YOU ASK:

What does long term care insurance cover?

WE ANSWER:

Long term care insurance covers the expenses needed in the care of an individual due to a medical impairment or disease. This insurance pays a daily or monthly benefit for this purpose. There are also policies that pay a lump sum for the insured to spend at his discretion.

Long term care insurance usually covers expenses related to caring for a person who cannot perform certain day to day activities such as going to the bathroom/toileting, bathing and dressing, moving around (from chair to bed and vice versa), eating and controlling one's bowel movements.

The policies cover expenses related to:

  • Custodial care in nursing home
  • Home care services (either skilled or unskilled)
  • In-home nursing care
  • Homemakers and caregivers
  • Physical therapy
  • Assisted living
  • Home health aides and home health agencies that are either licensed by the state or are Medicare-certified
  • Adult day care
  • Alternate care provided in the community
  • Salaries for a person who is a member of the household and acts as the caregiver

Again, this depends on the policy. There are policies that cover care given in assisted living or nursing facilities only.

The diseases covered under long term care insurance include:

  • Heart disease (myocardial infarction or heart transplant)
  • Alzheimer's disease
  • Multiple sclerosis
  • Cancer
  • Kidney failure
  • Major organ transplant

Please note that most policies will have their own list of covered impairments and will have specific definitions on what instances these impairments will be covered and payable. The usual requirement is that the covered disease must be life threatening.

For instance, for a specific type of cancer to be payable, it should be the kind that is not just physically debilitating but also medically-proven to be life-threatening and will necessitate long term care. In the case of heart disease, a heart transplant, a stroke that results in tissue death or scarring, as well as a blockage that keeps the efficient flow of blood to the heart is considered payable. However, an angina is not.

The policy will, however, not cover specific some conditions, such as drug abuse, alcoholism, some nervous and mental disorders and self-inflicted injuries. The policy will also not cover pre-existing conditions, or health issues that you have had prior to the issuance of the policy.

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