Q&A Topics

Friday, April 1, 2011 10:58:01 AM

What does long-term care insurance cover? And what does long-term care insurance not cover?

Long-term care insurance policies typically cover care and services needed in various long-term care settings. These may include:

• Your own home, with services such as skilled nursing care or physical, speech, occupational or rehabilitation therapy. It also covers the services of an aide to help with your daily activities, such as personal care, bathing, dressing and feeding. The policy also may pay for a helper who shops, does laundry, prepares meals or assists with other household needs.

• Daytime health care centers for adults.

• Care provided to give time off to primary caregivers.

• Hospice care.

• Recovery benefits following a stay in a hospital or other care facility.

• Assisted living centers.

• Centers that specialize in dementia care and Alzheimer’s disease.

• Nursing homes.

The policy also may include the hiring of a geriatric care manager to coordinate long-term care services.

Long-term care insurance does not cover:

• Care or services provided by a family member who usually wouldn't be compensated. There are exceptions, but the specifics have to be worked out with your long-term care insurer.

• Care or services provided outside the United States or its territories. If you know that this may be an issue because of travel or retirement plans outside the United States, there are policies that may cover this contingency. However, the additional cost would need to be built into the long-term care policy.

• Services that normally would not be paid for.

• Accidents or care needs related to war.

• Any intentionally self-inflicted injury or suicide attempt that causes harm or injury. It makes no difference whether this person is declared sane or insane.

• Services or care connected to drug addiction or alcoholism. The only exception would be an addiction caused by prescription medication that was administered by your doctor.

• Treatment provided in a government-run facility.

• Services available through Medicare or other government programs (except Medicaid), or any state or federal workers' compensation program.

Any long-term care insurance policy needs to be studied carefully so that both your current needs and anticipated needs will be covered. Keep in mind that a long-term care policy will not pay for creature comforts such as a TV in your room at a long-term care center, a haircut or a manicure. The policy is meant to cover your basic needs.

It's difficult to think about long-term care needs and look toward the future, but the best time to figure this out is while you're healthy and rational and before you’re in the midst of a serious situation.