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Determining What Long-Term Care Insurance Will Cover

A patient and her doctor

It may come as a surprise to many people that health or medical insurance often do not cover in-home care services, even when those services are ordered by a physician or required when discharged from a hospital.

Research has shown that nearly 70% of Americans at the age of 65 will require some form of assistance with caring for themselves and majority of people surveyed say they want to remain at home for long as possible. Long-Term Care insurance (LTCi) covers in-home care services when assistance and support is needed for at least two activities of daily living (ADLs). Surprisingly less than 10% of Americans have long-term care insurance.

What’s the Difference?

It can be confusing what insurance covers when it comes to in-home care services and there is often misunderstanding about what in-home care services include. People don’t know the difference between in-home care services and home health services.

Home Health Services or “skilled services” are medically necessary and ordered by a physician. This care is provided by a medical professional, such as a Registered Nurse (RN), Physical Therapist (PT), Occupational Therapist (OT) or a Speech Therapist. These medical professionals can administer medications, create exercise and physical therapy programs, care for open wounds and provide advanced medical care. Home health services are typically covered by Medicaid, Medicare or private health insurance.

In-Home Care Services often called “private duty” are nonmedical services which include hands on personal care, companion care and transportation support. Personal Care is hands-on assistance with activities of daily living, such as bathing, dressing, grooming, toileting feeding and mobility. Transportation can include rides to and from a doctor’s appointment, to run errands, or visit with friends.

In-Home Care Services and Home Health Services can often overlap. For example, an In-Home Care Agency may give a client a shower whereas a Home Health Services agency could send a CNA to perform the same task. Often caregivers can receive guidance and direction from a physical therapist and help the client with exercises.

When to Purchase Long Term Care Insurance

When purchasing long term care insurance, a variety of factors should be considered, including life expectancy and how long one might be ill. One should consider the cost of long-term care insurance versus expenses associated with privately paying for in-home care or staying in an assisted living facility. It is also important to consider nursing home costs associated to chronic conditions that might affect premiums or even ability to get insurance. A study conducted by The Home Care Association of America in 2016 entitled, “The Value of Home Care” showed that in-home care can reduce the need for doctors’ visits, decrease the probability of a fall and dramatically reduce the chances of re-admission to a hospital.

When assessing the need and cost associated to long-term care options, it is important to talk to family members, financial planners and people in the long-term care industry. A great deal of information on long-term care insurance can be found on at such as a breakdown of the typical benefits for in a Long Term Care policy, details on the cost of care and an overview of our free LTC claims processing service.

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