NJ Department of Military and Veterans Affairs
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Employee Relations » Long Term Care

Long Term Care

Long-Term Care is the kind of care that you would need to help you perform daily activities if you had a chronic illness or disability. It also includes the kind of care you would need if you had a severe cognitive problem like Alzheimer’s disease. It is help with eating, bathing, dressing, transferring from a bed to a chair, toileting, continence, and so forth. Long-term care can also include assistance with such tasks as shopping, transportation, housecleaning, or preparing meals. This type of care isn’t received in a hospital and isn’t intended to cure you. It is not acute care. It is chronic care that you might need for the rest of your life. It can be received in your own home, at a nursing home, or in another long term care facility. Long term care insurance is insurance that helps you pay for long term care services, such as home care or care in a nursing home or assisted living facility.

The problem with long-term care is that it can be quite expensive. It can easily exhaust your savings, which is one reason you might decide to buy long term care insurance. It is important for you to know that most health plans do not cover long term care. While health insurance plans generally cover hospital stays and doctors’ bill, they often provide limited or no benefits for nursing home care or home health care. And while they may cover some of the skilled medical services you may need when you can’t care for yourself after an illness or injury, this is usually for a limited period and only as long as you are showing improvement. Health plans, including the Federal Employees Health Benefits Program (FEHBP) and TRICARE, typically do not cover ongoing chronic care such as an extended stay in an assisted living facility, or a continuing need for a home health aide to help you in and out of bed.

Choose the Correct Plan by obtaining the answers to these questions:

  1. Does the policy require a hospital stay before you can begin receiving benefits? The vast majority of policies these days don’t, but be sure the ones you are considering don’t have this as a precondition.
  2. Does the policy cover home care, as well as care in a nursing home or other facility? You don’t want to be forced to move to a nursing home or other facility in order to receive care.
  3. Does the policy cover both adult day care and “personal care” (sometimes called
    “Custodial Care”)? You probably want a policy that covers both these kinds of care.
  4. Does the policy require that home health care be provided by someone from a certified home health care agency or a professional health care worker in order to be covered? Generally, you don’t want this kind of limitation in your policy.
  5. Ideally, you want a policy that does not exclude preexisting conditions at all. If you can’t get that, then you want a policy that excludes preexisting conditions for no longer than six months.
  6. The policy should allow you a “grace period” so that you do not have to pay premiums while you are collecting benefits. Once you are on your feet again (have left the nursing home, for instance, and are no longer collecting benefits), you begin paying premiums again.
  7. The policy should require you to satisfy the elimination period just one time. If you have an elimination period of 30 days, for example, and enter a nursing home, you pick up the tab for the first thirty days, during the elimination period. After the 30-day elimination period ends, your long term care insurance benefits kick in, and the insurance company pays for the nursing home care. If you then leave the nursing home, but have to return for a second stay, you don’t want to have to satisfy the 30-day elimination period again. You want a policy that requires you to satisfy the elimination period only once, with the insurance company picking up the entire tab if you have to reenter the nursing home (or receive another kind of care) multiple times.
  8. Under the policy your premiums should not increase unless the increase is an across-the- board increase for all the insured in a particular area or group.
  9. The policy must be “guaranteed renewable,” which means that as long as you pay your premiums, you will be covered.