Long-Term Care Policy Premium Rate Increase Request Review Process

Your Long-Term Care Insurance Policy, Why Do My Premiums Keep Going Up? – Consumer Brochure

What is Long–term Care?

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. This care may include help with daily activities, as well as home health care, adult daycare, nursing home care or care in a group living facility. Long–term care insurance is one way to pay for long–term care. It is designed to cover all or some of the services provided by long–term care.

When will benefits be available?

Long–term care policies have an elimination period, which is the number of days you must need nursing home care or home health care before your policy pays benefits. A shorter elimination period will mean you pay a higher premium. Elimination periods may range from 0 to 180 days.

Are there other triggers that must be met before benefits can begin?

Most policies require that you be unable to perform a given number of daily living activities, such as dressing, bathing and eating without assistance. Also, most policies have a benefit trigger for cognitive impairment.

How much in benefits will the policy pay?

The benefit amount usually is a daily benefit ranging from $50 to $250 per day.  A maximum benefit period may range from one year to the remainder of your lifetime. It is important to ask the person selling the policy if the benefit amounts will increase with inflation and if that coverage increases your premium.

Are there exclusions?

Every policy has an exclusion section. Some states do not allow certain exclusions. Many long–term care policies exclude coverage for the following:

  • Mental and nervous disorders or diseases (except organic brain disorders)
  • Alcoholism and drug addiction
  • Illnesses caused by an act of war
  • Treatment already paid for by the government
  • Attempted suicide or self inflicted injury

Is long-term care right for me?

Whether you should buy long–term care insurance depends on your age and life expectancy, gender, family situation, health status, income and assets.

  • Age and Life Expectancy: The longer you live, the more likely it is that you will need long–term care. The younger you are when you buy the insurance, the lower your premiums will be.
  • Gender: Women are more likely to need long–term care because they have longer life expectancies and often outlive their husbands.
  • Family Situation: If you have a spouse or adult children, you may be more likely to receive care at home from family members. If family care is not available and you cannot care for yourself, paid care outside the home may be the only alternative.
  • Health Status: If chronic or debilitating health conditions run in your family, you could be at greater risk than another person of the same age and gender.
  • Income and Assets: You may choose to buy a long–term care policy to protect assets you have accumulated. On the other hand, a long–term care policy is not a good choice if you have few assets or a limited income. Some experts recommend you spend no more than 5 percent of your income on a long–term care policy.

Do you qualify for Medicaid?

As an older adult, you may qualify for Medicaid, which pays almost half of the nation’s long–term care bills. To qualify for Medicaid, your monthly income must be less than the federal poverty level, and your assets cannot exceed certain limits. Medicaid will cover you only in Medicaid-approved nursing homes that offer the level of care you need. Under certain circumstances, Medicaid will pay for home health care.

Are there state options for long-term care?

The Connecticut Partnership for Long-Term Care is a program of the State of Connecticut that works in alliance with the private insurance industry. It is a joint effort by State government and private industry to create an option to help you plan to meet your future long-term care needs without depleting all of your assets to pay for care. For more information on the Connecticut Partnership click here.