What long-term care is, and what Medicare won’t pay
Long-term care means help with the basic activities of daily living, such as bathing, dressing, eating, using the toilet, moving from a bed to a chair, and continence. It also includes supervision for someone with dementia or other cognitive impairment. This kind of help is called custodial care, and it can be needed for months or years.
Many people are surprised to learn that Medicare does not cover long-term custodial care. Original Medicare covers skilled nursing facility care for up to 100 days per benefit period, but only after a qualifying three-day inpatient hospital stay and only while you need skilled care. Days 21 through 100 carry a daily coinsurance. Once you need only custodial care, Medicare coverage stops.
That leaves three main ways to pay: your own savings, Medicaid after you’ve spent down most of your assets, or insurance planned ahead of time. Long-term care insurance is about keeping choices in your hands, including where you receive care and who provides it. It can also ease the load on a spouse or adult children, who often become unpaid caregivers when no other plan is in place.
- In-home care: a home health aide or homemaker services
- Adult day care: supervised care during the day
- Assisted living: housing with help for daily activities
- Nursing home care: around-the-clock care and supervision
Traditional, hybrid and short-term care policies compared
Traditional long-term care insurance is designed only for long-term care. You choose a daily or monthly benefit, a benefit period and an elimination period, which is a waiting period before benefits begin. Premiums are usually lower than hybrid plans for the same amount of care, but they are not guaranteed and can increase if the carrier receives approval for a rate change.
Hybrid life and long-term care policies combine life insurance or an annuity with long-term care benefits. If you need care, you can use the benefit to pay for it. If you never need care, your beneficiaries receive a death benefit. Many hybrids have guaranteed premiums, often paid in a lump sum or over a set number of years.
Short-term care insurance covers care for a shorter benefit period, often a year or less. It typically has simpler underwriting and lower premiums, which makes it an option for people who can’t qualify for traditional coverage or who want to cover a shorter stretch of care.
| Traditional LTC | Hybrid life/LTC | Short-term care | |
|---|---|---|---|
| Main purpose | Long-term care only | Long-term care plus a death benefit | Shorter periods of care |
| If you never need care | No payout | Death benefit paid to beneficiaries | No payout |
| Premiums | Ongoing; can increase with state approval | Often guaranteed; lump sum or set years | Typically lower; ongoing |
| Underwriting | Full health review | Full health review | Usually simpler |
| Benefit length | Chosen benefit period | Based on policy design | Often a year or less |
Ohio’s Long-Term Care Partnership Program
Ohio participates in the Long-Term Care Partnership Program. Partnership-qualified long-term care policies are designed to work alongside Medicaid. If you use up the benefits of a qualified policy and later need Medicaid to help pay for care, the program is designed to let you protect some of your assets from Medicaid’s spend-down rules.
Not every policy is partnership-qualified, and the rules about which assets are protected and how this works across state lines can be detailed. Kris can tell you whether a specific policy is partnership-qualified, but for Medicaid planning questions she’ll encourage you to speak with an elder law attorney. She is a licensed agent, not a legal or tax adviser.
Even if Medicaid planning isn’t on your radar today, it’s worth asking about partnership qualification when you compare traditional policies. It can add a layer of protection for your savings without changing how the policy pays for care. Kris will point out which policies qualify so it becomes part of your decision, not something you discover years later.
Long-term care coverage is medically underwritten, and conditions like a recent stroke, a dementia diagnosis or needing help with daily activities can make you ineligible. Many people start looking in their 50s or early 60s, while they’re more likely to qualify.
Key choices when you design a policy
A long-term care policy is built from a few main pieces. The benefit amount is how much the policy pays per day or month. The benefit period or pool of money is how long or how much it pays in total. The elimination period is how many days you pay for care yourself before benefits begin.
Inflation protection is one of the most important choices, especially if you’re buying in your 50s. Care costs tend to rise over time, and a benefit that seems adequate today may fall short in 20 years. Inflation riders increase your benefit over time, though they add to the premium.
Finally, look at how benefits are triggered. Most policies pay when you need help with two of six activities of daily living or have a severe cognitive impairment, as certified by a licensed health care practitioner. Kris walks through each of these choices so the policy fits your budget without leaving gaps.
- Daily or monthly benefit amount
- Benefit period or total benefit pool
- Elimination (waiting) period
- Inflation protection
- Home care, assisted living and facility care coverage
- Shared benefits for couples, where available
How Kris helps
Kris begins with a conversation about your health, your family, your savings and how you’d want care provided if you needed it. Some people want to stay in their home as long as possible. Others want to protect assets for a spouse. Those goals shape which type of coverage makes sense.
She then compares traditional, hybrid and short-term care options from carriers she represents, explains what each premium buys, and shows you how the benefits would work in a real situation, such as a year of in-home help after a stroke or a move to assisted living. She helps you through the application and underwriting, and reviews the policy with you once it’s issued.
Kris also stays available when it’s time to use the coverage, helping your family understand how to start a claim. If you’re weighing long-term care alongside retirement income, she can also explain how annuities and permanent life insurance can fit in. Contact Kris to start the conversation.
Long-term care planning in northwest Ohio
Families in Perrysburg, Toledo and across northwest Ohio often face long-term care decisions suddenly, after a fall or a hospital stay. Planning ahead gives you more options and less stress. The Area Office on Aging of Northwestern Ohio in Toledo is also a helpful local resource for information on in-home services and caregiver support.
Kris can meet you in person at her Perrysburg office, or by phone or video if your adult children want to join from out of town. Consultations are no-cost and no-pressure. You can also review your Medicare options in the same visit, since Medicare and long-term care planning go hand in hand.
Kris is licensed in Ohio, Michigan, Indiana and Florida, which matters if you might move closer to children or grandchildren later in life. Most long-term care policies pay benefits wherever you receive covered care, but it’s still smart to ask how a policy handles a move. Kris will walk through that with you before you apply.
Who long-term care insurance may be right for
- Adults in their 50s and 60s who want to plan while they’re healthy enough to qualify
- Couples who want to protect savings for the healthy spouse
- People who want to receive care at home as long as possible
- Anyone who doesn’t want to rely on family as their only caregivers
- People who prefer a hybrid policy that pays a death benefit if care is never needed
Life insurance and annuity products are issued by the insurance company, and guarantees are backed by the financial strength and claims-paying ability of the issuer. Kris Kryder is a licensed insurance agent, not a tax, legal or investment adviser.