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May
23

Assisted Living

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  1. Brock Dezayas says:

    Assisted living as it exists today emerged in the 1990s as an eldercare alternative on the continuum of care for people, for whom independent living is not appropriate but who do not need the 24-hour medical care provided by a nursing home and are too young to live in a retirement home. Assisted living is a philosophy of care and services promoting independence and dignity.

    1. Phyllis Shelton says:

      That’s right Brock. Many people bought older long-term care insurance policies before assisted living facilities were introduced. Insurance carriers have been good to use the alternate plan of care provision found in most policies to pay for assisted living even when it wasn’t mentioned as a specific covered service.

      “Alternate plan of care” is intended to make a way contractually for a long-term care insurance carrier to pay outside the contract when it is cost-effective and makes sense medically for the patient. The policy language is very clear that the insurance company, the doctor and the family must agree on how this provision is used.

      A great way this provision has been used is to pay for new services that come along. As I mentioned, a great example is that it has been used often to pay for care in an assisted living facility from a policy that was sold to pay inpatient care only in a nursing home. Assisted living facilities (ALFs) are less expensive than nursing homes and patients generally are much happier in them because they don’t look anything like a nursing home. Without alternate plan of care, however, an insurance carrier could deny assisted living facility claims because an ALF isn’t mentioned as a covered service in the policy.

      So if assisted living coverage isn’t spelled out in the policy, look to see if there is an alternate plan of care provision and policyholders can ask the insurance company to pay for assisted living under that.

  2. Christine A. says:

    Does purchasing LTC insurance protect your assets, banking acct. etc. if you need to use assisted living or nursing home care?

    1. Phyllis Shelton says:

      The global answer Christine is yes but I have to qualify that with “it depends on the type of policy you buy”, and I will add two qualifiers for you to consider. First, you need to consider a long-term care Partnership policy which allows you to protect assets equal to the benefits paid out if you have to turn to Medicaid for help in the event the insurance isn’t enough. The premium is the same as for a non-Partnership policy so there is no downside to getting one. You do have to buy the appropriate inflation benefit for your age but you would want to do that anyway. You can learn more about Partnership policies by clicking here. That post will tell you the inflation requirements by age group and provide a link to a map that shows you the 40 states that are participating in the LTC Partnership. All of the states reciprocate on the asset protection except California. Second, you need to buy a meaningful benefit so you can make up the difference at claim time…otherwise a Partnership policy won’t help you. You can get some tips from “Your Customized Benefit Selection Process” but here is a quick formula: Look at the cost of care in your area, project it at 5% for 30 years, and choose a benefit that will pay the portion of that cost at that time. Do you want a plan that will pay half, 2/3, 80%? It’s most important to make sure your daily or monthly benefit pays the amount you want at claim time. How long it will pay is the secondary decision, especially if you buy a Partnership policy. If you need help going through this process and you don’t have a local professional who is knowledgeable in long-term care insurance, please complete the short questionnaire under the “Contact Us” tab. Oh yes, and a bonus answer to your question is that long-term care insurance also protects your assets if you need care at home, not just in a facility. Three-fourths of LTC happens at home and that’s really good news, isn’t it?

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