Tips on buying long term care insurance

Patricia Hafermann • Benefit Specialist

Check on the agent selling the policy.

You can check with the Office of the Commissioner of Insurance (OCI) to see if an agent is licensed (https://ociaccess. oci. wi. gov/ ProducerInfor/ PrdInfo.oci). It is a good idea to work with a local agent who will be available to help file claims and answer questions. Feel free to ask the agent how long he or she has been an agent, as well as the names of other companies the agent represents. Check with friends and neighbors for the name of a good agent and try to schedule an appointment in the agent’s office.

Try to compare several policies.

Contact several companies and agents before you buy a long-term care insurance policy. A list of long-term care insurance policies currently being sold in Wisconsin is available from the Office of the Commissioner of Insurance (OCI). OCI publishes two booklets to help you in making your decision about long-term care insurance. The Long-Term Care Insurance Policies Approved in Wisconsin booklet lists individual, group and tax-qualified long-term care insurance policies, nursing home policies and home health care policies approved for sale in Wisconsin; and also includes benefit information and sample premiums. The Guide to Long-Term Care explains different types of long-term care insurance and the types of policies sold in Wisconsin to cover long-term expenses.

Call the Medigap Helpline at 1-800-242-1060.

This is a nationwide toll-free number that has been set up by the state to answer questions for the elderly concerning health insurance.

Check with the Office of the Commissioner of Insurance (OCI) to find out whether there have been any administrative actions taken against the company or the agent (https://ociaccess.

Take your time.

This is not the type of purchase you should make without considering all your options and making sure that you need and can afford the insurance. Do not let anyone pressure you into making a quick decision. Use the Guide to Long-Term Care to assist you in making your decision. You can also obtain a copy of the Long-Term Care Insurance Approved Policies in Wisconsin booklet that provides information that will allow you to compare long-term care insurance policies offered in Wisconsin.

Don’t be misled into thinking that your medical history is not important. You should answer all the questions on the application completely and accurately. If an agent fills out the application for you, you should read it and make sure the application is accurate before you sign it. If you sign an application that includes incorrect or incomplete information, the insurance company may refuse to pay your claims and can cancel your insurance policy.

Questions to Ask the Selling Agent:

What type of policy is it and what coverage does it provide? Is the policy considered a longterm care, nursing home only, or home health care only policy?

What types of facilities or providers are eligible to provide the care covered by the policy? Are these facilities and providers available in my community?

How long will the benefits last?

How much will the policy pay each day?

Does the policy have elimination periods before benefits begin? How long are they?

Are there preexisting condition limitations?

What is the cost of Nonforfeiture benefits? Inflation protection? Waiver of Premium?

What happens if I don’t pay my premium?

What conditions are not covered by the policy?

What number of Activities of Daily Living (ADLs) must be deficient?

Is the policy a “tax-qualified” policy?

Whom do you contact if you have questions about coverage or if you need help filing a claim?

Free-Look Periods

Policies must include a “freelook” period. You will have at least 30 days from the time you receive the policy to look it over and decide if you want to keep it. If you decide to return the policy to the company within the “freelook” period, you will receive a full refund of your premiums.

However, if you decide to keep the policy, be sure that your application is correct and complete. The application is part of the policy.

Do not be misled by advertising

Don’t be misled by the endorsements of celebrities. Most of these people are professional actors who are paid to advertise insurance policies. They are not insurance experts.

Be wary of cards received in the mail that look as if they were sent by the federal government

They may actually have been sent by insurance companies trying to find potential buyers. Be skeptical if you are asked questions over the phone about Medicare or your insurance. Any information you give may be sold to insurance agents who will call you or come to your home.

Don’t over-insure

It is not necessary to buy several policies. One good long-term care insurance policy, which covers both institutional and community based care, is enough.

Be careful about dropping one policy to buy another

Before you buy a new policy, be absolutely sure that it is better than the one you already have. If you switch policies, you may be subject to new preexisting condition waiting periods or have other restrictions placed on your benefits. However, if you replace your policy and there is no lapse in coverage, the time you were covered under one policy counts toward meeting the preexisting condition waiting period under the new policy.

Never pay an agent in cash

Pay by a check made payable to the insurance company.

Be sure to get the name, address, and telephone number of the agent and the company.

Obtain a local or toll-free number (if the company has one) so you can contact the company.

If you don’t receive your policy within 45 to 60 days, contact the company or agent.

Review your policy carefully

If you have questions about your insurance policy, contact your insurance agent for clarification. If you still have questions, contact the Office of the Commissioner of Insurance or the Board on Aging and Long-Term Care.

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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