Frequently Asked Questions about Long Term Care

What is Long Term Care and what are my odds of needing it?

Pennsylvania Long Term Care consists of assistance with everyday tasks that you may no longer be able to perform by yourself. For example, there may come a time when you need help getting dressed, eating, or bathing. Long Term Care also includes help in case you have a severe cognitive impairment, such as Alzheimer's disease. You can receive Long Term Care in a variety of settings, including your own home, a nursing home or an assisted living facility. For people over the age of 65, about 70% will need some Long Term Care, and nearly 40% of people currently receiving Long Term Care are ages 16-64.

Why would I need Long Term Care Insurance?

Long Term Care is very expensive and it can deplete your hard-earned retirement savings. In Pennsylvania the average cost for nursing home/facility care is over $85,000 annually and Home Care can cost over $60,000 per year. Long Term Care Coverage will pay for these costs regardless of where you are receiving care.

Doesn't my Health Insurance or other insurance cover Long Term Care ?

NO! Health Insurance does not pay for Long Term Care. Medicare will pay for 100 days in a facility, (not for Home Care) and then you are on your own. Medicaid requires that you are impoverished before they pay for your Long Term Care, and will demand that you "spend down" your assets to receive assistance. In addition, Medicare and Medicaid will not pay for Home Care, which is where most people choose to receive care.

Are costs for Pennsylvania Long Term Care Insurance fixed once I’m enrolled or do they increase each year?

Policy costs (premiums) are "locked in" based on a person's age and health at the time of purchase. However, in a formal sense, all insurers reserve the right to increase the premium. If this were to happen, it would increase on a class basis, for the entire product series and it must be approved by the State Insurance Commission. Premium rates cannot be arbitrarily increased due to an individual's claims, health status, or age. Because of the involvement of the State Insurance Commission and the auditing and examination necessary for a premium increase, such increases rarely happen.

What is the "right age" to buy Pennsylvania Long Term Care Insurance?

Because your premiums will be based on your age and health, the younger you are, the lower your premiums. Premium cost will increase each year that a person waits to buy coverage.

Nationally, the average age of one who purchases Long Term Care Insurance is 57. If you do decide to purchase, you can save a significant amount of money by buying sooner rather than later.

Premium costs rise dramatically if you wait until you're older to purchase a policy, because the likelihood that you'll need long-term care is directly related to your age. As an example, a 65-year-old purchasing Long Term Care Insurance might pay three times more than a 50-year-old would pay for a policy providing the same benefits. An 80-year-old might pay ten times more than a 50-year-old for the same level of coverage.

Also, your health status is "locked-in" upon purchase. Premium costs are partially determined by your health status. However, once you buy a policy and your health takes an expected turn for the worse, the premiums will not increase! If you buy your policy while you are healthy, the lower the premiums. If your health changes, and then decide to purchase, the rates will be higher. If the health issue is serious, you may even become ineligible.

Long-Term Care Insurance policies in Pennsylvania offer many options of coverage and plan features. How do I decide which plan is right for me?

There are many important factors to consider when establishing a suitable amount of coverage for you and your family. A good point of reference to start with is being aware of the costs for Long Term Care in your area. You will also want to consider the amount of your personal savings, family budget, and where you are going to be the most comfortable receiving care. A personal consultation with a Long-Term Care Specialist can help you examine these issues and determine the level of coverage that is right for you.

When does one become eligible for benefits?

Benefits are paid if one of these conditions are in place:

1. The inability to perform two of the activities of daily living (ADLs)--bathing, dressing, toileting, transferring (from bed to chair, etc), eating, and continence. 
2. Cognitive mental impairment (such as Alzheimer's disease).

What does a Long-Term Care policy mean in regards to "Total Amount of Benefit Dollars"?

When you purchase Long Term Care Insurance, you are buying a bucket of money or a pool of dollars from which you can pay your Long Term Care expenses. This means that you will have a specific dollar amount available for reimbursement of your Long Term Care expenses. This pool of dollars for your care is based on your benefit period multiplied by your daily or monthly benefit amount. Your Long-Term Care Specialist will help you determine the benefit amount that is right for you.

What is the difference between buying Long-Term Care Insurance and paying for my Long-Term Care out of my own pocket?

The difference is that, with Long-Term Care insurance, you are transferring some or all of the risk of paying for long-term care to an insurance company. When trying to budget for your long-term care needs, you will want to research the average amount needed to invest to have enough reserves to pay for your long-term care. If you decide to use your personal savings for your long-term care expenses, you should consider starting to save as soon as possible. In Pennsylvania, the average cost for a one-year stay in a nursing facility is projected to exceed $177,000 per year by 2024.

Some say, my spouse or family will provide care for me. If that is a possibility, why would I need (or want) Long-Term Care Insurance?

The most tender and devoted family members might not be on hand or have the skills necessary to offer the kind of care you need when you need it. What if your spouse/family member was in poor health as well? What if you become single or the family is scattered around the state or country? Furthermore, in many cases, adult children have demanding jobs that keep them occupied that might make it nearly impossible to devote care for their parents. Long Term Care Insurance is the one way to ensure you have the resources to pay for Long Term Careby qualified and licensed caregivers, without depleting your Retirement Savings.

Home