What are the typical caveats and restrictions of Long-term Care Insurance?

There are many to know and understand.  For example, try to have a clear understanding about:

Limits on benefits
Benefits are usually described in terms of the amount the carrier will pay per day for care in a nursing home and vary from $75 up to $250 a day. Gain familiarity with the general charges for nursing homes in your area before you buy a policy. Keep in mind that prices will increase by the time you will need care, so all you are obtaining is a reference level to familiarize yourself with the market. Once you know prices in your area you can calculate the range of future charges by following the Rule of 72. This simple formula allows you to determine the length of time it will take for a price to double at a given rate of interest. Assuming a nursing home near you charges $100 per day and that nursing home charges will increase at an annual rate of 6% per year. How long will it take the price to reach the $200 level? The answer is calculated by dividing the number 72 by the interest rate. Seventy-two divided by six gives a quotient of 12. Assuming a six percent rate of inflation, the $100 a day charge will double in 12 years. So if you are 60 years of age and purchasing a policy with the expectation that you may need nursing home care in your early seventies, you should be looking for a policy that will be paying benefits of at least $200 per day twelve years from now.

Home care is growing in popularity with patients and carriers so read policies carefully for limits. Many policies usually agree to pay for home care at a rate that is one-half of the nursing-home rate. Other policies limit the benefits for home care to a specified daily sum or limit the number of hours at a specific rate per hour.

All policies allow you to specify how long you desire benefits to last. Benefit periods range from one year to life. Remember that most nursing home stays are three months or less and many people have illnesses that last for years. Obviously policies with long benefit periods cost more. How do you decide? If you own your home or have a minimum mortgage and will be depending upon Social Security and a company pension for retirement income, you will want to protect your equity in your home in order to preserve a place for your spouse to live. Assume that you will need up to 19 months in a nursing facility at current rates and compute that cost. Compare that to your available assets and you can begin making some intelligent choices.

Carefully consider any limits on benefits if you have a repeat stay in a nursing home. Some policies require that you must be discharged from a nursing home for a stated time period before you can be re-admitted. Others calculate the second admission as part of the first if you return within 30, 90 or 180 days. Does the policy require an elimination period to run again for a second stay? Repeat nursing home admissions are not the rule, so this is a minor consideration when comparing policies.

Under home care provisions, the benefit period is usually more limited than for nursing home stays and benefit periods of one to two years are available.

Calculating when benefits will begin
Most policies do not pay benefits until after a waiting period, commonly called "an elimination" or a deductible period. That means benefits begin 20, 30, 60, 90 or 100 days after you are admitted to a nursing home. Some policies have no elimination period and they naturally cost more. During any waiting or elimination period, you are responsible for paying for your care, but there are significant trade-offs. Having a reasonable waiting period during which you are personally responsible for your care means the insurance company can expect to pay out fewer benefits and accordingly underwriters can establish lower prices for these contracts.

Waiver of premium
A provision waiving premium payments is common in health insurance policies. It discontinues your legal obligation to pay premiums if you are receiving benefits. Some companies stop billing you as they make the first benefit payment. Others wait 60 to 90 days. Often premiums are not waived while you are in a hospital or if you are receiving care at home.

Nonforfeiture benefits
Nonforfeiture benefits in policies provide that at least some benefits will be paid even if the buyer fails to keep up premium payments and the policy is cancelled for non-payment. The benefits provided are usually minimal.

Death benefits
Death benefits are an agreement to refund to your estate any premiums you paid minus benefits paid to you.

Fear of Financial Disaster
Agents skillfully utilize carefully contrived scripts to stampede customers to buy now by using the fear of financial ruin, becoming dependent on family or going on "welfare" because of catastrophic medical bills. Sometimes more subtle tactics are used, but real scare tactics are effectively used because they motivate many seniors to buy coverage in the first place and sales agents readily manipulate this common concern.

Uninsurable tomorrow
Closing the sale is often accomplished by telling the customer that he/she risks being uninsurable in the future, but if the consumer hands "over a check today," he or she would be covered even if an illness or disability struck tomorrow. Not so easy. Agents do not explain that a customer could still be turned down for the policy and he or she would not receive any benefits, regardless of whether the prospective insured paid the whole premium immediately.

Another technique is to threaten the risk of increasing premiums in the future so that consumers will "buy now." But buying long-term care insurance at a younger age can be a mistake. Many policies limit increases for inflation after 20 years or at the point where the original benefit doubles, so a consumer buying early in life could be left with inadequate benefits when needed.
What are some tips for getting the best deal, or the most appropriate coverage?
Who offers long-term care policies?
What are the long-term care policy product offerings like?
How much does it cost?
What are the long-term care policy product offerings like?
What are the typical caveats and restrictions of Long-term Care Insurance?
What is Inflation protection?
What are some examples to avoid?
 
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