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Navigating Long Term Care Insurance: Why Is It So Difficult? | Fedelta Home Care, Seattle WA

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February 15, 2022

Navigating Long Term Care Insurance: Why Is It So Difficult?


Health insurance and other types of insurance policies can feel like critical decisions to get right; however, the systems are quite complex. This makes it challenging for the average person to evaluate their insurance options, and pick the right coverage for their perceived needs and risk tolerance. Many times the emotional side of the equation winds up tipping the scales one way or the other, too.


As you evaluate your retirement and future financial needs, medical care is going to be an important financial component of your calculations. While nobody wants to admit it, there is some likelihood that you might be diagnosed with a chronic illness or condition that necessitates the benefits of in-home service care or a skilled nursing facility. In these situations, your health insurance may not cover the costs associated with your care. In that kind of situation, long term care insurance might be just what you need. Here’s what you should know about long term care insurance. 


At Fedelta, we understand the importance of preparing for unexpected health events. This is why we’ve made understanding and discussing your long term care insurance options a priority for our clients and their families.”

  • Matthew Helbert, RN - Director of Clinical Services 


What is Long Term Care Insurance?


Most health insurance policies like Medicare and Medicaid won’t cover certain costs associated with disabilities or chronic illness. At the same time, specialized senior companion care might be necessary in order to have the quality of life you deserve. It’s estimated that about two thirds of seniors 65 and older may need at least a few years of long term support or care in their lifetime. This may impact your finances significantly if your retirement funds and savings aren’t enough to cover it. 


Long term care insurance helps fund this sort of care, in the event that you do receive a diagnosis that meets the criteria of your policy. Long term care insurance policies can help cover specialized care from a variety of specialty, professional providers, including in-home service care, 24-hour caregivers and skilled nursing facilities.


How will long term care insurance influence those living in Washington?


If you live in Washington state, then you have the opportunity to take advantage of new legislation aimed at helping address the developing long-term care crisis. With so many seniors likely needing assistance in some way, Washington recently launched the WA Cares Fund. This fund uses worker contributions to help fund an insurance plan that aids in paying for the cost of long term care.


In order to qualify for the WA Cares Fund, you’ll need to meet one of the two criteria listed below: 

  • Working at least ten years (at any point in your life) without a break of five or more years within those ten years.

  • Or, working at least 500 hours per year during those years. 


You can learn more about the fund and how to earn your benefits online. One benefit of Washington’s online portal is the ability to access features like a paycheck calculator that helps you determine how much per paycheck you will need to contribute in order to be eligible for the WA Cares Fund. For example, someone making $40,000 gross pay annually would only wind up contributing a little under $20 a month to the program to have the peace of mind that comes with it.


What are some of the difficulties in obtaining Long Term Care Insurance?


There are a variety of hoops and obstacles to navigate that may make it difficult to obtain LTC insurance. As such, it’s important to review the eligibility requirements of your policy to make sure that you know what does and doesn’t constitute qualifying circumstances. Generally speaking, if you need supervision or help from another person to assist with at least two common tasks like bathing, eating, dressing, or mobility you may qualify. That being said, some caregivers might not be covered under your policy. 


Additionally, some policies only activate if you’ve previously been admitted to a hospital or skilled nursing facility. Knowing the ins and outs of your policy before you need to use it can help you avoid these challenges and get the support you need.


What are alternatives to Long Term Care Insurance?


Unfortunately, the only real alternative to long term care insurance is just footing the bill yourself. This means maximizing your retirement accounts, other savings, or asking family members for financial assistance. Of course, if you live in Washington, you should be able to take advantage of the state’s new legislation.


Long term care insurance can seem daunting, but as long as you carefully read your policy and ask questions, you shouldn’t run into too many problems. Best of all, if you currently reside in Washington state, you may not need to get your own policy.