Ohio Department of Insurance Communications 

“Before anyone purchases long-term care insurance, it’s extremely important to consult your family, attorney, tax advisor and review many factors, including your future ability to pay premiums and your family’s commitment to tend to your health care needs in the future,” said Mary Jo Hudson, Director of the Ohio Department of Insurance. “Long-term care insurance can be expensive and needs to be a carefully considered purchase.”

Long-term care insurance can help pay for medical care given in a nursing home, assisted living facility, adult day care center or your own home. It can also pay the expenses related to skilled care and treating sudden or ongoing health problems. Long term care policy terms vary, so it’s important to review them carefully before purchase.

The Department’s Ohio Senior Health Insurance Information Program (OSHIIP) provides unbiased and free information about long-term care insurance coverage. Ohioans can call OSHIIP at 1-800-686-1578 with questions and are urged to utilize the Department’s Shopper’s Guide to Long-term Care Insurance, available at www.insurance.ohio.gov. You can also request that the guide be mailed to you.

Important things to consider before purchasing long-term care insurance

1. Consider whether or not long-term care insurance is right for you

• Review your budget. Premiums for long-term care insurance can be expensive. Make sure that your current and anticipated future income will be sufficient to pay your anticipated premiums.
• Consider other benefits you may be able to receive. Nursing home care can be paid through veteran’s benefits, Medicaid and certain pension or retirement plans. Check with your eligible plans to determine long-term care benefits that you may be entitled to receive.
• Consider other care options. Will your family be available to assist you with care needs, such as eating, dressing and bathing? If so, then you might not need long-term care insurance.

2. Consider ways that you might pay for long-term care insurance

• You and your family. You can pay for care with current income, savings and/or investments. You should only consider purchasing long-term care insurance if the payments fit comfortably into your monthly budget.
• Ohio Long-term care Partnership. These policies allow you to buy coverage, receive benefits from the policy and protect a matching amount of assets if you continue to need long-term care and apply for Medicaid. Ohio encourages those at risk who can afford long-term care insurance to consider buying this type of policy, but buying and using a partnership policy does not guarantee you will otherwise be eligible for Medicaid. 
• Medicaid. If you receive Medicaid or Supplemental Security Income (SSI) you do not need long-term care insurance.
• Medicare. Medicare coverage is very limited. It may pay for some skilled nursing care and pays nothing for custodial care, the most common type of care needed by older persons.
• Check with your employer. Some companies make this coverage available for employees to purchase for themselves and family members through group policies. Most of these programs can be converted to individual policies upon retirement or when you leave the employer. Check for conversion rights under these group policies.
• Military veteran benefits. Veterans are entitled to certain care for life. Your level of care will depend on the nature of the disability or illness. Check with a VA representative for further information.

3. Know the places where you can receive care

• Your insurance policy determines where it will pay for covered benefits. Care is usually delivered in nursing homes, adult day care centers, assisted living facilities and/or in your home. Some policies may cover care in all four settings.

4. Know when your coverage starts

• Policies have “triggers” to determine when you are entitled to benefits. The inability to perform a certain number of “activities of daily living” (eating, bathing, dressing, toileting, continence and transferring) or if you have been diagnosed with cognitive impairments such as Alzheimer’s are typically considered as triggers.

Shopping tips for long-term care insurance

• Take time: Take the time to shop around and conduct research. Call the Ohio Department of Insurance with any questions. You can also talk with an agent to determine what coverage would best meet your needs.
• Premium factors: Remember that your age, type of benefit, daily benefit amount and benefit period are all factors that impact your premium.
• Don’t cancel too soon: If you already have a long-term care policy, do not cancel it until your new one is in effect.
• Understand the elimination period: Familiarize yourself with the policy’s “elimination period” (also called “deductible period”). This is the number of days you will pay your own health care bills before insurance payments start. Elimination periods vary in length by policy. The longer period you select, the lower your premium amount.
• Benefits period: Understand the policy’s “benefits period,” which describes how long the policy will pay benefits (i.e., one year, four years, five years or lifetime).
• Daily benefit: Know the maximum the policy will pay for your care each day. A larger daily benefit will cost you a higher premium.
• Inflation protection: Ask about “inflation protection” to keep your future costs down.
• Excluded coverage: Every insurance policy has a list of things that are not covered. Make sure you know what they are.
• Save paperwork: Be sure to save any paperwork regarding your insurance policy. Save receipts, policy plans, riders, endorsements and agreements.

Where to go for help

Unbiased and free long-term care insurance information is available by calling OSHIIP at 1-800-686-1578 and visiting www.insurance.ohio.gov and www.ltc4me.ohio.gov. The Ohio Department of Job and Family Services at 1-800-324-8680 determines Medicaid eligibility and administers the Ohio Long-term Care Partnership program.