What expenses does long term care insurance pay for?


It really depends on the long term care insurance policy that you got, since the coverage may be designed to suit your unique needs.

Here are some of the things that can cover:

  • Long term health care facilities. This may include the fees charged by:
    • a nursing home
    • an assisted living facility
    • a home health care service
    • hospice care
    • respite care
    • adult day care - this refers to a facility that provides not just therapeutic or nursing care, but also assistance towards social activities and supervision.
    • Care provided after a surgery or hospital stay
    • Special needs facilities - these cater to patients with special needs, such as those with Alzheimer's

    Please note that for these facilities, the insurance company has set some minimum standards as to the facility's licenses, as well as the licenses of the people working there. Not all policies will pay for all these facilities. There are some policies that are especially dedicated to cover a specific long term health care facility, i.e. a policy is sold to cover fees for a nursing home.

  • Money to pay from training a family member in caregiving
  • Money to renovate the house in order to install adaptive equipment

It is best to check the benefits listed in the policy, as well as the benefit amounts. Long term health care facilities may be paid in varying amounts and may also have different payment periods.

The insurance may provide monthly, weekly or daily limits. There are also some one-time payments for major purchases, such as the installation of communication devices suited for the client's needs.

The insurance will not pay for the following:

  • Care provided for injuries or medical conditions that are self-inflicted, resulting from alcohol or drug abuse or resulting from wars or acts of war
  • Services that are given for free
  • Services that are given by a family member who is not under the employ of a facility that provides care, service or treatment.
  • Fees for treatments from a government facility
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