When Does Long-Term Care Insurance Kick In?

Shawn Plummer

CEO, The Annuity Expert

Navigating the insurance world can often feel like a labyrinth, especially regarding long-term care insurance (LTCI). You’ve probably asked: When does long-term care Insurance kick in? Why does it take a while before benefits are activated? What triggers the start of these benefits? Today, we’re breaking down the answers to these questions straightforwardly. So let’s unravel the complexities of LTCI together.

Understanding the Basics of Long-Term Care Insurance

Long-term care insurance is a specific policy designed to cover costs related to long-term care services, often not covered by regular health insurance or Medicare. These services could include assistance with routine daily activities, such as bathing, dressing, eating, and mobility — often called Activities of Daily Living (ADLs).

When Does Long-Term Care Insurance Kick In

When Does Long-Term Care Insurance Kick In?

Here’s the thing about long-term care insurance: there’s a specific timeline before the benefits kick in. This period, known as the “elimination period” or “waiting period,” is a predetermined time from when care is needed until benefits can be paid out. This period can range anywhere from 30 to 90 days, or even longer in some cases, depending on your specific policy.

Example: Imagine it’s like a timer set on a microwave — once you hit start (the moment care is needed), the timer (elimination period) starts counting down, and only once it hits zero (end of the elimination period) can the “meal” (benefits) be “served” (paid out).

Why Does it Take That Long for LTCI to Kick In?

The elimination period is a deductible, meaning it’s an out-of-pocket expense before the insurance company begins to cover the costs. Insurance providers do this to prevent overuse and to keep premiums lower. Therefore, your policy’s elimination period is crucial so you can plan accordingly and be prepared for these initial out-of-pocket costs.

What Triggers to Receive Long-Term Care Benefits?

Receiving long-term care benefits hinges on two primary criteria. First, you must be unable to perform a certain number of ADLs without assistance. Second, a healthcare professional must verify that this assistance is needed for an expected duration, often 90 days or more.

When Does Long-Term Care Kick In

How Many ADLs Does it Take to Trigger LTC?

In most cases, the inability to perform two out of six defined ADLs triggers LTCI benefits. These six ADLs typically include bathing, dressing, eating, transferring, continence, and toileting. However, it’s important to note that terms may vary depending on your policy.

Example: You have trouble eating independently and moving from your bed to your wheelchair. If these are due to a chronic or long-term condition and a healthcare professional can verify this, your LTCI benefits should be triggered.

Next Steps

Understanding when and how long-term care insurance kicks in is crucial in planning for future care needs. There is a waiting period before your benefits begin, often tied to your inability to perform certain daily activities. Knowing these critical details about your policy can help ensure you’re adequately prepared when the time comes for you to benefit from your long-term care insurance. Remember, knowledge is the key to navigating the labyrinth of insurance successfully. Now that you’re armed with this information, you can confidently take control of your long-term care planning.

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Frequently Asked Questions

What types of long-term care services are typically covered by insurance?

Long-term care insurance typically covers assisted living, nursing home care, and home health care.

What is the waiting period for benefits to begin after filing a claim for long-term care insurance?

The waiting period for long-term care insurance benefits varies and depends on the policy terms.

Shawn Plummer

CEO, The Annuity Expert

I’m a licensed financial professional focusing on annuities and insurance for more than a decade. My former role was training financial advisors, including for a Fortune Global 500 insurance company. I’ve been featured in Time Magazine, Yahoo! Finance, MSN, SmartAsset, Entrepreneur, Bloomberg, The Simple Dollar, U.S. News and World Report, and Women’s Health Magazine.

The Annuity Expert is an online insurance agency servicing consumers across the United States. My goal is to help you take the guesswork out of retirement planning or find the best insurance coverage at the cheapest rates for you. 

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