Q&A Topics

Friday, June 3, 2011 10:22:11 AM

Does a long-term care insurance policy cover Alzheimer's disease? What are the health restrictions for long-term care insurance?

Long-term care services are provided when a person is unable to perform certain “activities of daily living” or is cognitively impaired because of senile dementia or Alzheimer’s disease. Most commonly, the activities of daily living used to determine the need for services include eating, bathing, dressing, getting from a bed to a chair and using the toilet.

Alzheimer’s disease and other organic cognitive disabilities are leading causes for nursing home admissions and are a worry for many older Americans. These conditions generally are covered under long-term care insurance policies.

Today’s policies cover skilled, intermediate and custodial care in state-licensed nursing homes. Long-term care insurance policies usually also cover home care services such as skilled or non-skilled nursing care, physical therapy, homemakers, and home health aides provided by state-licensed or Medicare-certified home health agencies.

Many policies also cover assisted living; adult day care and other community-based care; alternate care; and respite care for caregivers.

“Alternate care” refers to non-conventional care and services developed by a licensed health care practitioner as an alternative to more costly nursing home care. Benefits for alternate care may be available for such things as specialized medical care and medically necessary modifications to an insured person’s home the addition of wheelchair ramps, for example. A health care professional develops the alternate care plan, which the policyholder or insurer may initiate, and the insurer then approves it.

It is your responsibility to know what your long-term care insurance policy does and does not cover. Discuss all aspects of your current and expected long-term care needs with a professional so that you have clarity, and are as prepared and informed as possible.