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Understanding Your Long Term Care Insurance Benefits, Part 8: What Does My Long-Term Care Insurance Policy Cover?

The purpose of this video is to talk about the types of care covered by most long-term care insurance policies, the costs and benefits of your policy, and the criteria for activating a claim against your policy. One vital distinction that we discuss when activating a claim is that typically it can be done based on the need for assistance with ADLs -OR- a cognitive impairment.

This video is part 8 of a video series that has been created to help individuals obtain a better understanding of Long-Term Care Insurance. More specifically, what Long-Term Care is, who needs Long-Term Care, what the types of Long-Term Care are, what Long-Term Care Insurance covers, Considerations, and whether or not someone can still purchase long-term care insurance.

The entire video series can be found here on our YouTube channel:


What does your long-term care insurance policy cover?

I'm going to speak more in generalities on this slide because every policy can be a little bit different. The costs and the benefits are going to differ based on when you bought the policy, how much coverage you wanted, and any optional benefits, such as an inflation rider, death benefit, or spouse coverage. Each policy can cover different types of long-term care.

For example, some cover both home-based care and community-based care, while others only cover home-based care or only cover community-based care. In some cases where a policy has been written to cover only community-based care, you might find that you can work with the long-term care insurance provider to show them that the cost will actually be lower if you stay at home and receive care there.

The costs or the premiums, as well as the benefits of your long-term care insurance policy, are based on how old you are when you purchase the policy, the maximum amount the policy will pay, and any other additional or optional benefits that you choose, such as the inflation rider that we spoke of previously.

To be eligible to open a claim against the policy, in most cases, you must require either substantial assistance with at least two of the six ADLs recognized by long-term care insurance companies, and those are eating, bathing, dressing, toileting, continence care, and transferring -OR- substantial supervision to protect yourself from threats to health and safety due to cognitive impairment.

For example, what would be included under cognitive impairment are Alzheimer's and Parkinson's disease. One thing that is important here is the use of the word "or." You're either eligible based on requiring assistance with two of the six ADLs OR you require substantial supervision due to your cognitive impairment. It is not both. So, I'm making an important distinction here. It's one or the other. Either you require assistance with two of the six ADLs, or there's a cognitive impairment.

Now, if you're activating a claim based on a cognitive impairment, here's something to consider. If, for example, your loved one cannot stay home safely by his or herself while you go out and run errands, well, that's likely going to be an appropriate situation to activate a claim.

Also, I want to point out that you want to be honest when the assessment is done in terms of when you have filed your claim. So, one mistake that I see sometimes is that individuals let pride stand in the way of them receiving the care that they need. For example, a person who needs help, even if that help is just someone standing by when they are bathing so they don't fall, that person may tell the insurance company, "Hey, I can bathe on my own."

Or another example is a person that can do most of their dressing, and I'm talking about putting on their clothes, they can do that by themselves but still need some assistance. So, for example, putting on their socks, and that is a part of dressing that needs to be considered. So, my point is don't let pride get in the way of getting your claim approved.

We oftentimes, here at this agency, can be available for our clients in person during an assessment by the insurance company to help advocate for them.

Thank you for watching this video. Make sure you watch the next video as we continue this discussion about long-term care insurance policies.


Home Helpers of Bradenton is one of the region's leading home care franchises specializing in comprehensive services for seniors. Home Helpers' sole mission is to make life easier for clients and their families. Based in Bradenton, Florida, the company serves all of Manatee County, including the communities of Anna Maria, Bradenton, Bradenton Beach, Ellenton, Holmes Beach, Lakewood Ranch, Longboat Key, Palmetto, and Parrish. For more information or to request a free in-home care assessment, contact our office at (941) 499-5946 or visit our website