Long Term Care

Long term care helps you with the activities of daily living (ADL) and everyday tasks called the instrumental activities of daily living (IADL). ADLs include bathing, eating, dressing, and using the bathroom. Common IADLs include housework, preparing meals, shopping, and taking care of pets.

Most long term care is received at home. Many people stay in their homes for as long as possible with the aid of a family member or friend as a caregiver. A blended approach to receiving care works best.

There are varying degrees of control over how you receive services. Participant-directed services let you control what care you receive, who is providing it, and how and when those services are delivered. Under this arrangement, you can have a caregiver or home care service. Facility-based services will give you control over your schedule, who provides your care, and the meals you eat. In a home or community setting, you will be able to give feedback and request changes.

Paying for Long Term Care

Medicare only covers long term care when you need skilled services or rehabilitative care, covering up to 100 days in a skilled nursing facility. Medicaid does cover long term care, based on your income, eligibility requirements, and level of assistance you need for activities of daily living (ADL). If your health insurance covers long term care, it is typically only for skilled, short term, medically necessary care.

Long Term Care Insurance

Insurance specifically for long term care provides you a daily benefit to use toward your care in many settings. Coverage is comprehensive and includes care in your home, adult day service centers, hospice care, respite care, assisted living facilities, Alzheimer’s special care facilities, and nursing homes. Serves in your home can include skilled nursing care; occupational, speech, physical, and rehabilitation therapy; personal care (ADL); and homemaker care (IADL).

To receive your benefits from long term care insurance, you must have passed the Elimination Period and meet criteria called the Benefit Trigger. A company-sponsored nurse or social worker will assess your capacity to perform activities of daily living (ADL) or evaluate your cognitive impairment. You meet the Benefit Trigger if you need help with 2 or more ADLs. Once you meet the trigger, your elimination period starts, which acts like a deductible. This period will be 30, 60, or 90 days. After this point, your insurance company will pay your costs up to a pre-set daily limit. Some policies have a pre-set cash amount that they will pay you for every day you meet the benefit trigger. The maximum they will pay is either a defined limit or the number of days they will cover you.

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Qualifying for Long Term Care Insurance

You may not qualify for this type of insurance if:

  • You already use long term care insurance
  • You already need help with activities of daily living (ADL)
  • You have AIDS
  • You have dementia
  • You have a progressive musculoskeletal condition (such as MS or Parkinson’s)
  • You have a history of strokes
  • You have metastatic cancer

Contact Texas Medicare Advisors to learn more about long term care insurance and if it best fits your coverage needs.