What kind of senior care does long term care insurance pay for?
Long term care insurance policies typically pay out a daily benefit amount, which can be used to pay for care at nursing homes, assisted living facilities, hospice care, respite care, adult day service facilities, or at-home healthcare services.
A “benefit trigger” must occur before LTC benefits are paid out to policy holders. Benefit triggers include:
- Patient has been diagnosed with a chronic condition and has received care which is diagnostic, preventice, therapeutic, or rehabilitative
- Unable to perform a minimum of two ADLs
- Care is expected to last at least three months
- LTC insurance deductible is met, which can either be a dollar amount or a time period deductible, which is known as an elimination period and can be 90 days or longer
HIPPA defines guidelines for which conditions are considered chronic conditions eligible for LTC. Long term care insurers pay out benefits after a medical professional performs physical or cognitive tests and determines that the patient is chronically ill and unable to perform Activities of Daily Living.
Last updated: January 12, 2023