Long Term Care

Senior woman with long term care

Long-term care is responsible for helping you with the activities of daily living (ADL) and everyday tasks called instrumental activities of daily living (IADL). ADLs include bathing, eating, dressing, and using the bathroom. Common IADLs include housework, preparing meals, shopping, and taking care of pets.

Most long-term care is received at home. Many people stay in their homes for as long as possible with the aid of a family member or friend as a caregiver. A blended approach to receiving care works best.

There are varying degrees of control over how you receive services. Participant-directed services let you control what care you receive, who is providing it, and how and when those services are delivered. Under this arrangement, you can have a caregiver or home care service. Facility-based services will give you control over your schedule, who provides your care, and the meals you eat. In a home or community setting, you will be able to give feedback and request changes.

Paying for Long Term
Care Insurance

Medicare and most health insurance, including Medicare Supplement Insurance, also known as Medigap, don’t pay for long-term care.

This type of care includes medical and non-medical care for people who have a chronic illness or disability. Even though Medicare does not cover long-term care, it does cover home health care. Under the home health benefit, Medicare pays in full and can provide you with help if you require skilled care such as skilled nursing or therapy services.

Home health service provides personal care services, including help with bathing, toileting, and dressing. However, Medicare will only pay for this kind of service if you need skilled care explicitly, not personal care. Also, if you need skilled services or rehabilitative care, Medicare can cover up to 100 days in a skilled nursing facility.

On the other hand, Medicaid covers long-term care, based on:

  • Your income
  • Eligibility requirements
  • The level of assistance you need for activities of daily living (ADL).


Also, the rates you pay for this type of insurance can vary depending on your marital status, the richness of coverage, gender, and of course the insurance provider.

If your health insurance covers long-term care, it is typically only for skilled, short-term, medically necessary care. Even though Medicare doesn’t cover long-term health insurance, you have a number of options if you decide to purchase Long-Term Care Insurance.

If you find yourself in a financially challenging situation but in need of long-term care, it’s possible to get help paying for this from your state’s Medicaid program.

Considering long-term care costs is an important part of anyone’s financial plan, especially in your 50s and beyond which is considered to be the prime time to get long-term care insurance. Also, long-term care insurance can be very expensive so thoughtful consideration is necessary.

Keep in mind you won’t qualify for long-term care insurance if you already have a weakening condition, and long-term care insurance carriers won’t approve most applicants over the age of 75.

Long Term Care
Insurance Coverage

Insurance, specifically for long-term care, provides you with a daily benefit to use toward your care in many settings. Coverage is comprehensive and includes care in your home, adult day service centers, hospice care, respite care, assisted living facilities, Alzheimer’s special care facilities, and nursing homes.

Serves in your home can include skilled nursing care; occupational, speech, physical, and rehabilitation therapy; personal care (ADL); and homemaker care (IADL).

What long-term care policies usually don’t cover:

  • Preexisting conditions

This kind of condition implies an illness you received medical treatment or advice for six months before the date of coverage.

  • Mental and nervous disorders

Long-term care policies don’t cover some of these types of disorders. However, they must cover any age-related disorders such as schizophrenia, major depressive disorders, and Alzheimer’s disease.

  • Care by family members

Most long-term care policies won’t pay your family members to take care of you with the exception of the possibility of paying for their training that enables them to be caregivers.

Long-term care
insurance eligibility

To receive your benefits from long-term care insurance, you must have passed the Elimination Period and meet criteria called the Benefit Trigger. A company-sponsored nurse or social worker will assess your capacity to perform activities of daily living (ADL) or evaluate your cognitive impairment.

You meet the Benefit Trigger if you need help with 2 or more ADLs. Once you meet the trigger, your elimination period starts, which acts like a deductible. This period will be 30, 60, or 90 days.

After this point, your insurance company will pay your costs up to a pre-set daily limit. Some policies have a pre-set cash amount that they will pay you for every day you meet the benefit trigger. The maximum they will pay is either a defined limit or the number of days they will cover you.

There are no age requirements to purchase long-term care insurance. In case one is thinking of getting this type of insurance it is advisable to purchase it in their 50s to mid-60s.

When you start the process of purchasing long-term care insurance it is wise to get quotes from several insurance companies for the same coverage to compare prices and then make a decision.

Is long-term
insurance for you?

To help you decide whether long-term care insurance is right for you, it would be smart to consider your health, assets, income, and how important it is for you to secure yourself with appropriate care and insurance.

In general, it would be wise for everyone to at least consider getting long-term care insurance as the future is uncertain and health maintenance is extremely important especially as you get older.

Also check what Medicare doesn’t cover.

Since long-term care insurance can be expensive, you shouldn’t rush into it and get the first policy you lay your eyes on but rather take the time to research your options as well as reflect on your health needs, resources, overall financial situation, and priorities as well as your ultimate financial goals.

Texas Medicare Advisors offer free consultations to get you started with creating your own plan concerning long-term care insurance.

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You may not qualify for this type of insurance if:

  • You already use long term care insurance
  • You already need help with activities of daily living (ADL)
  • You have AIDS
  • You have dementia
  • You have a progressive musculoskeletal condition (such as MS or Parkinson’s)
  • You have a history of strokes
  • You have metastatic cancer


Contact Texas Medicare Advisors to learn more about long term care insurance and if it best fits your coverage needs.

Qualifying for
Long Term Care Insurance

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