Long-term care (LTC) insurance primarily pays for supervision or assistance with everyday tasks (such as bathing or dressing) whether at home with caregivers, in a community program, in an assisted living facility (ALF) or in a nursing home. Most LTC services do not require a licensed healthcare professional to provide care, as senior helpers and caregivers come from all walks of life. Some LTC policies only pay benefits for care in institutional settings, while others only pay for home and community-based care such as adult day care (ADC) facilities. Comprehensive policies include benefits for all of the places listed above.

People often need LTC services after an illness or injury, such as a stroke or a broken hip, or because of a cognitive disorder, such as Alzheimer’s disease. Many people get care at home with help from family members or a care agency and go to a nursing home only as a last resort. Others go directly to a nursing home from a hospital because of the severity of their condition. Assisted living facilities provide LTC services and can act as a bridge when a person can no longer live at home, but doesn’t need to be in a nursing home. Many people receive care services while at an ALF, too.

Some people will never need LTC, some will only need it for a short period of time and others will require elderly assistance for many years. Some people will be able to live at home with small amounts of senior care while others may need memory care services. You should include family members in your planning because your adult children may be involved when you need care. If you are considering LTC insurance, research the best set of benefits for your needs, as well as the best company to provide those benefits. Counselors from the Health Insurance Counseling & Advocacy Program (HICAP) can help you sort through and understand many of these issues, compare the benefits and features of several policies from different companies, and help you understand when you need advice from a trusted professional. To make an appointment for HICAP counseling, call 1-800-434-0222. While Medicare covers certain short-term skilled care, it does not cover most LTC. You also do not need to be on Medicare to get LTC insurance.

Before LTC insurance benefits can be paid, you must meet certain requirements listed in the policy. In California, insurance companies must pay LTC benefits when you cannot perform two activities of daily living (i.e., bathing, dressing or eating) or you have a cognitive impairment serious enough to require supervision. This standard is the same wherever you need care services provided.

Buying LTC insurance is part of a planning process for life and retirement. You need enough income to pay the premiums for the rest of your life, regardless of premium increases or life changes, such as the death of your spouse. You need to consider how long the benefits should last in relation to the premium you will pay. Most people with modest resources may be better able to pay for a policy with 1, 2 or 4 years of coverage rather than one with benefits that last as long as they need care. 

Remember, what is best for one person may not be good for another. The benefits and amount of coverage an individual or couple needs depends on their unique circumstances. Services for seniors are available, though they can come with a large price tag.

Some people will never need LTC, some will only need it for a short period of time and others will require elderly assistance for many years. Some people will be able to live at home with small amounts of senior care while others may need memory care services.