Neither employer-based health insurance nor Medicare will cover medical care or daily living assistance required on a daily basis over an extended period of time, including in-home caregivers, nursing homes, or assisted living facilities. As a result, more Americans are purchasing long-term care insurance to cover their anticipated needs if they become unable to care for themselves. You can apply for private long-term care insurance in advance of your future needs, or you can apply for Medicaid to help cover long-term care if you need it now and aren’t covered by a private insurer.
Method 1 Applying for Private Insurance
1. Find out if your employer has a policy in place. Some employers provide long-term care insurance at a group discount.
Employer-sponsored plans typically have lower rates than individual policies, and you may not be required to meet the same medical requirements if you purchased an individual policy.
You may also be able to obtain long-term care insurance through a professional or service organisation to which you belong.
2. Determine the level and type of coverage you require. Although it may be difficult to determine if you’re looking for a policy decades before you expect to need it, you should consider the different types of long-term care available in your area and which you prefer.
Consider the help you may receive from family and friends. If you can reasonably expect significant assistance from them, you may need less coverage.
The level of coverage you are eligible for may be determined by whether you have any pre-existing conditions that increase the likelihood that you will require long-term care later in life.
Keep in mind that long-term care can cost between $200 and $300 per day for a private room in a nursing home or assisted living facility, with in-home care costing at least $20 per hour.
3. Examine your financial situation. Your financial situation will influence not only the premiums you can afford, but also the amount of benefit you’ll require and how quickly it will kick in after you require long-term care.
Keep in mind that premiums frequently rise over time, and your income may fall as you age. If you have to cancel your policy because you can no longer afford the premiums, you will forfeit the benefits as well as any money you have already paid into it.
Before applying for long-term care insurance, you should consult with a lawyer or financial advisor about your retirement savings and other options for covering future long-term care expenses.
4. Examine various service providers. Once you have a good idea of the type of policy you require, you should look into companies that provide those policies.
Insurance agencies in your state should be licenced to sell insurance, and the agent you work with should have additional training and experience in long-term care insurance.
You can check with your state’s insurance department to see if a particular provider’s licence is active and if any complaints have been filed against them. You could also check consumer forums and organisations like the Better Business Bureau to determine the company’s reputation.
You should also consider the company’s overall stability and history with long-term care insurance. You don’t want to buy long-term care insurance from a company that has a high risk of going bankrupt.
Keep in mind that some employers may require you to use specific services or health-care providers rather than providing you with a choice. Knowing what types of long-term care you would be comfortable with can help you narrow down the policies offered by various companies.
One company, for example, may not cover in-home long-term care. If you know you’d rather stay in your own home than be transferred to a nursing home or assisted living facility, make sure the policies you’re considering cover in-home care.
If your insurance company requires you to use only specific services or long-term care providers, you should also ensure that the provider is located in your area.
Recognizing that your premium may rise over time, you can request that each company provide information on the rate history for its premiums, or you can look into anti-inflation protection for your policy.
5. Request quotes. When you’re ready to purchase your policy, get quotes from at least three reputable insurers so you can choose the one that best meets your needs and fits within your budget.
Before providing you with a quote, the company may conduct an informal review to determine if you are eligible for the policies it offers.
Make sure you get a written copy of the policy so you can thoroughly review it. If there are any terms that you don’t understand, you should consult with an attorney or a financial advisor.
Compare the amount of benefits to your financial projections for the money you’ll have available to cover long-term care as well as any familial or other support you have to determine how useful a policy will be to you.
You should also compare the benefits offered to the average cost of care in your area. If the policy does not cover your care, it is pointless for you to pay into it.
When deciding between policies, consider how each one defines the events that occur when you become eligible for benefits. In general, you are eligible for benefits if you are unable to perform two or three basic daily activities such as bathing, eating, or using the toilet without assistance. Some insurance companies, however, require that you be physically unable to perform those activities rather than having mental difficulties due to an illness such as Alzheimer’s disease.
Examine the policy for a nonforfeiture provision. Based on how long you have paid into the policy, this provision allows you to receive a lower benefit amount even if you can no longer afford the premiums. These provisions are mandated in some states but not in all.
When evaluating potential policies, make sure you understand the waiting or elimination period for each policy, the daily benefits that will be provided, what must happen to trigger benefits, and what conditions are excluded.
6. Select your policy. Once you’ve decided on a policy, it’s usually just a matter of signing some paperwork and paying your premium.
Even after you’ve signed your policy, you typically have 30 days or so to review it and return it for a full refund with no questions asked if you change your mind about your purchase or decide to go with another company.
Long-term care insurance policies in the United States typically cost between $2,000 and $3,000 per year. That sum buys a comprehensive policy that covers both in-home and facility care for about five years at a cost of $100 to $200 per day.
Pay your premiums on time or you risk losing your policy and any benefits you’ve invested in.
You usually have the option of selecting the waiting or elimination period for your policy. When you require long-term care, this period begins. Consider this period to be similar to your auto insurance policy’s deductible – the shorter the waiting period, the higher your premiums will be.
Method 2 Applying for Medicaid
1. Check to see if you’re qualified. Unless the value of your assets falls below a certain threshold and your monthly income is less than the federal poverty level, you are ineligible for Medicaid.
If you have a low income and few assets, it may be better to wait and apply for Medicaid when you need long-term care rather than straining your finances by paying an extra insurance premium.
Some states also have long-term care insurance programmes that can assist you in meeting your long-term care needs if Medicaid requires you to spend down your assets in order to qualify for Medicaid services.
Contact the Medicaid office in your area. Medicaid is a federal-state partnership programme, with local offices accepting and reviewing applications.
More information about Medicaid offices and procedures can be found by clicking on your state on the map at https://www.insurekidsnow.gov/coverage/index.html.
Medicaid applications, information, and assistance are also available in many states through Aging and Disability Resource Centers. These facilities provide information on public and private long-term care options for seniors and people with disabilities.
2. Compile documentation. To complete your Medicaid application, you will need information about your income, assets, and medical need.
Your state agency will require copies of your most recent tax returns or tax bills to validate your income and assets. If you own a home, you may also be required to provide a real estate appraisal and copies of your mortgage.
You will also need to provide proof of your age and citizenship, as well as proof of all sources of income, including any benefits.
3. Complete your application form. You may be able to download an application online, or you may be able to obtain one by visiting your local Medicaid office or calling and requesting that one be mailed to you.
You might be able to get someone else to fill out your application for you, but that person will need access to your financial records and be able to answer all of the application’s questions completely.
Your application will request information about your income, assets, and medical needs. The documents you collected can assist you in answering these questions.
Each state may have slightly different application procedures, so check with your state’s Medicaid office to find out what is required in your state.
After you submit your application and all required documents, the state Medicaid office must usually make a decision on your eligibility within 45 days.
4. Complete your functional eligibility evaluation. If you require long-term care, Medicaid requires this evaluation before you can be approved.
The functional eligibility assessment assesses your ability to perform basic daily activities such as bathing, eating, and using the toilet.
The assessment also considers whether you require skilled services on a daily basis, such as assistance from a licenced nurse.
You will be evaluated by a medical specialist, such as a nurse or social worker, who is licenced to perform these assessments in your state. He or she will go over the information you provided and may conduct an interview with you.
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