Not all long-term care insurance policies are alike. Unfortunately, some policies were underwritten prior to when assisted living became a care category and thus are silent on whether the policy covers assisted living or even dementia care. Most long-term insurance policies purchased within the last 20 years offer coverage for assisted living in one of two forms, an agreement to pay costs up to a maximum daily rate or a daily rate regardless of the actual costs of care. In most of these policies, coverage is triggered when the insured demonstrates the need for two or more activities of daily living or has significant cognitive impairment.
Activities of daily living include in most policies bathing, dressing, continence, toileting, eating and transferring. Policy language may include references to hands-on or standby care. The requirement of hands-on care has significant implications on a coverage trigger as many older adults are able to perform daily living activities but inconsistently and often poorly unless guided by a caregiver. Our staff will advocate for coverage especially in situations of erroneous denials of coverage.
Another form of long-term care insurance is a hybrid long-term care-life insurance policy. This product is very helpful to seniors who remain very active and healthy, but are interested in hedging the bet that eventually they need long-term care because unlike traditional long-term care insurance, the funds they place into the product remains within their control. Independent residents at a senior living community may be candidates to purchase such financial instruments as there is an underwriting criteria but not as extensive as traditional long-term care insurance. This product is appropriate for persons who want to receive a rate of return on premiums, while taking advantage of the morbidity credits available for buying into a pool. (The theory is for every 5 people who access the long-term care benefit, 20 will not, giving you more benefit.) If you do not ever use funds you invested into the financial product, the funds also act as whole life insurance.