Will long-term care insurance cover assisted living? Yes. A good long-term care policy will help pay for assisted living and include coverages in other settings.
But the real question is whether or not you currently have a long-term care policy.
Most seniors do not. And by the time you need one, you might not qualify due to age or pre-existing conditions.
More than 70% of American seniors over 65 will likely need long-term care at some point. But only 10% of Americans have any long-term care coverage.
Without long-term care insurance, you or your family will most likely pay for your long-term care costs from savings, retirement accounts, equity loans against your house, or other private sources.
And depending on if you decide to age in place at home or choose an assisted living community, these costs are challenging for most families. Using Sarasota, Florida as an example, according to Genworth Financial, the 2023 monthly costs average about $6,700 for Home Health services, $4,570 for assisted living, and $10,500 for a semi-private room at a nursing home.
What is Long-Term Care Insurance?
Long-term care insurance provides many services not covered by regular health insurance. Every policy is different and has specific coverage. But most long-term care policies include assistance with routine daily activities, like dressing, bathing, or getting in and out of bed.
Where Does Long-Term Care Apply?
Long-term care insurance helps seniors pay for the services and support they need as they age. And long-term care is for more than just assisted living communities. These policies often cover long-term care provided at:
- Your home
- An assisted living residence
- A nursing home
- An adult day care center
What Is Covered Under Long-Term Care Insurance?
Long-term care policies help with areas often ignored by other health insurance policies. A long-term care policy can help cover the costs of chronic medical conditions, a disability, or a condition like Alzheimer’s.
This includes:
- Assistance with your activities of daily living (ADLs)
- Certain homemaker services that are in conjunction with personal care
- Skilled nursing care
- Physical, speech, and rehabilitation therapy
- Respite Care
What Is Not Covered Under Long-Term Care Insurance?
Like most insurance policies, long-term care policies have limitations and exclusions. It is essential to read and understand the policy to know what is covered and what is not.
Many long-term care policies do not cover:
- Pre-existing conditions for a certain period of time. Understanding this clause is crucial. A pre-existing condition is typically defined as receiving medical advice or treatment or having symptoms within a certain period before applying for the policy. Some companies look further back than others, and some do not have restrictions for pre-existing conditions at all.
- Self-Inflicted Injuries
- Certain nervous disorders or mental conditions
- Drug and alcohol abuse
Why buy long-term care insurance?
The reason to buy long-term care insurance is the same reason you purchase other insurance, like car, home, and health insurance: peace of mind. You pay a little each year or month, so you don’t have to worry about paying a large amount of money should the unexpected happen.
But long-term care is different, because needing it is expected and a normal part of aging in the US. More than 70% of the population will need long-term care help not covered by regular health insurance.
Suppose you are fortunate enough to be wealthy and can easily cover all long-term care expenses out of pocket. In that case, long-term care insurance may not be for you. But for most Americans, long-term care insurance can be a valuable part of their financial planning.
Do Medicare and Medicaid Cover Long-Term Care?
Long-term care insurance policies are specifically designed to help with most long-term care costs. Medicare does not pay for long-term care. Medicaid is a state-run program designed for those whose assets and income are under the state’s low threshold. Even then, the program is complex, the benefits are limited and minimal, and the waitlist can take years.
Medicare Does Not Pay for Long-Term Care
Medicare is of little help with long-term care costs. The Medicare website is pretty blunt about this subject, stating, “Medicare and most health insurance, including Medicare Supplement Insurance (Medigap), don’t pay for long-term care.” The site goes on to explain it is important to plan for long-term care to maintain your independence and get the care you need in the future.
Medicare does pay for limited stays in rehabilitation facilities, like in-patient physical therapy for a hip replacement. But, the limit is 100 days. And suppose after that you must move to assisted living or a nursing home. In that case, Medicare does not cover your custodial costs.
Medicaid Is Very Limited and Can Take Years
For seniors over 65, Florida Medicaid is a minimal program. You must require nursing-facility-level care, and your assets must be below Florida’s low threshold. The program was designed to help the frail and neediest first, and you can be on the waitlist for years.
Medicaid recipients typically have a low income and have exhausted most of their savings. Because of the complexity, uncertainty, and length of time required to access any benefits, expecting Medicaid to help with long-term care needs may not be the best option.
When Should You Buy Long-Term Care Insurance?
The time to buy long-term insurance is before you need it. And the premiums are less when you are younger. Typically, most long-term care insurance buyers are between 50 and 65. It is becoming challenging to buy long-term care coverage over 70 due to health conditions, insurance company policies, expensive premiums, and pre-existing conditions.
And even if you are age-qualified, the insurance company might reject your application if any of the following are true:
- You currently need help with daily activities (ADLs).
- You are already receiving long-term care.
- You have been diagnosed with dementia or another cognitive impairment.
- You have a progressing neurological condition like Parkinson’s or ALS.
- You have had a stroke.
- You have specific cancer diagnoses. However, a diagnosis of cancer does not automatically get you declined. It depends on the type of cancer, how long ago you were diagnosed, and the individual insurance companies’ underwriting guidelines.
The best advice is to buy long-term care insurance before you need it and while you are younger and healthy.
Summary: Should You Get Long-Term Care Insurance?
Everyone ages and almost everyone will need help with senior care expenses, whether they age in place at home or choose an assisted living community.
But paying for that care can be overwhelming and severely impact a family’s budget and savings. Many families are forced into difficult financial challenges with an additional and unexpected $5,000 to $10,000 monthly expense for care.
Long-term care insurance can help you plan for the future and give you and your family peace of mind. Whether your senior loved one is deciding to age at home or considering an assisted living community, Florida Senior Consulting can help.
And if they don’t have long-term care insurance, we can help you navigate all the other options. We are a Florida-based company with expert knowledge of the Florida senior market. While senior options can seem confusing, this is all we do.
Florida Senior Consulting helps seniors decide their next best steps and the easiest way to afford the transition. We have certified staff, licensed nurse advocates, and decades of experience in the field.
Senior living should be on your terms, and the choice should always be yours. Call us, and we will answer all your questions and help you decide what is best for you or your senior loved one.
