How Does Long Term Health Care Insurance Work?

Long term health care insurance is a type of insurance that pays for long term care services in many settings, such as at home, a nursing home, assisted living facility, or adult day care facility. It goes beyond normal health insurance, covering expenses not covered under private health insurance, Medicare or Medicare supplement policies.

It works like this: You apply for coverage. If you are accepted, then you begin paying your premiums. Later, if you need long term care, you will be reimbursed for covered long term care up to the amount of coverage you bought. You may be responsible for an initial period of care, depending on your policy. Most policies require you to pay for the first 30, 60 or 90 days of care, called the elimination period. Different plans have different options for type and length of care, daily dollar amount, inflation protection, and length of elimination period.

You become eligible to receive benefits once a doctor certifies that you are unable to perform certain “activities of daily living” (ADLs), or are cognitively impaired because of senile dementia or Alzheimer’s disease. Most commonly the ADLs used to determine the need for services include bathing, dressing, transferring (getting from a bed to a chair), toileting, eating, and continence.