There are different types Long Term Care Insurance Policies. “Indemnity” or “Expense Incurred” policies are most common. When you buy an expense incurred policy, you choose the benefit amount. Regardless of what you spend an “indemnity” or “per diem” policy pays up to a fixed benefit amount. An “indemnity” or “per diem” policy reimburses for the actual expenses for services received up to a fixed dollar amount per day, week, or month.
“Integrated Policies” or policies with “Pooled Benefits” offer a total dollar amount which may be used for different kinds of long term care services. Usually there is a daily, weekly, or monthly dollar limit for long term care expenses covered by the policy. Let’s say for example you buy a policy with a maximum benefit amount of $300,000 of pooled benefits. With this policy you will have a maximum daily benefit of $300 that would last for 1,000 days if you spend the maximum daily amount on care. You will receive benefits for more than 1,000 days if your care costs less than the maximum daily amount of $300.
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.
Assisted living care provided in 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. Room and board in these facilities are not the only services covered by these kinds of policies. Expenses of all long term care services you receive in either of these facilities is covered by this policy up to the policy’s maximum daily benefit amount.
Care for patients with cognitive impairment (dementia) from Alzheimer is provided in small neighborhood homes also called board and care facilities, retirement homes and specialized community facilities which are part of the RCFE. This kind of policy provides for assisted living benefits equallingl to atleast 70% of the nursing home care benefit.
Comprehensive Long Term Care Insurance Policies provide coverarge for costs rising out of care in a nursing home, assisted living facility, home care and community care (adult day care). Different companies require different criteria to be met before benefits can be paid by LTC Comprehensive policies. Comprehensive Long Term Care Insurance Policy will pay you benefits 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. The criteria required for the benefits remains same whether care is provided at your own home, in a nursing home, or in an assisted living facility.
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