Eligibility for Long-Term Care Insurance
Many insurance companies have the right to deny your application for long-term care insurance if you answer yes to any of the following:
- Currently already use long-term care services
- Already need help with one or more of six basic activities of daily living (ADL): eating, bathing, dressing, toileting, walking and continence
- Have AIDS or AIDS-Related Complex (ARC)
- Have Alzheimer's disease, a form of dementia, or other cognitive dysfunction
- Have a progressive neurological condition, such as multiple sclerosis or Parkinson's disease
- Had a stroke within the past 1–2 years or have a history of strokes
- Have a form of cancer that has spread beyond its original site
The Cost of Long-Term Care Insurance
Long-term care insurance can be bought from an insurance company or through an agent, and some employers offer long-term care coverage that can be purchased from the company's insurance provider at a group rate.
The cost of long-term care policies are based on a few key factors:
- Age – Coverage costs less the younger you are at the time you buy the policy.
- Gender – Generally women pay more than men because they typically live longer and thus are more likely to make a long-term care insurance claim.
- Marital Status – Premiums are lower for married couples than for single people.
- Daily Allowance – The maximum dollar amount that a policy will pay per day.
- Policy Term – The maximum number of days or years that a policy will pay.
Be aware that the premium costs could go up after a policy is purchased. Prices are not necessarily guaranteed to stay the same.
As long-term care insurance policies vary in their benefits, it's worth taking the time to shop around to find the best policy that fits your needs and budget. You can find out which insurance companies offer long-term care coverage in your state by contacting your state's Department of Insurance.
Receiving Long-Term Care Benefits
Having a long-term care insurance policy means being equipped to receive help with the personal care needs that can arise with aging, but it's possible that some services won't be covered. Just as you have to qualify for buying long-term care insurance, you also have to qualify to receive the payouts from your policy.
Eligibility for Receiving Long-Term Care Benefits
Eligibility to receive long-term care benefits is a two-phase process:
- Benefit Trigger – An insurance company will assess your physical condition and health to determine if you need to receive benefits. Most policies will determine that you qualify for receiving benefits if you need help with two or more of the six ADLs, or at the onset of a cognitive impairment.
- Elimination Period – If your benefit trigger is confirmed and you've received an approved Plan of Care from your insurance company, you'll have to wait either 30, 60, or 90 days before you start receiving payments for long-term care services. The elimination period is also a factor in determining the cost of your long-term care insurance. A longer elimination period will cost you less than a shorter elimination period.