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Long Term Care Insurance: Do I Qualify? | Fedelta Home Care, Seattle WA

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June 01, 2022

Long Term Care Insurance: Do I Qualify?

Long-Term Care Insurance: Do I Qualify?

Having solid insurance is important at every stage of life, but gets even more important (and in some cases more difficult to navigate) as you age. You may have some concerns about whether or not certain kinds of treatment or care are covered under your insurance plan. This can be especially true if you’re counting on utilizing Medicare or Medicaid once you retire or about to turn 65. In many cases, unfortunately, certain forms of long-term care—including caregiving for chronic conditions outside of a hospital—are not covered.

Thankfully, the Washington State Cares Act has established a fund to help seniors pay for the cost of long-term care insurance through a nominal payroll tax! Keep reading to learn more about the ins and outs of long-term care insurance, as well as whether or not you qualify as insurable.

Learn more about navigating Long Term Care Insurance in this blog post.

What Is Long-Term Care Insurance?

While Medicare and Medicaid cover a fair amount of your medical costs, there are certain types of care involved with disabilities and chronic illness that may not be covered. While this is unfortunate, it’s important to stay abreast of any new information and learn whether or not you qualify early. Knowing whether or not you qualify can allow you and your family to look into other options if needed. There are times when services like skilled nursing care aren't covered by your insurance but you may in fact still need the care. Enter the long-term care insurance plan. 

Long-term care insurance can help you pay for some of the costs associated with in-home care, assuming that you meet your policy’s criteria. If you’ve taken advantage of the Washington State Cares Act to fund your long-term care insurance policy, that means that cost may not be as prohibitive in selecting the best Seattle in-home caregiver to meet your needs.

Keep in mind that according to state law in Washington, long-term care insurance is an “insurance policy, contract or rider that provides coverage for at least 12 consecutive months to an insured person if they experience a debilitating prolonged illness or disability.”

What Qualifies Me For Long-Term Care Insurance?

In terms of coverage, long term care insurance can help you manage the costs associated with the following: 

  • Diagnostic Work
  • Preventative Medicine
  • Rehabilitation
  • Personal Care

The caveat is that these services need to be provided outside of a hospital setting. 

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You can purchase long-term care insurance from a specialized provider or take out a rider on your existing insurance policy. Keep in mind that according to the Office of the Insurance Commissioner, “To qualify as LTC in Washington state, a long-term care rider attached to a life insurance or annuity policy must pay a benefit dedicated to cover long-term care services.” Your best bet is to look for standalone LTC policies and riders that are already recommended by the Office of the Insurance Commissioner so that you don’t wind up with coverage that you can’t use.

What criteria must be met in order to receive long-term care insurance? For starters, in order to receive a payout, you’ll need to have lost the ability to independently to perform at least two of the following activities without assistance:

  • Eating
  • Dressing
  • Bathing
  • Using the bathroom (or controlling your bladder)

What Disqualifies Me From Long-Term Care Insurance?

Depending on the policy or rider you purchase, there may be some exclusions that you need to be aware of before you intend to use your insurance. For starters, many insurance companies require a waiting period for long-term care insurance, and some may also have an extra waiting period if you have a pre-existing condition which has already been diagnosed by a medical professional.

You may also find when comparing various long-term care insurance providers that some have restrictions about mental illness (with exceptions for conditions like Alzheimer’s), injuries that were self-inflicted or coverage outside of the United States. Also, if you have a rider known as an accelerated death benefit, that would not qualify as long-term care insurance. An accelerated death benefit is related to your life insurance and is only intended for use by those with terminal diagnoses, as opposed to chronic illnesses or disabilities. 

"Insurance can be a complex and emotionally fraught subject, but with the right information, you can make the most appropriate decision for you and your family. Make sure to really dive deep into your insurance policy before signing up for long-term care insurance so that you fully understand how it can and can’t be used." - Krista Hunter, CEO

If you’re still confused and need additional assistance please reach out to a Fedelta Home Care Advisor today.