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Qualifying for Long Term Care Insurance Benefits

Posted by Curt Horowitz

Oct 31, 2014 4:18:56 PM


So you finally decide to buy a long term care insurance policy. Once you receive the policy, you file it away and hope you never need to use it.

However, if you do find yourself in a situation where you need care, how do you qualify to begin receiving your benefits payment?

Here is what you need to know about qualifying for long term care insurance benefits.


How to qualify to begin receiving benefits.

There are two ways to qualify for benefit elegilibity:

  1. Physical need.
  2. Mental need.

Physical need.

In terms in the physical needs, your licensed health care practitioner (this can be your medical doctor, nurse practitioner, or social worker) must certify:

  • You are chronically ill.
  • Due to your condition, whether it be from illness, age or infirmity, you require assistance with a minimum of two Activities of Daily Living (ADLs).
  • That they expect you will need care for 90 days or longer.

What are ADLs?  

ADLs include: bathing, dressing, toileting, continence, eating, transferring.

It doesn't matter what causes the physical need, it could be a car accident, a fall that causes a broken hip, or just mobility issues.

Mental need.

Qualifying with respect to mental needs requires the health care practitioner to certify you will need supervision due to any cognitive impairment that would cause a safety concern including:

  • Dementia.
  • Senility.
  • Alzheimer's.

Elimination period.

Once your health care professional determines that you are eligible for long term care (LTC) services, you will need to satisfy the elimination period that you have selected.

Once the elimination period is satisfied, you will then begin receiving benefits. 

To learn more about long term care insurance policy design, please see these posts:

What to do if you need to make a claim.

If something does happen that causes you to need LTC the steps to take are:

  1. Consult with your health care professional.
  2. Make your health care professional aware of the fact that you have an LTC insurance policy and provide them with your broker/agent's contact information.
  3. Your broker/agent can work with your doctor and the insurance company to facilitate the process to determine if you can receive benefits.

Editor's note: This post was originally published on April 2, 2008. It has been edited and updated with the most current information.


Topics: Long Term Care Insurance, Long Term Care Planning