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Living on a fixed income can present significant challenges, especially when faced with the rising costs of long-term care. According to the Department of Health and Human Services, more than half of Americans turning 65 today will require some form of long-term care, making it essential to plan ahead. This is especially true if nursing […]

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Long-Term Care Insurance: The Basics

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Long-term care insurance is a financial safety net designed to cover the costs associated with extended care services that aren’t typically covered by health insurance, Medicare or Medicaid. These services include assistance with daily activities such as bathing, dressing, eating and mobility, which may be provided either at home, in an assisted living facility or in a nursing home. As such, it’s sometimes referred to as nursing home insurance.

","

Policies are tailored to meet individual needs, and offer coverage for various levels of care. Things you’ll want to consider include the daily benefit amount, the duration of coverage and any elimination period (the waiting time before benefits begin). Premiums vary based on factors such as age, health and the specific features of the policy.

","

Securing long-term care insurance early, ideally in your 50s or 60s, can result in lower premiums and increased chances of qualifying for coverage. While it requires a financial commitment, this type of insurance can protect your savings and provide peace of mind by ensuring access to quality care when needed. Consulting a financial advisor can help you navigate policy options and select a plan that aligns with your long-term goals.

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Nursing Home Insurance: What to Consider

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Before you buy a policy, get an idea of what you want and what’s available. Here are three key points to keep in mind.

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1. Buy it before you need it. First, consider buying nursing home insurance before you need it. Just like life insurance, long-term care insurance is cheaper if you’re younger and in better health. Your chances of being denied a policy are lower, too.

","

The American Association for Long-Term Care Insurance provides the following estimates of annual premiums based on its 2024 study of different long-term care insurance carriers.

","

Annual Premium Estimates

","

Status	Age	Premium
Single Male	55	$950
Single Female	55	$1,500
Couple	55	$2,080 (Combined cost)

","

Unlike most life insurance policies, however, nursing home insurance policies can raise your rates over time. Make sure you have enough in the budget to cover future increases.

","

2. Get the right amount of coverage. Next, consider the amount of coverage you need. Remember that the average cost for a shared nursing home room is $8,600 a month. That cost will rise, and you’ll want to make sure you have enough coverage when you truly need it. Read up on the maximum a plan will pay per day or per month, then compare it to your anticipated needs.

","

3. Know your benefit period. In addition to a maximum dollar amount, plans may have a cap on how long they’ll pay benefits. Benefit periods can be anywhere from two years to the rest of your life, but lifetime policies are uncommon – and likely much pricier.

","

Although pricey, if you follow the above rules, long-term care insurance can be extremely helpful down the road. Here’s a breakdown of a few important benefits associated with these policies:

","

Keeps you from eating into your hard-earned savings for a nursing home.
Can bring you peace of mind knowing you’ll be covered if you need help down the line.
Gives your children comfort that their inheritance won’t be consumed by your long-term care costs.
Reduces your need for federal help from sources like Medicaid – which should only be used as a last resort because it can limit your options.

","

Understanding the “Elimination Period” of Nursing Home Insurance

","

","

An elimination period is the time between when you are first eligible to receive nursing home benefits and when you actually begin receiving them. Usually, you’re first eligible when you need help with at least two ADLs – which is verified by a nurse or doctor – after which your elimination period begins.

","

You can think of an elimination period as a waiting period, during which time you must cover your own costs in a nursing home. Once the period is over, your plan’s coverage kicks in and pays for your nursing home stay. Nursing home insurance policies typically let you choose your own elimination period, like 30, 60, or 90 days. If you choose a 60-day elimination period, you’d likely need to spend 60 consecutive days in a nursing home (while covering your own costs) before your policy pays a dime. That means an expense to you of $14,700.

","

Many people relate an elimination period to a deductible, where rather than paying dollars, you “pay” in days. And much like high deductible health plans, if you choose a longer elimination period, your premium will be lower. If you choose a shorter elimination period, your premium will be higher.

","

Look Into Buying Extra Benefits

","

Some nursing home, or long-term-care, policies have additional perks, such as a waiver of premium. With this perk, once you begin using your policy’s benefits, you no longer need to pay premiums to keep your coverage.

","

Other policies offer “shared” coverage, extending coverage to both you and your spouse or partner. Sometimes called a joint policy, this type of coverage provides assurance that if one person doesn’t use all the benefits, the other still can – a very handy option for many couples.

","

Another possible addition to some policies is inflation protection, which increases your policy’s payouts to match inflation. And with the cost of care rising each year, that could be crucial to receiving adequate coverage. Of course, any extras could end up increasing your monthly premiums.

","

Do States Offer Long-Term Care Partnerships?

","

You may already know that Medicaid can pay for long-term care in a nursing home. However, this is only after you spend nearly every penny of your personal savings. Long-term-care state partnership programs can be a solution to this dilemma.

","

In a long-term-care state partnership, people can buy long-term-care policies approved by the state. These then protect that person’s assets once insurance benefits run out. Practically speaking, this means a person can qualify for Medicaid while having a higher net worth, allowing protection for their savings while Medicaid covers continuing long-term care costs.

","

As a simplified example, suppose a person bought a qualified policy for $100,000 and used all the policy’s long-term care benefits but needed more care in a nursing home. Because the policy was within the state partnership program, the person could disregard up to $100,000 of their personal savings and qualify for Medicaid coverage to continue nursing home care without paying from their pocket.

