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How Do I Qualify For my Long Term Care Insurance Benefits?

A common question consumers ask is: "What do I need to do to qualify for benefits when I need them?"  

Activities of Daily Living (ADL) of Long Term Care Insurance

When you need help or supervision with your activities of daily living you may be eligible for your long term care insurance benefits.  It's up to your doctor to certify your need for long term care. 

A common set of "ADL's" are used to determine your need for long term care.  The activities of daily living are eating, bathing dressing, toileting, transferring, and maintaining your continence.  The exact details on these triggers can be found in your long term care policy so be sure to read how to qualify for benefits.  Most long term care insurance policies will pay benefits when you cannot do 2 out of 6 of the activities of daily living. 

The top long term care insurance companies (such as Genworth Financial, John Hancock, MetLife, Mass Mutual, NY Life, and Allianz) will pay for both physical and standby assistance.    For example, physical assistance would be when you physically need help whereas stand-by assistance would be when you need supervision to make sure you can perform the ADLs safely.

Cognitive Impairment

Conditions such as Alzheimer's or dementia are common conditions that can trigger long term care insurance benefits; these conditions cause a person to need supervision so they don't leave the stove on or roam the neighbor hoods.  Although they might not need someone to physically help them, they will need supervision to make sure they are safe. 

Prior Hospitalization

Policies sold today do not require prior hospitalization to start benefits. However, Medicare still requires a three-day hospital stay to be eligible for Medicare payment of skilled nursing facility benefits.

 

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