Benefit Amounts on Institutional Care and Home-Based Care

Facility Care Benefit Amount

Daily nursing home benefit is the core of any long-term care insurance coverage. These policy benefits normally cover services related to custodial or nursing care that are incorporated in packages from  its corresponding institution. Everything that is covered by Medicaid will be excluded from the policy; however, Medicaid can pay the services as adjunct to insurance coverage.

Licensed facilities include in its coverage the Alzheimer’s facilities, skilled care, intermediate care, and custodial care facilities. Assisted living facilities or alternative care facilities are covered by most modern insurance policies. Assisted living facilities may be covered by either home and community policy or facilities policy. Nevertheless, the best policies offer it under facilities.

Many modern LTC policies pay the benefits acquired on a weekly or monthly basis instead of daily. For instance, the daily benefit amount may pay for $100 per day while monthly benefit amount may pay $3,000 per month. The total benefits paid by the policy are equivalent on either policy provided that there’s no combination of claims happenedin any given day that exceeds $100. The policy paying weekly or monthly benefits more likely pay all the long term care costs unlike the daily policy benefit. The monthly paying benefit is an important windfall to your policy, and it can be purchased as additional rider. This extended benefit may be used in home care or nursing care or it may apply to all benefits offered under the policy,

The amount of the daily benefit should be determined to make the most out of LTC insurance. The amount of daily benefit is based on the sources of retirement income of the policyholder and the portion of that income to cover the long term care costs.

Home and Community Care Benefit Amount

All surveys and studies unveil that people choose home rather than institutional care and any other options available. Actually, 78% of long-term care is provided in the community. However, some policies are biased on facility care, making home-based care below the levels of institutional care.  One concrete example is group plan. Most group plans are inclined to cut home care to about 50%, 75%, or 80% of the amount allocated for facilities. For instance, a $120 daily home care policy would only pay half or quarter, say $60, for home care, adult day care or hospice, and some poorly-designed policy would pay only $60 for assisted living.

Most insurance companies tell that home care costs less than institutional that’s why nursing care is given much priority and importance. This idea may be true or not. To some strength, it’s true because government shows statistics revealing that home care cost is only a fraction than that of nursing homes. Throughout the country, the family members take care of their sick loved ones primarily because they have insufficient budget to accommodate the costly services of nursing homes. Therefore, this reflects that home care is less expensive than nursing care.  However, when the care giving family member has to end or limit his or her responsibilities to the sick/disabled loved one, paid services or institutional care comes in between.  

Policies for home care normally cover the services of licensed nurses, aides, and therapists. Some companies, otherwise, include in the coverage the services of non-licensed providers and even the personal care-giving family. However, home care is usually limited to five or six daily living activities as defined in the policy. Several add-ons such as “homemaker” services should be stated in the policy before it takes effect.