First, Seek to Understand Long-Term Care

By Gretchen Barry

As the demand for long-term care soars, so do anxieties about paying for these essential services. As someone who experienced this recently with a parent, I understand that anxiety. According to a 2023 KFF survey, 43% of respondents don’t feel confident that they’ll be able to afford care as they age. Additionally, only 28% of adults aged 50 to 64 have saved money for future living assistance expenses.1

For this article, I want to focus on how long-term care coverage is and how insurance can help alleviate funding concerns by providing financial support for extended care services. This insurance can give policyholders peace of mind and safeguard their financial futures. By learning about the ins and outs of long-term care insurance, you’ll help your clients effectively plan for their future health needs.

What Is Insurance Coverage for Long-Term Care?

Long-term care insurance — also known as custodial care coverage — covers the costs of extended care services for people who need ongoing support. It pays for expenses not covered by Medicare or traditional insurance, such as assisted living and skilled nursing.2

A long-term care insurance policy can help pay for the cost of care that is needed due to a chronic illness, disability, or injury. Primarily, long term care insurance is designed to cover the costs of custodial and personal care, as opposed to medical care alone.

Coverage may include the cost of staying in a nursing home or assisted living facility, adult day care or in-home care.

So, what does long term care insurance cover? When your policy has been activated you can use it to cover many types of expenses, including:

• Respite care

• Alternative care

• Adult day care

• Nursing home

• Assisted living facilities

• Memory care

• Resident care

• Short term hospice

Ideally, someone would purchase coverage when they are still young and healthy people to cover future medical expenses.

A long-term care insurance policy can help pay for the cost of care that is needed due to a chronic illness, disability, or injury. Primarily, long term care insurance is designed to cover the costs of custodial and personal care, as opposed to medical care alone.

Services Covered by Long-Term Care Insurance

Long-term care insurance covers ongoing medical expenses for people with complex health needs that require extended and specialized support. Policyholders must meet specific criteria to begin using their long-term care benefits. Insurers require a physician’s diagnosis for cognitive or physical impairment.

Policy coverage typically includes these essential services:

In-Home Care

In-home care coverage allows policyholders to receive healthcare services from the comfort of their homes. These services are available for seniors, people with disabilities, patients recovering from surgery or illness, and others.

In-home care takes many forms, including:

• Companion care: A caretaker provides non-medical services and social support to help patients stay engaged and prevent loneliness. For instance, an aging patient may go on daily strolls with their caretaker and get help with grocery shopping.

• Help with ADLs: An in-home care professional can assist with bathing, caring for dental hygiene, and other daily activities.

• Nursing care: A licensed healthcare provider travels to the patient to deliver healthcare services. For instance, a person recovering from knee replacement surgery may receive wound management and physical therapy.

In-home care allows older adults and others who need ongoing assistance to maintain their independence. Patients who receive these services can remain in their homes and communities instead of moving to an assisted living or skilled nursing facility. However, keep in mind that these services are in high demand. Depending on where one lives, it may be difficult to find a qualified caregiver.

Facility Care

Insurance coverage for long-term care also includes facility care. This type of care allows policyholders to receive healthcare services in residential settings.

Common types of facility care include:

• Assisted living: Residents live in independent units and receive help with ADLs. For instance, staff may provide housekeeping and remind residents to take their medications.

• Nursing home: These facilities provide comprehensive medical care and 24/7 supervision. Nursing homes are a great option for people with limited mobility, cognitive impairment, and other conditions that require around-the-clock support.

• Memory care: Memory units offer specialized support for people with Alzheimer’s disease, dementia, and other cognitive disorders. These facilities typically provide brain-stimulating activities and have security measures to keep residents safe.

Facility care allows residents to build social connections with peers, reducing loneliness. These communities also offer communal dining, recreational facilities, and other amenities that improve residents’ quality of life.

Activities of Daily Living

Many people require assistance with everyday activities due to age, disabilities, and illnesses. Long-term care insurance providers typically allow policyholders to receive benefits if they can’t perform two of these six ADLs:3

• Bathing

• Continence

• Dressing

• Eating

• Transferring in and out of a bed or chair

• Toileting

Long-term care insurance enables eligible policyholders to receive daily assistance with these tasks. For instance, a person with a spinal cord injury could have an in-home caretaker who helps them transfer from their bed to their wheelchair. Similarly, someone who experiences a stroke could move into an assisted living facility to receive assistance with bathing and toileting.

Assistance with ADLs improves patients’ quality of life and allows them to maintain their dignity. Coverage for these services also reduces the strain on family members and enables policyholders to receive professional support.

Filing Claims for Long-Term Care Insurance

People often assume they can use their long-term care insurance whenever they need it, but that’s not the case. Policyholders must follow their insurance company’s filing process to get reimbursed for claims. At BuddyIns, we recommend that folks reach out to our Community Partner, Amada Senior Care, to get help understanding how to file a claim.

As healthcare costs continue to rise, insurance coverage for long-term care has become a wise option for many people. This insurance can enable policyholders to receive necessary care without wiping out their savings or going into debt.

Help Your Clients Plan Ahead

We need to continue to educate more Americans about the importance of planning and communicating a plan to their loved ones. Long-term care services allow individuals to age with dignity and receive essential healthcare. However, these services can cost thousands of dollars a month, especially for people who need specialized care.

As healthcare costs continue to rise, insurance coverage for long-term care has become a wise option for many people. This insurance can enable policyholders to receive necessary care without wiping out their savings or going into debt.

As a reliable advisor, you can help clients understand the benefits of long-term care insurance and make informed decisions about their current and future health.

California Broker is pleased to have a collaborative relationship with Buddy Insurance, a leading long-term care insurance education, marketing and technology company. CEO Marc Glickman and his specialists will collaborate with health and life insurance professionals to help design LTCi options. Learn more about LTCi and refer clients — or learn how to write your own LTCi policies using Marc’s system.

CONNECT to Buddy Insurance LTCi PORTAL HERE:

Group: www.buddyins.com/program/calbroker/group

Individual: www.buddyins.com/program/calbroker/

Gretchen Barry, As Chief Marketing Officer for BuddyIns, Gretchen has been instrumental in shaping the company’s identity as a leading LTCi education, marketing, sales, and technology company. With over 20 years of experience in marketing leadership roles across financial services and tech start-ups, Gretchen brings a wealth of expertise and passion to her work. She oversees a diverse and talented marketing team that delivers innovative and effective solutions for BuddyIns’ clients and partners.

Gretchen can be reached at gretchen@buddyins.com