All About Your Long-Term Care Insurance Premiums
When people think about long-term care insurance, the first thing that usually comes to mind is the cost. While no one wants to pay their premiums, there’s value in knowing that if you ever need support, the cost won’t fall entirely on you or your loved ones.
Often, people don’t realize they won’t be making those payments forever. In most cases, once you start receiving care and your claim is approved, the premiums will stop.
What are you paying for?
A long-term care insurance policy covers services like home health care, assisted living, or nursing home care. To keep that safety net in place, you pay regular premiums, just like with car or life insurance. But long-term care premiums are unique. They’re influenced by underwriting and the specifics of the coverage you select.
Years ago, many insurers issued policies that were generous to clients, but financially unsustainable for the insurance companies. Over time, smaller insurers struggled to keep up with the claims, and many were acquired by larger companies. In my almost 10 years in the field, I’ve seen it happen time and time again.
Today, underwriting is far more sophisticated. With the help of artificial intelligence, insurers can assess risk with more accuracy. This means new policies are harder to qualify for and less likely to be as generous for clients as those from the past. That’s why comparing offers from multiple insurance companies is important.
What affects your premiums?
Several factors are used to calculate how much you’ll pay. They include:
- Age at application – the younger you are, the less you’ll typical pay
- Health and medical history – better health = lower premiums
- Coverage level – includes monthly/daily benefit, number of years covered, inflation protection, etc.
- Elimination period – how long you wait before benefits kick in
How are premiums paid?
Most people pay either monthly or annually, often through automatic bank payments. Other options include:
- Level pay plans – payments stay the same each year (aside from any class-wide increases)
- Limited-pay plans – higher payments for a shorter period, after which premiums stop permanently
The right approach will depend on your long-term budget and goals.
The waiver of premium
One of the most overlooked and valuable features of long-term care insurance is the waiver of premium. Once your claim is approved and you’ve met the elimination period, your premium payments usually end. The catch is that the approval is not automatic. Claims have to be submitted properly. That’s where guidance from an experienced agency can make a big difference.
How a home care agency supports clients
The LifeWorx team can help you:
- Clarify what documentation is needed and help you gather it
- Ensure your care plan matches the policy’s benefit triggers (typically needing help with at least two activities of daily living, or having a diagnosed cognitive impairment)
- Communicate with the insurance company on your behalf
- Assist with appeals if a claim is denied
A recent client is both cognitively and physically impaired, but like many people, he struggles with accepting help. On the day of his home assessment, he was having a “good day.” He told the nurse that he didn’t need any help and that the caregiver didn’t have much to do. He was able to perform some activities of daily living independently during the visit. Based on the nurse’s assessment, the insurance company decided that he didn’t need care. The claim was denied, but he continued to decline, and our team was providing daily care.
To file the appeal, I carefully reviewed the denial letter because I used their exact wording in our argument. If the insurer said he could perform ADLs “independently,” I would counter with documentation showing the hands-on help he received. Additionally, I requested letters from physicians and hospital records to paint a more accurate picture of his condition. It was also important to emphasize the practical realities. For example, without support, the client could make unsafe choices, something as small as forgetting a coat in cold weather, or as dangerous as wandering into traffic.
The appeal was filed within a week, and while the review took about 30 days, we continued with invoices and updates throughout. Without our expertise, one “good day” could have erased years of careful planning and resulted in the appeal being denied.
Long-term care insurance premiums are a small, steady investment in protecting your future. But when the time comes and you actually need care, you don’t want to be chasing down benefit approvals or stuck still paying monthly premiums.
That’s why working with the right agency matters. With LifeWorx, our support doesn’t end with home care services. We’re here to help make sure you’re getting the most out of your policy. Contact us today for a free policy review.
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