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Long Term Care Insurance (LTCi): Features of a good policy

Don't let your LTCi be a disappointment
"I have 0 a day for life," Gloria, one of my clients, complained. "Why do they only give Carolyn .00 a day?"

Gloria owns several policies with my company. However, her LTCi, which she is currently using, is with a different company. Carolyn, her home health aid, receives limited pay because Gloria's policy includes only 50% home care. While Gloria would receive 0 a day indefinitely in a nursing home, she can only get .00 a day for home-care. Furthermore, since Carolyn does not work through an agency, she is considered "non-professional" and will be paid no more than .00 an hour. To make matters worse, Gloria is still paying her full monthly premium because her policy does not include a waiver of premium unless she is in a nursing home! This situation could have been avoided.

Take action to protect your interests
Long Term Care insurance, a type of protection that pays the bills when a person needs extended care either at home or in a nursing home, should be part of senior planning for every adult who owns property, investments or savings–or who simply wants to protect freedom of choice, independence, and family harmony. Nevertheless, 65% of adults over 40 admit to having made no plans for long term care for either themselves or a spouse, according to Genworth Financial.

Put the excuses on the table
The first excuse for putting off the purchase of LTCi is money, but the real reasons are usually a matter of denial–you don’t really believe you will ever need it–and confusion over the mountain of information. Numerous companies offer LTCi insurance, and while the policies are similar, the language can vary significantly from one company to another. Make one inquiry, and multiple packets crammed with information will soon fill your mail box. You don't know what to do, so you do nothing.

LTCi: Basic coverage and features
Fortunately, understanding LTCi is not as difficult as it seems. However, it is not a one-size-fits-all program, so doing it on your own or over the phone is not a good idea.

Basic coverage
All LTCi begins with the basic coverage–a maximum dollar amount per day multiplied by the number of days of coverage. The actual premium is then based on your age. For example, a three year, 0 per day benefit would give you 1095 days times 0, or a "pot of money" of 9,500 to spend. Even though most nursing homes charge more than 0 a day, your pot will last at least three years because you can't spend more than 0 per day. Once the company has paid 9,500, your policy is exhausted, and you will have to pay for additional care yourself.

The other part of your basic coverage is the elimination period, a deductible consisting of a set number of days that you must pay for care before your policy will start paying. Some companies go strictly by the calendar, others go by the actual days you received care. A longer elimination period reduces your premium.

Feature 1: Home care
Features are benefits included with no extra cost. For example, most companies can offer a choice of whether you want to include care in your home. It may be included at a slightly higher premium, or it could be a rider, depending on the company. You can also choose 50% or 100% home care. If you choose 100%, you can spend your maximum of 0 per day for care in your home. Furthermore, while nursing home care has to be calculated on a daily basis, most companies calculate home care by the month. You could thus spend one day and 0 another day, so long as you do not go over 00 per month (in our 0 per day example).

Feature 2: Waiver of premium and discounts
Most companies will waive your premium when you have to start using your coverage. Some waive the premium from day one while others require you to be on claim for at least 90 days first. If you should get well and go off of claim, your premium would resume. Some companies waive the premium for both spouses if just one goes on claim. However, nearly all companies give a discount if husband and wife are on the same policy.

Feature 3: Restoration of Benefits
The best companies include a restoration of benefits feature, meaning that if you only need care for a few months and are able to go off of claim, your entire pot of money is "restored," giving you the full policy to use again when you need it. However, the pot can only be refilled if it has something left in it–even as little as .00.

Feature 4: Home modification
Many companies will pay several times your monthly benefit to modify your home with things like wheel chair ramps, widening of bathroom doors, or rails in the bathtub or around the commode.

Feature 5: Caregiver training
Do you have a family member who is able and willing to participate in your care? Some companies will pay several times your daily benefit to train that person who will then take care of you at their own expense, making your policy benefit last much longer.

Feature 6: Respite care
Respite care is simply a vacation for a family member who has agreed to help take care of you. For a certain number of days each year, a company will put you in a nursing home or find someone else to take care of you, and the company will foot the bill up to your maximum daily benefit.

Feature 7: Equipment rental
Equipment rental is simply the rental of hospital equipment–such as a hospital bed–usually up to the purchase price of the equipment.

Feature 8: Adult day care
The better companies include adult day care where you can get therapy and interact with other seniors. Usually transportation, meals, therapy, and help with activities of daily living are included.

Feature 9: Prescription drugs
The inclusion of prescription drugs–of the type given in a nursing home or hospital–is a very important feature, but many companies only include drugs with a rider. Ask about it.

Feature 10: Room reservation
What if you get sick while you are in the nursing home and have to go to the hospital? The room reservation feature reserves your bed for a certain number of days each year.

Feature 11: Hospice and ambulance
Medicare pays for the nursing needed during hospice as well as for a certain number of ambulance trips per year. However, most LTCi policies offer some additional ambulance dollars as well as the home health aid and domestic services if you are on hospice.

Feature 12: Patient Care Coordinator
Companies have different names for this, and many don't offer it at all. A patient care coordinator is a person who will work with you to find the agencies in your area. The person will find out what the agencies charge, and will help you choose the appropriate agencies to meet your need. The coordinator can also help you file claims by explaining how to correctly complete the paper work.

Remember, features of a policy are included without extra charge. It's worth paying a bit more for a policy that includes a lot of features rather than buying something cheap only to find out that benefits you would have liked aren't included.

About the Author: One thing Gary Stuart learned quickly was that long term care (LTC) insurance was as much about education as it was about selling. People need to understand what they are buying, why they need it—or don't need it—and what it will do for them and their family. Furthermore, since every family's needs are different, there is no such thing as one size fits all either in LTC insurance or in educating people about this relatively new kind of insurance. Visit his web site for more information:

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