couple of years, whereas unlimited will cover their needs for the duration. This article’s major takeaway is that every policy and situation is different. For questions on individual coverage, it’s best to speak with your agent to confirm how your benefits will work.
Are there conditions that prevent people from receiving a policy?
Yes. Alcohol and substance abuse are common conditions or instances that may prevent policies from being issued. Pre-existing conditions such as cancer or stroke can result in a denial of a policy, along with having a criminal record.
Once a policy is issued, holders may also lose eligibility for coverage. Reasons for a loss in coverage can include a cognitive impairment (including a diagnosis of dementia), terminal illness, pre-existing condition, or failure to provide an accurate health history.
Can I get my premiums for a long-term care policy refunded if I am disqualified?
Maybe. It depends on what your policy states and the reason you were disqualified. For policyholders who pass away before using benefits, their families may be entitled to a death benefit. This varies depending on your policy.
What is an inflation rider?
The costs of living rise every year—some years more than others. An inflation rider is an additional option that can be purchased to account for variable and rising inflation costs. With an inflation rider, policyholders may receive extra funds paid monthly to adjust for rising costs of care.
Additional ways to pay for long-term care:
Medicaid typically covers assisted living, memory care services, and skilled nursing facility care. Each facility is different in whether or not they accept Medicaid funds. Medicaid rules differ in every state. If you’re exploring Medicaid, it’s best to speak with your local county aging and disability benefits office to determine your eligibility.
Should you qualify for Medicaid, please know that not all long-term care facilities accept Medicaid as payment. Some organizations may have restrictions like paying for care out of pocket for months or years before Medicaid funds can be used. Each long-term care residence will have different rules. If you have a specific building or community in mind, it’s best to ask them about their policies on accepting Medicaid.
Medicare does not pay for assisted living or memory care. However, skilled nursing facilities, aka nursing homes, can be covered under Medicare if patients meet specific requirements. Medicare typically has a maximum number of days to approve patients requiring long-term residence in a skilled nursing facility.
Edgewood offers independent living, assisted living, and memory care if you’re looking to downsize or require care. If you have questions about how to afford care, contact us at info@edgewoodhealthcare.com.
