What You Should Know About Long Term Care Insurance
Do I Need Long Term Care Insurance?
Most of us will need long-term care at some point in our lives. In fact, data shows that more than 70% of people 65 and older will need care services or support.
And 40% of us needing long-term care services or support today are younger than 65.
We may need long-term care for just a few months while we recover from surgery or a fall. Or we may need long-term care for months or years.
According to LongTermCare.gov, women typically need care for an average of 3.7 years, while men require it for 2.2 years.
So, now that we’ve established long-term care is a likely necessity, we can answer the question, “what is long term care insurance?”
What Is Long Term Care Insurance?
You’ve probably heard that getting long-term care coverage is a good plan for you and your family. But what is long term care insurance? Long-term care insurance provides you with the help and support you need to complete daily activities at home, due to an illness or injury. Long-term care insurance pays for support outside of a hospital, including things like:
- Diagnostic services
- Preventive care
- Therapeutic care
- Rehabilitative care
- Maintenance
- Personal care
Private long-term care insurance is also supposed to pay benefits when you can no longer independently do two or more of the following activities of daily living:
- Bathe
- Go to the bathroom
- Eat
- Dress
- Get out of bed or a chair
- Control your bladder or bowels
Complaints Against Private Long Term Care Insurers in Washington State
Now that we’ve answered the question “what is long term care insurance,” we can begin to look into how we can get coverage. According to an investigation of consumer complaints officially filed with the Washington State Office of the Insurance Commissioner (OIC), Washingtonians filed 800 complaints about long term care insurance companies between 2015 and 2021. While complaints were filed against 50 different companies, the complaints shared common themes:
- insurers denying or delaying claims
- unexpected large rate increases
- policy cancellations
- refusal of coverage
- confusing policy language
- inaccurate communication from insurance providers
- unsatisfactory refunds
- inflexibility when it comes to care settings
- overly complicated processes that kept people from receiving the care or benefits they paid for
Cathy Jeffers was led to believe that her uncle’s long term care policy would cover the facility he went into when dementia meant he couldn’t continue to live independently. Jeffers shared: “We followed all the steps the insurance company said were required. They told us to pay the first month at the home and they would take care of the rest. Well, they ended up denying any benefit claims on the policy my uncle got while he worked for Boeing. He paid a lot of money into that policy for years thinking he was well-protected going into retirement. People don’t realize that when they need it most, these plans just aren’t there for them.”
6 Reasons Private Long Term Care Insurance Is Not For Everyone
Most people don’t have long term care insurance. In fact 98% of Americans don’t have it, according to the American Association for Long Term Care Insurance.
Here are the top reasons the vast majority of Americans don’t have long term care insurance:
- It’s too expensive. Premiums start at $150 per month or more, and go up by as much as 300% as you get older.
- If you pay late or miss just one premium payment, they will cancel your coverage with no refund of what you’ve already paid in.
- It’s more expensive for women. Women are charged 50% or more per month than men.
- Long term insurance companies are notoriously unreliable and go under, with no refunds to policy holders.
- They stall on paying out benefits, hurting the people who need help the most like Nina and her husband Joe.
- They reject people with pre-existing conditions, like Anthony who has Lupus.
Learn more about private insurance costs here.
Many people can’t get private long term care insurance policies because they have a “pre-existing condition.”
Pre-Existing Conditions Are Common Reasons For Private Insurance Exclusion
Many people can’t get private long term care insurance policies because they have a “pre-existing condition.”
These common conditions include diabetes, cancer, high blood pressure, lupus, depression, sleep apnea, asthma, and many more.
Currently, around 3.1 million Washington residents under the age of 65 have a preexisting condition that could disqualify them from private long-term care insurance coverage – or 57% of non-elderly adults.
More than 30% of us between 60 and 65 will be turned down for private long-term care insurance due to a pre-existing condition. A full 20% of people in their 50’s, or 197,353 Washingtonians, can expect to be denied coverage by a long-term care insurance company. Learn more here.
WA Cares Is A Reliable, Affordable Alternative To Private Long Term Care Insurance
Now that we know the answer to the question “what is long term care,” and we know the pitfalls of private insurance, what’s the solution for coverage? Luckily, Washington has an alternative to private long-term care. WA Cares provides $36,500 of long-term care benefits, adjusted for inflation, to any working Washingtonian. Regardless of gender, race, age, or pre-existing conditions, you’re eligible for WA Cares.
What’s even better is that we only contribute to the WA Cares Fund while we’re working. As soon as we retire, we stop contributing.
Similarly, if we become unemployed or leave the workforce to care for a child or other loved one, our contributions stop, and we stay in the program. That means we keep our WA Cares fund benefits no matter what.
One other key differentiator between WA Cares and private insurance: most private long term care insurers won’t cover family caregivers. WA Cares, though, will pay a family member (your spouse, child, or friend ) who spends their time caring for you.
The WA Cares Fund covers a broader range of needs than private long-term care insurance. Learn more about WA Cares here.
