Long Term Care Insurance

Long-term care insurance (LTC or LTCI), an insurance product sold in the United States, United Kingdom and Canada, helps provide for the cost of long-term care beyond a predetermined period. Long-term care insurance covers care generally not covered by health insurance, Medicare, or Medicaid.

Individuals who require long-term care are generally not sick in the traditional sense, but instead, are unable to perform the basic activities of daily living (ADLs) such as dressing, bathing, eating, toileting, continence, transferring (getting in and out of a bed or chair), and walking.

Age is not a determining factor in needing long-term care. About 60 percent of individuals over age 65 will require at least some type of long-term care services during their lifetime. About 40% of those receiving long-term care today are between 18 and 64. Once a change of health occurs long-term care insurance may not be available. Early onset (before age 65) Alzheimer’s and Parkinson’s disease are rare but do occur.


Long-term care insurance generally covers home care, assisted living, adult daycare, respite care, hospice care, nursing home and Alzheimer’s facilities. If home care coverage is purchased, long-term care insurance can pay for home care, often from the first day it is needed. It will pay for a visiting or live-in caregiver, companion, housekeeper, therapist or private duty nurse up to seven days a week, 24 hours a day (up to the policy benefit maximum).

Other benefits of long-term care insurance:

  • Many individuals may feel uncomfortable relying on their children or family members for support, and find that long-term care insurance could help cover out-of-pocket expenses. Without long-term care insurance, the cost of providing these services may quickly deplete the savings of the individual and/or their family.
  • Premiums paid on a long-term care insurance product may be eligible for an income tax deduction. The amount of the deduction depends on the age of the covered person. Benefits paid from a long-term care contract are generally excluded from income.
  • Business deductions of premiums are determined by the type of business. Generally corporations paying premiums for an employee are 100% deductible if not included in employee’s taxable income.

In the United States, Medicaid provides some of the benefits of long-term care insurance. A welfare program, Medicaid does provide medically necessary services for people with limited resources who “need nursing home care but can stay at home with special community care services.” However, Medicaid generally does not cover long-term care provided in a home setting or for assisted living. People who need long-term care often prefer care in the home or in a private room in an assisted living facility.

Types of policies

Private long-term care (LTC) insurance is growing in popularity in the United States. Premiums, however, have risen dramatically in recent years even for existing policy holders. Coverage costs can be expensive, especially when consumers wait until retirement age to purchase LTC coverage.

As they relate to U.S. income tax, two types of long term care policies offered are

  • Tax qualified (TQ) policies are the most common policies offered. A TQ policy requires that a person 1) be expected to require care for at least 90 days, and be unable to perform 2 or more activities of daily living (eating, dressing, bathing, transferring, toileting, continence) without substantial assistance (hands on or standby); or 2) for at least 90 days, need substantial assistance due to a severe cognitive impairment. In either case a doctor must provide a plan of care. Benefits from a TQ policy are non-taxable.
  • Non-tax qualified (NTQ) was formerly called traditional long term care insurance. It often includes a “trigger” called a “medical necessity” trigger. This means that the patient’s own doctor, or that doctor in conjunction with someone from the insurance company, can state that the patient needs care for any medical reason and the policy will pay. NTQ policies include walking as an activity of daily living and usually only require the inability to perform 1 or more activity of daily living. The Treasury Department has not clarified the status of benefits received under a non-qualified long-term care insurance plan. Therefore, the taxability of these benefits is open to further interpretation. This means that it is possible that individuals who receive benefits under a non-qualified long-term care insurance policy risk facing a large tax bill for these benefits.

California Partnership Plans

  • What Makes a Partnership Policy Unique?
    • A Partnership long-term care insurance policy will protect your independence by ensuring that you are covered for long-term care expenses and maintain your dignity by assuring you will not have to depend on others for your care needs.
    • A Partnership policy also has a unique feature. This feature is “lifetime asset protection”. This assures that catastrophic long-term care expenses won’t reduce you to poverty even if you run out of insurance benefits. That’s something other long-term care insurance policies do not offer.
    • Here is how this special feature works, when you need care your Partnership-approved private long-term care insurance policy pays for your care in the same way other high quality long-term care policies would; but, unlike a traditional non-Partnership policy, each dollar your Partnership policy pays out in benefits entitles you to keep a dollar of your assets if you ever need to apply for Medi-Cal services.
    • For most of you, the benefits of a Partnership insurance policy will provide all the care you will ever need. But you won’t have to impoverish yourself if you run out of insurance benefits and still need care. You can apply to Medi-Cal for assistance in paying the costs of your continued care and not have to “spend down” your savings to the poverty level. Each dollar your Partnership policy pays in benefits for your care is protected against Medi-Cal “spend down” rules. You may have to apply a portion of your income toward the cost of your care, but the assets you protected by purchasing a Partnership policy remain yours, for you and your spouse’s use or to leave to loved ones.
    • “Every once in a while an idea comes along that has some real merit. The California Partnership is a case in point.”
      Source: Senior World, October, 1994


Life Insurance with a Long Term Care Rider

A popular alternative to standard LTC insurance and referred to as a linked benefit product.

  • Helps you pay for long-term care if you need it
  • Provides an income tax-free death benefit if you don’t.
  • A way to help protect your retirement income from the risk of long-term care expenses

The downside to the life insurance with the LTC rider is that it is not inflation adjusted. For a young person, that may be an issue.

Blog post I wrote regarding Long Term Care, A Case For CLASS

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