When does a long-term care insurance policy start to pay for care?

Every long-term care insurance policy differs when it comes to what triggers benefits. In general, a long-term care insurance policy begins to pay benefits when someone suffers from cognitive impairment and/or is unable to perform two of the six activities of daily living.

Before that happens, however, a policyholder must first meet the elimination period. You can think of the elimination period as a deductible measured in time instead of money. It’s a waiting period between when an illness or disability begins and when you start receiving benefits.

During the elimination period, you are responsible for covering any expenses related to your care. Most long-term care insurance policies have an elimination period that lasts 30, 60 or 90 days. By choosing a longer elimination period, you may be able to lower your premium costs.

As a reminder, most of today’s long-term care insurance policies come bundled with life insurance coverage (or an annuity). This means you get two important coverages in one policy: life insurance coverage that offers your loved ones financial support if you were to pass away and long-term care coverage if a chronic illness or disability required you to need long-term care. Learn more about the benefits of these hybrid policies.

What Triggers Long-Term Care Benefits

It’s always best to read over your individual long-term care policy to understand the exact conditions that trigger long-term care benefits.

That said, many long-term care policies start to pay when the elimination period is met and one of the two following criteria are met:

  • You have severe cognitive impairment, such as Alzheimer’s Disease or other forms of dementia, that make it impossible for you to safely live independently.
  • You’re unable to perform two of the six activities of daily living (ADLs) without assistance or supervision. Typical ADLs include being able to:
    • Control your bladder and bowel movements
    • Dress yourself
    • Use the toilet and attend to your personal hygiene
    • Feed yourself
    • Bath yourself
    • Move yourself into and out of a bed and chair

If you feel you meet your long-term care insurance policy’s criteria for receiving benefits, you’ll want to file a claim as soon as possible. Learn more about how to file a long-term care insurance claim.

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