","

To apply for a state partnership policy, check with your state’s department of insurance. You’ll also need to see that the policy you want meets your state’s requirements. For instance, this could include inflation protection or waiver of premium.

","

Bottom Line

","

","

The likelihood that many of us will need long-term care makes nursing home insurance an important option to consider. You can also look into long-term care insurance policies that provide in-home care. If you decide to buy insurance, don’t delay. Finally, be sure you understand your policy’s elimination period, whether you can share it with a spouse and that your annual premiums may edge up over time.

","

Tips for Preparing for Healthcare Expenses

","$30","

Photo credit: ©iStock.com/FredFroese, ©iStock.com/Anetta_R, ©iStock.com/lisafx

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As you approach retirement, it’s understandable to ask what Medicare and Medicaid cover. There’s good reason for that question, as both Medicare and Medicaid cover quite a few types of healthcare costs. It’s imperative to understand how Medicare and Medicaid cover long-term care. This is especially true once your or a loved one’s ability to perform activities of daily living declines, at which point you may consider how a nursing home can help. For help with your full estate plan, consider working with a financial advisor.

","

Activities of Daily Living and Nursing Homes

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Before looking at what Medicare and Medicaid cover, it’s helpful to review the situations in which they offer their distinct services. One of the most common situations arises when someone gets to a point where it’s difficult or impossible to perform some activities of daily living (ADLs). ADLs are tasks that people must do every day to remain independent, and they include:

","

Getting in and out of a bed or a chair
Walking around (ambulating)
Using the bathroom
Brushing teeth or combing hair
Dressing and undressing
Feeding oneself

","

Once a person cannot perform one or more ADLs, they may choose to go to a nursing home. Nursing home is a general term describing a broad category of homes that provide care to residents, but the National Institute on Aging puts it the most succinctly: “A nursing home is a place for people who don’t need to be in a hospital but can’t be cared for at home.”

","

Generally, nursing homes provide long-term care for people who struggle with ADLs, but they can provide much more. Nursing homes can hire skilled nursing staff or other staff to help accommodate residents with ADLs as well as provide room, board and recreational events or outings.

","

Does Medicare Cover Nursing Homes?

","

Medicare doesn’t typically cover nursing homes and for two reasons. One is that Medicare seldom pays for room and board. Another is that Medicare doesn’t cover custodial care (another way to say “care for ADLs”) if the individual doesn’t specifically require attention from a medically trained specialist.

","

However, Medicare would cover any medical needs that might arise while a person is in a nursing home, such as needing hip surgery after a fall (if surgery were medically necessary).

","

Additionally, if the care needed was above the level of a nursing home, Medicare might cover it. For example, if a Medicare-enrolled person needed rehabilitation after surgery, Medicare Part A would pay for treatment in a skilled nursing facility (SNF). Treatment in an SNF could include a semi-private room, meals, physical therapy and more – supposing the patient has enough days left on their benefit period. See everything Medicare Part A covers here.

","

Does Medicaid Cover Nursing Homes?

","

","

Yes, Medicaid covers the cost of nursing homes, though coverage varies from state to state. Also, Medicaid should cover the cost of a nursing home once a person receiving Medicare coverage falls below a specified resource level.

","

A nursing home that meets the federal standards set by Medicaid will provide the following free of charge to Medicaid-eligible residents:

","

Semi-private room
Food specific to the needs of the resident
Nursing care
Activities to promote well-being
Basic grooming and hygiene services
Medications

","

Medicaid doesn’t include any extras (things like a TV, clothing, books or magazines, a private room, etc. – the “non-essentials”). Items or services such as these will be charged to the resident.

","

To check your eligibility for Medicaid or ask questions about your state’s Medicaid program, see this Medicaid.gov hub of state sites.

","

What Is Medicaid?

","

Medicaid is a state and federal program healthcare program that gives financial assistance to low-income people who are 65 and up or who have qualifying disabilities.

","

Medicaid is somewhat standardized by the federal government, but every state can make its own rules on who is and isn’t included. Since coverage varies, be sure to investigate your own state’s Medicaid qualification rules to see if you qualify and what it can pay for in your circumstances.

","

However, one consistent rule in every state is that, unlike Medicare, Medicaid will pay for custodial care (care that helps with ADLs). Of course, it only helps you if you can qualify for Medicaid.

","

There is good news in all of this: if you tried to qualify for Medicaid in the past but didn’t because your resource level was too high, you may be able to qualify if you need to be in a nursing home. Many state Medicaid programs allow people with higher incomes or resource levels to be eligible for nursing home care, so it’s worth trying again if you can.

","

What Are My Options to Pay for a Nursing Home?

","

Nursing homes can get costly. If you enter into a nursing home and have to pay for it yourself, there are several options:

","$41","

The Bottom Line

","

","

In general, Medicare doesn’t pay for nursing home care while Medicaid does – for qualified people. To qualify for Medicaid coverage one must, speaking generally, have resources below a certain level and be 65 or older. There are some situations when Medicare will cover nursing home care, for example, when a person is recovering from surgery and needs SNF. Other options for funding nursing home care include life insurance, long-term care insurance or spending down your own money until your resources fall below a level specified by your state’s Medicaid program.

","

Tips for Long-Term Care Planning

","$42","

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