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Long Term Care Benefits Overview

Long Term Care Benefits Overview Blog Image

There are a variety of LTCi benefit option policy rules and features available, which can vary by state and the company providing the policy. Typical benefits include the following:

Hybrid Life/Annuity LTCi

An alternative to traditional LTCi

Daily or Monthly Benefit


Benefit amount available for reimbursement for eligible services received at home, an assisted living facility, nursing home, or adult day care.

  • Daily: $50-500 ($10 increments)
  • Monthly: $1500 – $15,000 ($100 increments)

Length of Coverage

Minimum number of days to exhaust pool of money. It may take longer to exhaust pool of money if one is requiring less than the daily or monthly maximum or if receiving benefits on a nonconsecutive basis.

  • 2 years (730 days)
  • 3 years (1,095 days)
  • 4 years (1,460 days)
  • 5 years (1,825 days)
  • 6 years (2,190 days)
  • 8 years (2,920 days)
  • 10 years (3,650 days)

Pool of Money (days x daily benefit)

Ex: 1,095 days at $100/day = $109,500 pool

Elimination Period (Deductible)

Amount of time after certification (see benefit eligibility triggers) before benefits are reimbursable. Only one elimination period must be met in a lifetime.

  • 30 days
  • 60 days
  • 90 days
  • 180 days
  • 365 days

Service Day

Eligible services must be received on a given day to qualify

Calendar Day

Eligible services not needed on a given day to qualify

Inflation Protection

Increases the daily/monthly benefit and total pool of money by a fixed percentage typically between 3% and 5%. Consumer Price Index is not a fixed percentage and changes year to year.

  • Guaranteed Purchase Option (GPO)
  • Simple
  • Compound
  • Consumer Price Index (CPI)

Common Options Riders

  • Non-forfeiture
  • Restoration of Benefits
  • Return of Premium
  • Shared Care
  • Survivorship
  • Waiver of Home Health Care Elimination

Common Standard Features

  • Adult Day Care
  • Alternate Care
  • Assisted Living Facility
  • Care Management Services
  • Guaranteed Renewable
  • Hospice Care
  • No Pre-existing Conditions Exclusion
  • Portability
  • Skilled Nursing Home
  • Waiver of Premium

Benefit Eligibility Triggers

Certification that policy holder requires substantial hands on or stand-by assistance for an expected period of at least 90 days. Either a cognitive impairment, such as senility, dementia, Alzheimer’s, or an inability to perform without assistance two of six Activities of Daily Living, ambulation, bathing, dressing, feeding, grooming, and toileting, triggers eligibility of benefit.

Request a Complimentary Long Term Care Insurance Evaluation
Trying to determine if you have appropriate coverage for home care or processing long term care insurance claims can be extremely confusing and time consuming.

If you need help determining whether or not you or your loved one qualifies for home care services under their current insurance plan, Homewatch CareGivers can help.

Homewatch CareGivers offers long term care coverage evaluations free of charge

Contact us today for a free, no-obligation Long Term Care Insurance analysis. Our experienced LTC professionals will provide a policy eligibility determination and advise you on the terms of your policy in an effort to maximize the long term care benefits you are paying for.

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