How To Compare Long Term Care Insurance | Get Free Quotes and Information From an Expert Agent |
Long-term care insurance policies vary considerably and cover levels of nursing home care beyond the limited scope of Medicare for varying periods of time. There are policies that provide home care benefits which may be used after a patient has met any required elimination period for home care. You should review policies very carefully. Some of the major factors you should review in comparing policies are outlined in the following paragraphs: Payments for Services A policy usually pays a fixed amount per day (e.g. $20, $40, or $60 a day) while you are in a nursing home or personal care facility. However, actual charges for nursing home care may vary from $50 to $100 per day depending on the type of care required and the accommodations. Some policies will vary the amount paid per day according to the type of care required; however, the amounts for the different levels of care may not be unreasonably lower than the coverage provided for skilled nursing care. When Benefit Payments Begin Some long-term care insurance benefits begin on the first day of a skilled nursing home stay or when Medicare skilled nursing benefits end, or when the elimination periods have been satisfied for other levels of care. The number of days for which an insured must pay before the policy begins to pay benefits is the elimination period. Policies that pay benefits beginning on the first day are more expensive than policies providing benefits after a longer elimination period expires. In reviewing policies, you should bear in mind that you could be in and out of a nursing home in less than 100 days. Policy Restrictions All policies include some restrictions. You should review each policy carefully to identify the policy limitations. The most common restrictions are listed below: Prior Hospitalization: Some long-term insurance policies require 3 days prior hospitalization before the insurance will pay for skilled nursing home care if you have elected that option. Such policies have the requirement that nursing home care be for the same injury or illness that caused the hospital confinement. This is to assure that the reason for skilled nursing home admission is an underlying medical need for care. At your option, the policy may not require a prior hospitalization before skilled nursing home benefits are payable. Other Prerequisites for Specific Coverage: In Georgia, long-term care policies may not require a minimum period of skilled nursing care before a patient is eligible to receive intermediate, custodial, or home health care benefits. Those policies that cover home care can require the satisfaction of an elimination period before the home care benefits are payable. Preexisting Condition: No long-term care insurance policy or certificate shall use a definition of 'preexisting condition' which is more restrictive than the following: Preexisting condition means the existence of symptoms which would cause an ordinarily prudent person to seek diagnosis, care, or treatment, or a condition for which medical advice or treatment was recommended by or received from a provider of health care services, within 6 months preceding the effective date of coverage of an insured person. No long-term care insurance policy may exclude coverage for a loss or confinement which is the result of a preexisting condition unless such loss or confinement begins within 6 months following the effective date of coverage of an insured person. This means you would not be covered for preexisting conditions unless the loss or confinement resulting from such condition begins after 6 months following the effective date of the policy. Some policies may offer shorter waiting periods. Preexisting conditions are an important consideration, particularly if you are in poor health. Physician Review: Another common requirement is that a physician must review nursing home or home care utilization to determine if it is necessary for the well-being of the individual, rather than for the convenience of the individual. Benefits are usually not payable if the physician is a member of the covered person's immediate family. | Health Status: When you apply for long-term care insurance, you are usually asked questions designed to screen out those people who are considered to be too great a risk for the insurance company. These questions usually relate to your health status, prior hospitalization and nursing home confinements. Each insurance company has its own standards for evaluating answers to these questions and determining eligibility. Age: The risk of being admitted to a nursing home increases rapidly after 75. Some insurance companies will not offer long-term coverage to persons older than 80 or 82. Exclusions: Further limiting the coverage under long-term policies are the following exclusions under which the policy will not pay:
The mental or nervous disorders exclusion is particularly important to the elderly because of the high prevalence of mental disease. Alzheimer's disease and other related disorders. Long-term care insurance policies may only exclude coverage for mental disease and disorders which are not related to a disease physically affecting the body. Long-term care insurance policies must provide benefits for persons diagnosed with Alzheimer's disease and other organic brain disorders (since these conditions affect the brain and are considered to be organic in nature). Types of Facilities Covered: Long-term care policies require that nursing care be provided in a setting other than an acute care unit of a hospital, but most provide skilled, intermediate, and custodial care. The following facilities provide various types of nursing home care in Georgia.
What Should You Expect to Pay for Long-Term Care Insurance? Cost varies depending on the company, the policy benefits, and your health and age. Personal care and home care benefits will add to the cost. Higher or lower ages and/or higher or lower benefits will affect the cost accordingly. Use the Long-Term Care Insurance Checklist to compare the benefits and costs of different long-term care policies. Waiver of Premium After skilled, intermediate, or custodial care benefits have been paid under the policy for not more than 90 consecutive days, premiums becoming due thereafter shall be waived while you are institutionalized. Premium payments shall resume on the first premium due date on or following the date the payment of benefits ceased. How Do You Decide What to Buy? |
