A Beginner’s Guide to Long Term Care Insurance in Pennsylvania for Home Care

A Beginner’s Guide to Long Term Care Insurance in Pennsylvania for Home Care

 

Long-term care insurance is insurance coverage that will pay for assisted living, nursing home care or home health care in the event you are unable to care for yourself because of a chronic condition or disability.

Only about 7 to 9 million Americans have purchased these policies, and this coverage pays for only about 12 percent of the nation’s long-term care costs. But for those who are receiving benefits, it is clearly an important asset. Below are the most frequently asked questions about long term care insurance that should give you a better understanding of long term care. 

What is long term care insurance?

Long-term care insurance is an optional product that can be purchased that is intended to fill a gap in paying for long-term care needs. The policy is purchased at an age where you are healthy and in which you can afford the premiums (and that also makes financial sense). A long-term care insurance policy helps cover the costs of care when you reach a point in life that you need assistance due to cognitive and/or physical decline or other chronic conditions and when benefits are available. Most policies will reimburse you for care given in a variety of places, such as:

  • Your home.
  • A nursing home.
  • An assisted living facility.
  • An adult day care center

 

Who provides long term care insurance?

There are many different providers of long term care insurance. The most common long term care insurance providers are:

  • Mutual of Omaha
  • Transamerica 
  • MassMutual
  • New York Life
  • Pacific Life
  • Lincoln Financial
  • Genworth
  • State Farm
  • Northwestern Mutual
  • Nationwide Life


Does it matter which company I choose?

Definitely. It really depends on what you value, but each company and plans within them have varying levels of coverage and needs to fit different situations. Price is certainly one major factor to consider. Your individual circumstances and situation are very personal and unique and your coverage and premiums paid will depend on those varying factors. 

Others could include a difference in services offered or included, flexibility in policies, accessibility and elimination period differences, and benefit period differences. Don’t forget to consider the level of customer service offered and the simplicity or complexity of the policy as that may be an important consideration.

What does long term care insurance cover?

Most policies sold today are comprehensive. They may cover at-home care, adult day care, assisted living facilities, and care in nursing homes or other specialty care settings such as alzheimer’s or dementia care facilities. At home, care can include occupational therapy, rehabilitation, or nursing care. It also includes personal care and other non-medical home care services such as activities of daily living (bathing, dressing, grooming, etc.) in the form of home health aides, caregivers, and personal care aides


Finally, policies can include short-term hospice care for those that are terminally ill and also respite (temporary) care to give needed breaks to family caregivers, usually for periods of 14 to 21 days.


Why should I get long term care insurance?

There are various motivations and factors for wanting to receive long term care insurance but the following three reasons sum up the main benefits of long term care:

  1. You will have the ability to access care rapidly: by having long term care, you will have the funds available immediately to access it. Medicaid and government waiver programs are an option, but you must meet eligibility criteria first before accessing it and application periods can be long.
  2. You can have a long and costly claim period: you may end up with care needs over a long period of time or with intensive needs. With each, costs will be very high and can quickly drain assets and bank accounts. 
  3. You have freedom of choice in providers and decision-making: Unless you have substantial resources, you will inherently have fewer choices when it comes to dictating your own care. Long term care insurance can help to provide you with additional resources to give you the flexibility of choice among providers and care options. 

 

How much does it cost?

That’s a difficult question, as costs (and coverage) can vary dramatically between plans. It also is hugely variable depending on age. As you may imagine, a long term care policy initiated at age 70 will be dramatically more expensive than a policy that commences at age 45. This 2019 national long-term care price index is a handy guide comparing prices in several different scenarios for those starting coverage at age 55 as well as the benefits received at different ages. Remember, when comparing plans, don’t forget to focus on the amount of benefits received. The cheapest plans might not have the best level of coverage or fit one’s individual needs. Additionally, one provider who has the best rates for someone starting coverage at age 55 isn’t necessarily going to be the most competitive for someone commencing coverage at age 65. 

 

How much in care will long term care insurance cover?

