Long-Term Care Questions

What kinds of care does the policy cover?
Ideally, it should let you receive home health care, as well as skilled, intermediate, and custodial nursing home care. Happily, most people only need home-based care, so they can remain in an environment where they feel comfortable.

What is the policy's waiting period?
The insurer should not require a wait of longer than three months.

How are benefits paid to me?
Either you submit actual expenses for reimbursement, or the insurer sends you the amount directly.

Is there a preexisting condition clause?
Don't buy a policy with this.

Is there inflation protection on the policy?
You may not need LTCI for years. Be sure that your benefits will keep up with inflation.

Must I be hospitalized in order to be eligible for benefits?
Don't buy a policy that requires a hospital stay. If you only require home care, then you would have to pay out-of-pocket.

What conditions trigger benefit payments?
The policy should cover cognitive disabilities, like Alzheimer's. It should be triggered if you can't perform two out of five or six activities of daily living (ADL).

What are the daily benefits for both home health care and nursing home care?
Not everyone with LTCI coverage ends up in a nursing home, so know how much both types of care cost.

How long will the policy pay benefits?
Buy coverage with a benefit period of six years or more, in case you need longer assistance.

Is this policy qualified under the Health Insurance and Portability and Accountability Act?
Premiums for “qualified” policies may be deducted on your taxes.

Does the policy have specific, guaranteed protections against lapses and reinstatements?
If your condition prevents you from paying your premiums on time, you're covered.

Can I see a specimen policy of the coverage I want?
Ask for a sample contract. Double-check what it says.