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A review of standardized Long Term Care insurance plans

Because Medicare pays for 100 days or less of skilled care in a nursing home, an insurance policy may be purchased to cover Long Term Care in the home or nursing facility. Colorado requires all insurance companies to offer two standardized plans - Basic and Standard, to make it easier for the consumer to compare policies. Long term care insurance may be very expensive depending upon your age. You should review your finances carefully to determine if purchasing long term care insurance is appropriate.

If it is likely that you may qualify for Medicaid, you probably should not purchase long term care insurance. A list of companies approved to sell long term care insurance in Colorado can be obtained by calling 303-894-7552.

A Long Term Care policy offers the following coverage:

· Inflation protection
· A thirty day "free look" period
· Third party notice to prevent unintentional premium lapse
· An extension of benefits if policy lapses after confinement

Long Term Care Policies in Colorado may not:

· Be cancelled because of age or mental or physical deterioration
· Exclude coverage of a pre-existing condition for more than 6 months


Basic Plan
Nursing Home and Bed
Reservation Benefits		 Standard Plan
Nursing Home, Bed Reservation and Home Care Benefits
Daily Maximum
Maximum amount of benefit paid each day for a stay in a nursing home		 $100.00 $100.00
Lifetime Value
Maximum amount of benefits paid during your lifetime		 3 years $125,000.00
Inflation Protection
5% compound (the most generous available) unless rejected by the consumer		 5% compound 5% compound
Benefit Triggers
2 or 3 activities of daily living		 Coverage starts when insured is deficient in 2 or 3 (bathing, continence, dressing, eating, toileting, transferring) or has severe cognitive impairment Coverage starts when insured is deficient in 2 or 3 (bathing, continence, dressing, eating, toileting, transferring) or has severe cognitive impairment
Elimination Period
"One time" number of days you must wait to qualify before receiving benefits		 60 Days 60 Days
Federal Tax Status

 Federally qualified plan Federally qualified plan
Home Care Benefits None Up to 50% of daily maximum benefits for care and services received outside of a hospital or nursing home.

Note: All companies are required to offer Basic and Standard policies but may also offer other policies with more benefits. At present, the range for nursing home care is $95 to $175 per day.

Items to consider when examining Long Term Care Insurance Policies:

Does the policy cover:

Skilled, intermediate and long term care
Nursing care in a licensed, skilled or intermediate facility
Assisted living care
Home health care
Adult day care
Hospice care
Specific coverage for Alzheimer's disease
Payment for the actual cost of care (versus a set dollar limit)

Does the policy require:

Prior hospitalization before benefits are payable
A waiting period if you have a pre-existing condition
Payment of a deductible before benefits are in force

Does the policy clearly state:

What documentation is necessary to qualify for benefits
The length of confinement necessary before waiver of premiums
Conditions of reinstatement after cancellation or lapse of payment
Lifetime structure of payment schedule and adjustments for inflation
The requirements for upgrading the policy in years to come.

Due to the significant increase in costs in long term, more information is available at www.kriegerltc.com

For information on companies licensed to sell long term care insurance in Colorado see www.dora.state.co.us/Insurance/ by clicking on the Main Menu and then clicking on Senior Health Insurance.



Long Term Care Insurance
Since Medicare pays for 100 days or less of skilled care in a nursing home, an insurance policy may be purchased to cover Long Term Care in the homre or nursing facility. Colorado requires all insurance companies to offer two standardized plans (Basic and Standard) to make it easier for the consumer to compare policies. Companies may offer other policies with more benefits. Long-term care insurance may be very expensive depending upon your age. YOu should review your finances carefully to determine if purchasing long term care insurance is appropriate. If it is likely you may qualify for Medicaid, you probably should not purchase long-term care insurance

A Long-Term Care policy offers the following coverage:
**Inflation protection
**A thirty-day "free look" period
**Third party notice to prevent unintentional premium lapse
**An extension of benefits if policy lapses after confinement


Long Term Care policies in Colorado may not:
**Be cancelled because of age or mental or physical deterioration
**Exclude coverage of a pre-existing condition for more than six months


 Basic Plan


 Standard Plan
Daily Maximum
Maximum amount of benefit paid each day for a nursing home stay		 $110.00 $110.00
Lifetime Value
Maximum amount of benefits paid during your lifetime		 $115.00 $192,000.00 (almost 5 years)
Inflation Protection
5% compound (the most generous available) unless rejected by the consumer		 5% compound 5% compound
Benefit Triggers

 Must meet the federal definition of chronically ill. Coverage starts when insured is deficient in 2 of 3 (bathing, continence, dressing, eating, toileting, transferring) or continual supervision including cueing to prevent threats to safety from severe cognitive impairment Coverage starts when insured is deficient in 2 of 3 (bathing, continence, dressing, eating, toileting, transferring) or continual supervision including cueing to prevent threats to safety from severe cognitive impairment.
Elimination Period
"One time" number of days you must wait to qualify before receiving benefits		 60 Days 60 Days
Federal Tax Status

 Federally qualified plan Federally qualified plan
Home Care Benefits/
Alternative Care Facilitys/Respite/
Home Modification/Supportive
Equipment/Caregiver Training/
Case Management		 Defines minimum benefits for each type of care or service is required. Defines minimum benefits for each type of care or service is required.

Eileen Doherty, MS is Executive Director of Senior Answers and Services and the Colorado Gerontological Society. She has more than 20 years of experience in education and training, public policy, and clinical practice in gerontology. She can be reached at 303-333-3482

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Senior Answers and Services and Colorado Gerontological Society are not for profit organizations dedicated to education and the dissemination of information pertinent to seniors and professionals in the field of aging. Correspondence or questions regarding the information on this site should be forwarded to:

Eileen Doherty M.S., Executive Director
3006 East Colfax, Denver, CO  80206 *  303.333.3482 ** 303.333.9112 (fax)

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