Long-term care insurance (LTCI) is a specific insurance product sold in the U.S., Canada, and the United Kingdom that insure against the expenses associated with prolonged nursing care. Long-term care insurance usually covers routine nursing care, not covered by Medicare, Medicaid, or health insurance. For most states, you must obtain a qualified health care provider to accept the insurance and the premiums are generally paid directly from the insurance company.
There are two types of policies available, permanent health care insurance or Medicare supplement insurance for long term care, and a non-qualified health maintenance organization (HMO) type policy. A qualified health care provider is a licensed nurse practitioner (LPN), physician assistants (PAs), certified nurse midwife (CNM), or certified nurse practitioner (CNP) who accepts Medicare and has a doctor’s order for an LPN exam.
Some states require you to obtain LTCI coverage on an individual basis and some states require you to have it on your home-based policy. The benefits of having this type of insurance vary from state to state; the rates vary as well. For example, the premiums for LTCI are generally higher in states like Alaska, Hawaii, and some of the District of Columbia.
LTCI is the right insurance policy if you or someone else in your family needs to have long-term care. You do not need to pay all the costs right away because it is unlikely that you will need long term care at the same time.
LTCI is a good alternative to Medicare and Medicaid as a way to insure against long-term care. There are other options for long-term care insurance including a self-employed person’s health plan, a group health plan, and a health savings plan.
There are two main types of LTCI policies, health maintenance organizations (HMO) and preferred provider organizations (PPO). Most states require you to have health insurance through your employer if you are self-employed or part of a group health plan, but if you are self-employed, you may need to get a separate LTCI policy from the insurer you choose to be eligible for coverage.
If you are over 65 years old, you may qualify for Medicare supplement insurance through Medicare Part A and/or Part B depending on whether you are eligible for Medicare Parts A or B, respectively. In addition to this you may also be eligible for Medicaid, if you meet certain income requirements. And are a resident of one of the 50 states or the District of Columbia. Your health care provider can determine eligibility for Medicaid.
There are some people who are unable to afford to get nursing home care or to pay the cost of continuing nursing home care because of their medical condition, or for other reasons, such as a pre-existing condition. Long-term care is sometimes expensive to manage; however, when your need for it becomes urgent, it is often possible to use LTCI to pay the costs. Long term care insurance is not a perfect substitute for a skilled nursing facility. It is a good supplement to a comprehensive health care plan.
Long-term care insurance may be an option when you become unable to perform basic daily activities because of a terminal illness, or from injuries that have resulted from an accident. If you have an underlying condition, you should see your health care provider about the possibility of obtaining long-term care coverage. Often your health-care provider can help you select an appropriate LTCI policy.
You can obtain LTCI through an HMO or PPO, or they may be purchased separately. The most common long-term care plans are HMOs and PPOs. The benefits vary widely among health care providers, but in general you can expect to pay a monthly premium, copayment, or deductible for coverage and cover up to 100% of the total cost of long term care in your area.
Long-term care insurance has many benefits. Most LTCIs provide coverage for rehabilitation, medical care services, nursing home care, home health care, prescription drugs, and extended hospital stays.
LTCIs can also cover emergency room visits, prescription medications, surgeries, physiotherapy, rehabilitative therapy, and long-term services, and even dental care. You should be aware that there are many restrictions that apply to your coverage, so talk to your provider before you decide on this type of coverage.