What does Long-Term Care Insurance Cover?

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Long-term care insurance was developed specifically to cover costs of any long-term care services. These include those not covered by any traditional health insurance plan or Medicare. Included services can be received in your home, such as assistance with Activities of Daily Living as well as any care received in any facility or community setting.

The most popular options summaries and choices are:

* Your own selected daily benefit amount (i.e.$100/day), being the maximum daily amount for care paid for by the policy. With the variety of policies, this could range from $50/day to as much as $500/day.  More policies are starting to specify benefits in terms of a monthly amount to allow for flexibility as to when you will require more care, such as when family members aren’t available to assist you.

* You are often able to choose if you want the policy to pay the same amount for care in all settings, or less for care where it is less expensive, such as in a home setting. This could be changed to 50-75 percent of what you would normally pay in a nursing home setting.

* You have the opportunity to choose the type of coverage you prefer – comprehensive or facility care only. Comprehensive policies cover a wider range of settings in which you can receive care and services, such as at home and in various types of facilities.

* Many policies offer you additional optional benefits allowing for a more customized coverage. One of the most important is Inflation Protection. This will help protect you from any rising cost of health care over time. Be sure to talk to your insurance representative about this option before completing your application process.

Many policies may also pay for services or devices to support people living at home:

* In-home monitoring systems

* Grab bars, ramps and other home modification

* Assisted transportation to and from medical appointments

* Training courses for friends or relatives in order to provide personal care safely

What is not covered by long-term care insurance?

As with all insurance, long-term care policies have exclusions. These often follow particular state regulations on which exclusions are allowed. Long-term care policies typically exclude the following (even if you meet all the other requirements of the policy):

* Any care or services provided by family member is not covered. The only exception to this is if the family member is an employee of the facility or organization providing a particular service, and receives pay for services in the form of normal compensation such as a pay check.

* All care and/or service provided outside the USA, unless your policy has an international care clause allowing the patient to seek treatment outside the USA.

* Any care or services resulting from attempted suicide (no matter what the mental capacity) or intentionally self-inflicted injury.

* All services or care provided for treatment of alcoholism or drug addiction (except in cases of addiction to prescription medication when administered according to your physician’s advice).

* All treatments provided in any government facility (unless by law).

* Any services available under any governmental program such as Medicare (except Medicaid), workers’ compensation, employer’s liability or occupational disease law.

There are some policies providing coverage for everyday household needs such as housekeeping, laundry, managing medication, meals and other items required for daily activities. However, these are only available if you receive funds for Activities of Daily Living.

As a final note, long-term care policies will not pay for anything related solely to comfort or convenience. Some examples of these would be a television in your room, or visits to the hair salon (normally located in the nursing home).

By paying close attention to what your needs and desires really are, and comparing them to your present insurance policy, you may find it necessary to make some changes or additions to what you are covered for, and what you aren’t. This will make sure there are no unexpected surprises or disappointments later on.

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