What LTC Insurance Is
Long-term care insurance is a private insurance product that pays for personal care services when you can no longer perform basic activities of daily living without help. Unlike health insurance or Medicare, it specifically covers non-medical care — the kind of help that adult family homes, assisted living facilities, and home health aides provide.
Policies pay a daily or monthly benefit when the policyholder triggers eligibility, usually by needing help with two or more ADLs or having a cognitive impairment like dementia.
What It Covers
A typical LTC policy will pay for care delivered in: an adult family home, an assisted living facility, in-home care from licensed aides, adult day programs, hospice care, and skilled nursing facilities.
Some policies also cover home modifications (grab bars, ramps), durable medical equipment, family caregiver training, and respite stays. Read the policy language carefully — coverage details vary by carrier.
What It Doesn't Cover
LTC insurance does not cover acute medical care, hospital stays, doctor visits, or prescription drugs — those are health insurance or Medicare territory.
Most policies don't cover room and board separately from care services, meaning if you live in independent living and don't need personal care, the policy isn't triggered. They also generally don't pay until the elimination period is satisfied.
Typical Benefits and Structure
A typical policy purchased today might include a daily benefit of $100–$300, a benefit period of 3–5 years, an elimination period of 90 days (you pay for care during that window before benefits begin), and an inflation rider to keep the benefit's real value growing.
Translated: a $200/day, 5-year policy with inflation protection might pay out $365,000+ over its lifetime — enough to fund several years of AFH or in-home care.
Why It's Expensive After 60
Insurers price by age and health at the time of purchase. A 55-year-old in good health might pay $200/month. The same policy bought at 65 might cost $400/month or more. By 70, applicants are often declined for medical reasons.
The sweet spot for buying is generally mid-50s — old enough to be sure you want the coverage, young enough to qualify medically and afford the premium.
Connection to the WA Partnership Program
If you buy a policy certified by the Washington Long-Term Care Partnership Program, you receive dollar-for-dollar asset protection from Medicaid spend-down later. It's the same policy but with extra state-level benefits attached. Read more about the Partnership Program →
Check the WA Office of the Insurance Commissioner's list of approved Partnership carriers before buying.
How to File a Claim
When the time comes to use the policy: contact the carrier and request a claims package. They will schedule a cognitive and functional assessment (usually a nurse visits the policyholder) to verify the policyholder meets benefit triggers — typically needing help with two ADLs or having a cognitive impairment.
Once triggered, the elimination period begins. After it's satisfied, benefits pay out monthly. Keep meticulous records of care receipts, provider invoices, and assessments — the carrier will ask for them.
Frequently Asked Questions
Q: Should I buy now if I'm 50? A: It's an excellent time to buy if you have assets to protect and the budget. Premium savings vs. age 60+ are substantial.
Q: What if I never use it? A: Traditional policies are "use it or lose it." Hybrid life-and-LTC policies return value to your estate if unused.
Q: Can premiums go up? A: Yes — carriers can raise premiums on entire classes of policies with regulatory approval. It has happened repeatedly in the industry.
Q: Does it cover my spouse? A: Each policy covers one person; shared-care riders allow couples to draw from a combined pool.