Long-Term Care Insurance Terminology can be Tricky

Long-term Care (LTC) insurance –  is insurance that helps defray the costs of assistance with the activities of daily living or the costs of supervision due to a severe cognitive impairment – John Hancock

The Messiah Lifeways Coaching office occasionally fields calls from clients or their families with questions about their long-term care insurance policies. I can say after many of these conversations, the world of long-term care insurance can be overwhelming and confusing to some, especially when it comes to understanding what a policy does or does not cover. In Pennsylvania, the terms assisted living and personal care, once again, confuse consumers. I’ve written a number of articles explaining the difference between these two separate levels of care specific to PA. And though it’s nice to have choice, these separately recognized and licensed services often throw people when researching their coverage options. It can make policyholders question whether their claims will be approved, because the policy terminology does not identically match the level of care they anticipate needing.

Stale and regional terminology

Some consumers may have purchased a long-term care policy 5, 10 or even 15 years ago. And like many things in life, long-term care terminology has changed over that period of time. I recall looking at policies not all that long ago that still referred to nursing care as convalescent care and other policies using terms like domicile care. These terms are outdated and could mislead someone regarding their coverage. Furthermore, some policyholders will whip out the original policy from 15 years ago and do not have the updated language, statements, and coverage changes attached when they are ready to tap in to it. Another issue is where the insurer is based. If you live in Pennsylvania, but your policy is from another state, they may call the service or level of care something else. This is just the tip of the iceberg. The glossary of terms can be quite extensive. Click here to see a sample list from John Hancock. Interestingly enough, this list does not include the term “personal care home,” but that doesn’t mean they don’t cover it, as you’ll learn below.

Making sense of it all

First and foremost, my best advice for figuring out terminology and coverage is to call your insurer with your questions or concerns. However, I know some seniors struggle with getting the details or clarification over the phone. Therefore, schedule an appointment with a long-term care insurance broker or counselor affiliated with your insurance company. Here are a few other bits of advice to share:

  • Keep your long-term care insurance policy in an easily accessible place, especially if family member needs to obtain it for you if you’ve fallen ill.
  • Review your policy every 6 months with another family member or an insurance counselor
  • Read your policy thoroughly – it may be tedious, but it’s worth it.
  • If the original insurer sells the policy to another company or is bought out, be sure you have all the up-to-date contact information, coverage details and statements to either attach to or replace the original policy.
  • Don’t let it policy lapse.
  • Don’t forget you have a policy (I’ve seen it happen).

Lastly, regarding the original issue of personal care and assisted living terms causing uncertainty about coverage, I suggest that you do not get too hung up on this issue. In the end, if you need care and are ready to tap into the benefit, your insurer will require some sort of medical or physical evaluation either by a nurse or designee, your physician or the facility that will providing the care. This assessment will reveal the activities of daily living you require assistance with. This may include, but is not limited to, personal care activities like bathing, dressing, eating, transferring, toileting, continence, mobility and cognitive status. This will determine if you are eligible for coverage rather than focusing on a specific term.

For more information or contacts regarding long-term care, please contact the Messiah Lifeways Coaching office at 717.591.7225 or email Coach@MessiahLifeways.org.

Matthew J. Gallardo

Matthew J. Gallardo

Matt is the Director of Community Engagement and Coaching at Messiah Lifeways. He brings nearly 20 years of experience in counseling, advocating, and guiding older adults and caregivers through many of life’s tough decisions. His diverse background of working in hospital and rehabilitation settings, community services, and senior housing gives him the breadth and depth of knowledge to provide unique solutions, opportunities, and help individuals proactively plan for the future. He serves as the Lifeways Coach and as a writer, blogger, podcaster, and speaker for Messiah Lifeways, located in Mechanicsburg, PA.

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