Traditional long term care insurance policies include a daily benefit of $160, a three month waiting period before insurance kicks in, and a maximum of three years. Again, it must be repeated that plan details can significantly vary between plans, so study up and understand the differences. Whole life insurance policies are becoming much more popular which allow long-term care costs to be drawn from in the case of long-term care needs. These hybrid policies can even return money to your heirs if you don’t end up needing long term care. Another benefit to these types of plans is that your rate is locked in and isn’t subject to rate hikes from long term care insurance providers. That being said, a stand alone long term care policy will be much cheaper and more cost effective than a hybrid life insurance policy. Consider for yourself if the trade offs in flexibility are worth the additional costs if you are pondering a hybrid life insurance policy.

 

Doesn’t long term care insurance only cover nursing homes?

As previously mentioned, long term care covers much more than just nursing home care. This deserves special mention because common belief is that long term care only covers nursing homes. To repeat, long term care can cover at-home care services that assist with activities of daily living through a home health aide or personal care aide and caregiver plus skilled care such as an occupational therapist or nursing needs. Also, it can cover many other services like adult day care and assisted living. 

What is an elimination period?

You may have seen the term “elimination period” come up when reviewing long term care policies or terms. An elimination period is basically a waiting period before benefits kick in.The elimination period on a long-term care policy works like a deductible: It’s the number of days you pay for care yourself before the policy pays out. Typically, an elimination period is 90 days. Other plans may offer different elimination period options, such as 30 or 60 days. Some may have no elimination period at all, but these are normally reserved for short-term care insurance policies.


Can I get long term care insurance if I need it soon (or now)?

Possibly, but it’s likely that it won’t make sense. For starters, if you have urgent or near-term needs for long term care, you will likely be denied coverage outright. If you wait to start coverage at an advanced age and are approved, your premiums will often be cost prohibitive or not make financial sense in evaluating the overall pros and cons of coverage. 


At what age should I get long term care insurance?

You should consider long term care insurance coverage when you are young. Just like life insurance or health insurance, premiums increase with age. That is because if you are older, your policy is considered to be higher risk (and premiums will be adjusted accordingly). For example, if you start a policy at age 45 versus age 60, you could save $440 a year on premiums for a standard policy of 3 year terms. As mentioned previously, the longer you wait, the risk also increases that you will be denied coverage altogether. 

How do I find home care agencies or nursing homes that take my long term care insurance?

Unlike finding a doctor that accepts one’s health insurance, long term care insurance is different. For example, doctors and providers join health insurance networks, must be qualified through credentialing and other means, and will be considered in network or out of network. To find a provider that accepts your long term care insurance, one will simply need to determine if that accept long term care insurance. Long term care insurance will allow you to select the provider you wish as well, so just make sure to determine first as to whether your preferred provider accepts both long term insurance and, if applicable, the insurance company paying out the long term care policy. It’s not always clear if a company accepts your policy upfront, so when in doubt, ask. Chosen Family, for example, accepts all major long term care insurance plans. 

Doesn’t Medicare or Medicaid already cover long term care?

Medicare does not generally cover long-term care. Medicare will only pay for care at home under very limited circumstances.

Medicare does pay for skilled care in a nursing home only for short periods (up to 100 days) during which you are recuperating following a hospital stay for a related condition, but that’s not the same as long-term care. Once your care needs stabilize and you need personal or custodial care, Medicare will not pay those costs.

Medicaid may cover long term care, but you must qualify for waiver services by meeting financial and clinical criteria. Read our blog about Medicaid waivers in Pennsylvania and greater Philadelphia here for more information.

Where can I buy long term care insurance?

Most people buy long-term care insurance directly from an insurance agent, a financial planner, or a broker. Keep in mind that:

  • Pennsylvania regulates which companies can sell long-term care insurance
  • Pennsylvania regulates the products that companies can sell
  • There are more than 100 companies offering long-term care insurance nationally, but 15 to 20 insurers sell most policies (some of the most common listed above)
  • Find out more about long term care insurance through the Pennsylvania Insurance Department’s page here.

 

Different than traditional health insurance, long-term care insurance is created to cover long-term services and supports. It includes and covers care in a variety of settings such as your home, a facility or institutional care, or other community setting. 

These policies will reimburse policyholders a daily amount of money, up to a specified limit, for services to assist them with activities of daily living such as bathing, dressing, and eating.  You can select a range of care options that allow you to get both the services you need and where you need them.

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