Which Policy Is Right For You?
Is the Insurance Company Financially Stable?
The most important overall factor that you should look for in a company: will it still be in existence
and able to pay benefits if and when they are needed? The last thing you need to worry about is the financial
strength of the company.
- Are Benefit Triggers Well-Defined?
- Who determines whether you need nursing home care?
- Who determines whether you need home health care?
- What has to happen for the Insurance Company to pay the benefits?
- We see two very common benefit triggers:
Activities of Daily Living (ADLs) - Benefits are triggered by a person's inability to perform some
of the following activities: bathing, transferring, dressing, eating, continence and toileting. A licensed
health care practitioner must certify a person's inability to perform 2 of these activities of daily living
for a period of 90 days. Usually two out of six ADL's will trigger benefits.
Cognitive Impairment - When a licensed health care professional certifies that you require substantial
supervision as a result of severe cognitive impairment
Does your policy cover all levels of nursing home care?
Does the policy cover all three levels of care provided in a nursing home: Skilled, Intermediate and
Skilled nursing home care is daily nursing care which can only be performed by or under the direct
supervision of skilled medical personnel.
Intermediate care calls for occasional nursing care on a skilled level.
Custodial care consists primarily of attention to personal needs, such as help in walking, bathing
All levels of care should be covered. Since fewer than ½ of 1% of the residents in a nursing
home receive skilled care, and 95% require custodial care, it is important that nursing home policies
pay benefits at all levels of care.
Home Health Care which does not require prior hospitalization or nursing home confinement.
If a policy includes home health care, it should stipulate that benefits will be paid without first
having to enter a nursing home or without a prior hospital stay.
Click here for a guide to nursing homes and home and community based care.
Does it have a waiver of premium benefit?
Many insurers relieve policyholders of paying further premiums once they've been in a nursing home
for a period of time-usually 90 days-and begin receiving nursing home benefits. In some policies, you
can even qualify for a waiver of premium while you are receiving home health care benefits.
Does it cover Alzheimer's disease?
The policy should specifically state that Alzheimer's disease and related disorders are covered. Roughly
half of all nursing home patients suffer from Alzheimer's disease and related disorders, and it is now
a law in many states that long term care policies cover Alzheimer's.