Get Nursing Home Insurance

Nursing home insurance is a kind of safety net that will provide you with medical care when you need it, and protect you and your family from huge medical bills as you get older. This kind of coverage is also called Long-Term Care Insurance (LTCI). There are many options and providers, so it’s important to do your research. Ask about specific coverage and exclusions, and shop around with several different providers. Enroll early while you are still relatively healthy for lower premiums.

Steps

Asking the Right Questions

1. Ask about coverage specifics. It’s important to find a coverage plan that works for your specific lifestyle and level of health. Ask each provider what they cover, what the costs will be (both now and once you begin receiving care), and how this coverage fits with your specific situation.
   • Consider things like your family medical history and your current lifestyle to determine what coverage you may need in the future.
   • You should also verify that your policy covers all circumstances you think could be possible for you – like a lengthy nursing home stay or respite care.
2. Find out about benefit triggers. Many providers have specific events that are required to occur before they will begin paying out for nursing home care. Even if you are fully covered, these benefit triggers must take place before coverage benefits begin. Usually, these benefit triggers are categorized in terms of Activities of Daily Living (ADLs) or certain behavioral/cognitive impairments.
   • Some benefit triggers might include the inability to feed or bathe yourself, a deficiency in judgment or reasoning, or even short term memory deficits.
   • Ask about the benefit triggers for any policy you are interested in, and determine if you think these requirements are reasonable.
3. Ask about coverage exclusions. Most companies exclude coverage for self-inflicted injuries, drug and alcohol abuse, or even certain kinds of mental disorders. But some companies also specify certain illnesses or situations that aren’t covered by their policies, and this is where you need to be wary. These exclusions could include a disease like Alzheimer’s, or even a specific circumstance like requiring licensure of any caretakers.
   • Make sure there are no exclusions for most common illnesses – like Alzheimer’s, heart disease, diabetes, and cancer.
   • If your policy requires that a licensed professional must provide your care, it would exclude the possibility of a family member being able to care for you – unless they went through extensive (and expensive) training to become licensed.
4. Compare policies from several providers. Different providers have different coverage and premium options, so it’s important to shop around a bit before settling on one. Consult at least three different LTCI providers so that you can ask them all the necessary questions and find the policy that best suits your needs.
   • Be sure to compare coverage, cost, exclusions, and available locations/providers, and even online reviews of each insurance provider’s policy before making a decision.

Enrolling in Nursing Home Coverage

1. Decide when to start. Remember that when to enroll in this type of coverage depends entirely on your individual situation. If you have the financial stability to put away money each year on your own, that might be the right choice for you. If you qualify as a low-income citizen, you may be able to count on financial assistance from Medicaid and Medicare programs. If you have a family history of cognitive diseases like Alzheimer’s, you may need more nursing home coverage.
   • Since long-term care insurance can be quite expensive, you should decide if you can afford beginning coverage now, or if you need to wait until a later date when you have saved some additional money (but when your premiums may be higher). When thinking about your finances, it is typically true that if the insurance premiums are less than 10% of your gross income, it is a premium you should be able to afford.
   • If you need help deciding about these choices, there are several organizations that can help you discuss options, like the Area Agencies on Aging (AAAs), the Aging and Disability Resource Centers (ADRCs), and the State Medical Assistance Office.
2. Fill out the application. For most LTCI providers, you’ll simply need to fill out an application form that provides your personal information, along with some information about your medical history. In most cases, you will not need to submit to a physical examination or provide any kind of blood work or urine sample.
   • Some providers may require a face-to-face interview, but not all of them.
   • If your long term insurance provider finds out that you didn’t not notify them about a certain health condition, they may refuse payment for that condition.
3. Pay your premiums. Once you enroll in nursing home insurance, you’ll need to pay your monthly premiums. In most cases, this money will be paid directly to the insurance company. You may be able to work out quarterly payments, depending on the insurance provider’s payment options.
   • Remember that the initial premiums must be paid out of your own pocket. However, starting early will help control how medical care inflation affects you over time. Typically, medical care costs increase 4% each year, so starting early can help curb how that increase impacts your own finances.

Planning Ahead

1. Look into Medicare provisions. In the U.S., Medicare currently covers care in a skilled nursing home facility if it is medically necessary for you (and if you meet the other qualifications for Medicare). This means that if you require constant care, like for changing sterile dressings, you may qualify for nursing home coverage.
   • However, if you just need help with bathing or dressing, this qualifies as custodial care needs, which is not covered by Medicare.
   • Check with any nursing home you are interested in to make sure they accept Medicare payments. Not all nursing homes accept this type of coverage.
   • Medicaid provides some nursing home coverage for low-income individuals. So check your eligibility for this type of coverage as well.
2. Consider your financial situation. Long-term care can be quite expensive, but some people choose to plan for these needs out of their own pockets. If you are able to financially, it might be more beneficial to set aside some money each year in an interest-yielding account earmarked for long-term nursing home care.
   • Nursing home insurance is typically a good choice for middle-income families who wish to avoid burdening their family with end-of-life care costs. This includes those who have enough money that they don’t qualify for Medicaid coverage, but who can’t afford paying all of the costs out of pocket.
3. Start early. If you can afford it, begin paying for nursing home insurance sooner rather than later. After 50 years old, nursing home insurance premiums can increase significantly. You are also more likely to get a preexisting condition as you get older, which can also impact your coverage price.
   • Insurers can also deny coverage due to preexisting conditions. So the younger and healthier you are when you sign up, the better coverage and price you will get in the long run.

Tips

• This article is focused primarily on getting nursing home insurance in the United States. If you live in another country, you should consult with local insurers, government agencies, and other support organizations.

Related Articles

• Finance Nursing Home Care
• Apply for Long Term Care Insurance
• Find Health Insurance
• Find a Nursing Home for a Senior

Sources and Citations

See also

• Verify Health Insurance
• Get a Wheelchair Through Medicare
• Add a Spouse to Health Insurance
• Add a Baby to Health Insurance
• Get Health Insurance When Unemployed