There are various Long Term Care Insurance Policies. The most popular are the “Indemnity” or “Expense Incurred” where you choose the benefit amount. A fixed benefit amount is paid by an “indemnity” or “per diem” policy regardless of what you spend. The actual expenses for services received up to a fixed dollar amount per day, week, or month is reimbursed with an “indemnity” or “per diem” policy.
“Integrated Policies” or policies with “Pooled Benefits” pay a total dollar amount which may be used for different kinds of long term care services used. There is usually a daily, weekly, or monthly dollar limit for long term care expenses covered by this kind of policy. For example you buy a policy with a maximum benefit amount of $300,000 of pooled benefits. You will have, with this policy a maximum daily benefit of $300 that would last for 1,000 days if you spend the maximum daily amount on care. If your care costs less than the maximum daily amount of $300 you will receive benefits for more than 1,000 days.
There are three broad categories of LTCI policies based on where benefits are paid - Home Care Only, Nursing Home and Residential Care Facility Only and Comprehensive. Care received in your own home or a community setting is possible only with Home Care Only policies. Home health, adult day health care, hospice, respite care, personal care and homemaker services costs are coved by these kinds of policies.
Costs rising out of care in a nursing home or any place that provides assisted living care as long as this place is licensed as a Residential Care Facility for the Elderly (RCFE) is covered by Nursing Home and Residential Care Facility Only policies. This policy pays for more than just room and board in these facilities. The costs of all long term care services you receive in either of these facilities is paid by this policy up to the policy’s maximum daily benefit amount.
Some of the RCFE include small neighborhood homes also called board and care facilities, retirement homes and specialized community facilities for patients with cognitive impairment (dementia) from Alzheimer. In this kind of policy, the assisted living benefits must equal to at least 70% of the nursing home care benefit.
Expenses rising out of care in a nursing home, assisted living facility, home care and community care (adult day care) are covered by Comprehensive Long Term Care Insurance Policies. Before benefits can be paid LTC Comprehensive policies sold by different companies require different criteria to be met. When two activities of daily living (such as bathing, using the bathroom, dressing eating etc.) can not be performed or you have a cognitive condition that requires supervision, Comprehensive Long Term Care Insurance Policiy will pay you the benefits. The criteria required for the benefits remain as described above whether care is provided in a nursing home, at your own home or in an assisted living facility.
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