What Medical Expenses Does Long-Term Care Insurance Cover?

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What Medical Expenses Does Long-Term Care Insurance Cover?

If you are considering purchasing long-term care insurance, you probably have questions about what your policy will  cover. Sometimes people make the assumption that long-term care insurance only covers end-of-life nursing home stays. In reality, these policies are designed to cover other types of skilled care.

Specific insurance benefits will be defined by your policy itself, but there are some common types of care that are covered under long-term care insurance policies. Those include skilled care, intermediate care and custodial care.

  • Skilled Care. This type of care includes medical treatment provided by licensed professionals under a doctor’s supervision, often when someone needs daily care to help them recover from an injury or an illness.
  • Intermediate Care. Where skilled care is provided daily, intermediate care is provided intermittently, as needed.
  • Custodial Care. Custodial care is what most people think of when they hear “long-term care.” This is the insurance coverage that would pay for your room and board, as well as costs associated with helping you with daily activities.

Many long-term care insurance policies also provide coverage for care and assistance in your own home. Covered services often include homemaking and chores, providing help for those who aren’t able to handle things like cooking, bathing and transitioning on their own but want to remain in their own homes.

Policies may also cover alternate care, including medically-necessary modifications to your home so you can stay there as long as possible. Policies may also provide benefits for respite care, adult daycare and assisted living expenses.


What are Long Term Care Benefit Triggers?

  • Activities of Daily Living (ADLs): The inability to do activities of daily living is the most common way insurance companies decide when you are eligible for benefits. They are:
    • Bathing
    • Continence
    • Dressing
    • Eating
    • Toileting
    • Transferring

Tax-Qualified policies are required to use the inability to perform two of the six ADLs as a benefit trigger.

  • Cognitive Impairment: Most long-term care policies also pay benefits for “cognitive impairment”. Coverage of cognitive impairment is especially important if you develop Alzheimer’s disease, senility or other dementia


Talk to Your Insurance Professional to Learn More

To get more information about long-term care insurance, or to request a policy quote, contact us today.

Schneider & Shulman
Schneider & Shulman
For over 20 years, Jay Schneider and David Shulman have excelled at helping individuals establish long term care plans customized to their unique needs.