What Does Long-Term Care Insurance Cover?

What Is Comprehensive Long-Term Care Coverage?

Comprehensive long-term care insurance pays for the services you need for long-term care, including on-going health and personal support, such as nursing or therapeutic care, or personal assistance with daily activities such as bathing and dressing. Some policies will also include homemaker services, such as meal preparation or laundry duties.

You can use your benefit payment in a variety of ways to cover services you receive.

Where Can You Receive Long-Term Care?

• In your own home
• In an assisted living residence
• At an adult day services center
• At a nursing home
• In facilities offering hospice or respite care
• Specialized centers for specific services such as Alzheimer’s care

Rather than paying for medical treatment by doctors, long-term care benefits provides extended health care support and services one needs to perform the activities of daily life.

When planning on how to pay for long-term care, it is important to understand what long-term care insurance will and will not pay for. Be sure to gather all these details from a professional before purchasing a policy.

Daniel J. Adams, MBA, CFP®, CLU®Founder and President of CEG Life Insurance Services

As the founder of CEG Life Insurance Services, Daniel J. Adams has extensive experience with life and health insurance products. Daniel assists clients in building a secure financial future as a Certified Financial Planner™ professional and independent insurance agent. He also trains new agents and advises other financial professionals.

Coverage of Home Care and Assisted Living Facilities

Long-term care insurance covers the services you receive at home and/or in an assisted living facility.

For example, if you suffer from an injury but remain in your home, long-term care insurance will cover professional services such as occupational therapy while you recover, along with personal care such as aid with getting dressed.

If you reside in a nursing home, your LTC insurance will cover custodial care, which is personal support to help you with the basic activities of life such as eating, bathing and toileting.

Services your insurance will cover (but are not limited to) include:

• Professional nursing care
• Rehabilitative or other therapy care (i.e., occupational, speech, etc.) 
• Personal care services, such as bathing and dressing assistance
• Other nursing home costs

Coverage of Hospice Care

Hospice care is the service provided to people who are terminally ill. Hospices aim to make individuals comfortable, rather than improve or prolong their lives. 

Since it is considered short-term treatment, hospice care is not covered by every long-term care policy. However, if you have Medicare Part A and a terminal diagnosis with a life expectancy of six months or less, Medicare will cover the cost of hospice care.

Coverage of Respite Care

Respite care is temporary care that provides a valuable break for primary caregivers. The duration is typically short — no more than two to three weeks per year — and it allows hardworking caregivers a little time off to tend to their own needs.

Depending on the situation, respite care can be provided at home, in an assisted living facility or at a nursing home. The type and level of care will depend on the individual’s needs, and it may include any of the usual health or custodial support services, or homemaker services such as meal preparation or household chores.

What Long-Term Care Insurance Doesn’t Cover

Long-term care insurance may not cover health and/or custodial services provided by family members. It will also not cover the costs of services that are strictly medical in nature. Medicare, or private health care plans, cover medical costs. 

Many policies will have limits on the amount of coverage they offer. Depending on the policy and carrier, it might be a time limit (i.e. five years), or it might be a specific dollar value. In addition, if you have been diagnosed with a pre-existing condition, you may not be eligible for long-term care insurance.