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Washington State Office of the Insurance Commissioner
No one likes to think about the prospect of needing long-term care. However, as life expectancy
continues to rise, more and more Americans between the ages of 40 and 84 – especially those in
their mid 50s – will start to prepare for their older years.
Long-term care refers to a wide range of medical, personal and social services. You may need this
type of care if you have a prolonged illness or disability. It includes help with daily activities, such
as dressing, bathing, eating, toileting, getting in and out of a bed or chair, and walking. It also may
include home health care, adult day care, nursing home care or care in a group living facility.
This kind of care is sometimes paid for privately (out of pocket) or through insurance. Often, it’s a
combination of both. See page 5 for other ways to pay for long-term care.
Long-term care insurance is one way to pay for long-term care. It’s designed to cover all or some
long-term care services. Long-term care insurance may consist of an individual insurance policy,
or group coverage including a master policy and certificates of insurance. These policies pay for
certain services once your claim is approved.
What long-term care insurance policies cover
Long-term care insurance pays for care generally not covered by regular health insurance or
Medicare. Long-term care insurance can help you protect assets and retain more control over your
health care decisions later in life.
If you cannot afford to pay out-of-pocket for long-term care services or you choose not to buy long-
term care insurance, Medicaid may be an option for you.
When do long-term care insurance benefits start?
Long-term care policies include an elimination period. This is the number of days that you’ll be
financially responsible for your own care before your benefits start. Elimination periods can range
from zero to 180 days. Shorter elimination periods generally cost more.
Also, long-term care policies do not guarantee coverage unless you satisfy certain requirements.
These are called “benefit triggers” and they vary by policy. For example, most policies will not
provide coverage until you’re unable to perform a given number of daily living activities, such as
dressing, bathing, and eating without help. Make sure you know what the “benefit triggers” are in
your policy.
How much does long-term care insurance cover?
Long-term care insurance provides a daily benefit, which is the maximum daily amount your
insurance policy will pay in any single day for your care. The daily benefit may include room and
board, home care, adult day care, hospice, respite care, etc. It can vary based on the dollar amount
you select when you buy your policy and the type of care you end up receiving.
You also can choose a benefit period that is a specific number of days, months or years. A
maximum benefit period may range from one year to the remainder of your lifetime. Be sure to