Long-term care insurance frequently asked questions

GOOD TO KNOW
Patricia Hafermann • Benefit Specialist

Does Medicare cover longterm care services?

Medicare provides only limited coverage for long-term care related primarily to recuperating from a sickness or injury. Medicare pays only for skilled nursing care and medically necessary services. You should not rely on Medicare to pay for your long-term care needs.

Can my premiums be increased?

Yes, premiums for all long-term care insurance policies may be increased. However, if premiums are based on issue age, they may increase only if premiums are increased for all individuals insured under the same type of policy. If premiums are based on attained age, premiums will increase as you age.

Can the insurance company cancel my long-term policy?

No, your policy is guaranteed renewable for life. The policy may terminate only when you cease paying your insurance premiums or if you use the maximum amount of benefits available under the policy.

Are preexisting conditions covered under long-term care insurance policies?

Preexisting conditions must be covered by long-term care insurance policies. However, insurance companies may have a preexisting condition waiting period of up to six months. After your policy is in effect for six months, it will pay for covered benefits. However, if you have preexisting medical problems at the time you apply for coverage, the insurance company is not required to accept your application or to issue coverage.

Are Alzheimer’s and other dementias covered by long-term care insurance?

Alzheimer’s disease and other dementias are required to be covered by long-term care policies. However, if you have Alzheimer’s or other dementia at the time you apply for coverage, the insurance company is not required to accept your application or to issue coverage.

What is an elimination period?

An elimination period is similar to a deductible. This means that when you begin using long-term care services, there is a waiting period before the policy begins paying benefits. You are responsible for paying for all expenses during the elimination period.

Are benefits paid for all institutional settings, such as community based residential fa- cilities (CBRFs), assisted living facilities, and residential care facilities?

Long-term care policies pay only those benefits described or defined in the policy. Some policies pay for assisted living facilities, some do not. Most policies do not cover CBRFs or other placement. Read the definitions in your policy carefully.

How much does a stay in a nursing home cost?

The costs of nursing home care vary among facilities and locations. You should contact those facilities that you would consider acceptable and ask about their current daily charges. You can then determine the amount of coverage you will need.

If you have any additional questions, you may call Pat Hafermann, Elderly Benefits Specialist with the Aging and Disability Resource Center at (920) 467-4076.

Resource: Published with permission from the Legal Services Team at the Greater Wisconsin Agency on Aging Resources’ Elder Law & Advocacy Center


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