Does long-term care insurance cover assisted living?

Most long-term care insurance policies sold in the last thirty years cover licensed assisted living and memory care, not just nursing homes. The catch is in the details of each policy. Here is how to read yours.

Five things to find in the policy

1. Covered settings. Look for “assisted living facility” or “residential care facility” and how it is defined. Minnesota-licensed assisted living normally meets the definition.
2. The benefit trigger. Typically, needing hands-on or standby help with two of six activities of daily living, or having a severe cognitive impairment. A doctor or nurse has to certify it.
3. The elimination period. A waiting period, often 30, 60 or 90 days, that you pay for yourself before benefits begin. Find out whether days are counted by the calendar or only on days you receive paid care.
4. The daily or monthly benefit. The most the policy pays, and whether it has grown with an inflation rider.
5. The lifetime maximum. Stated in years or in dollars.

Starting a claim

• Call the insurer as soon as a move is likely and ask for a claim packet. Approval commonly takes several weeks.
• The insurer will ask the community for its license, the nurse assessment, the care plan and monthly invoices.
• Most policies reimburse. You pay the community, then the insurer pays you. Some will pay the community directly if you sign an assignment of benefits.
• Keep paying the premium until the insurer confirms in writing that premiums are waived.

Common snags

• The policy requires care “under a plan of care” and nobody sent the plan.
• The elimination period only counts days with documented care, and the first invoices did not itemize care.
• The policyholder has dementia and can no longer sign. A power of attorney needs to be on file with the insurer.

Using a policy at Oakwood

Oakwood prices the base rate and the level of care as separate lines, which is the kind of itemization insurers ask for. Bring the policy when you visit, or see our rates first.

Confirm Oakwood invoices itemize base rate and care level separately, and whether staff help families with insurer paperwork.

General information only. It is not legal, financial or medical advice, and program rules change. Check details with the Senior LinkAge Line (800-333-2433), your county, your insurer or a qualified advisor.