About the NAIC …The National Association of Insurance Commissioners (NAIC) is the oldestassociation of state government officials. Its members consist of the chiefinsurance regulators in all 50 states, the District of Columbia and five U.S.territories. The primary responsibility of the state regulators is to protect theinterests of insurance consumers, and the NAIC helps regulators fulfill thatobligation in a number of different ways. This guide is one example of work doneby the NAIC to assist states in educating and protecting consumers.Another way the NAIC lends support to state regulators is by providing a forumfor the development of uniform public policy when uniformity is appropriate. Itdoes this through a series of model laws, regulations and guidelines, developedfor the states’ use. States that choose to do so may adopt the models intact ormodify them to meet the needs of their marketplace and consumers. As you readthrough this guide, you will find several references to such NAIC model laws orregulations related to long-term care insurance. You may check with your stateinsurance department to find out if these NAIC models have been enacted in yourstate.NAIC Executive Office444 North Capitol Street NW, Suite 701Washington, DC 20001Phone: 202-471-3990NAIC Central Office2301 McGee Street, Suite 800Kansas City, MO 64108-2604Phone: 816-842-3600Fax: 816-783-8175NAIC Securities Valuation Office48 Wall Street, 6th FloorNew York, NY 10005-2906Phone: 212-398-9000www.naic.orgRevised 2009
A Shopper’s Guide ToLong-Term Care Insurance Table of Contents1 About this Shopper’s Guide2 What is Long-Term Care?2 How Much Does Long-Term Care Cost? 3 Nursing Home Costs 3 Assisted Living Facility Costs 3 Home Care Costs3 Who Pays for Long-Term Care? 3 Individual Personal Resources 3 Medicare 4 Medicare Supplement Insurance 5 Medicaid 5 Long-Term Care Insurance6 Who May Need Long-Term Care?7 Do You Need Long-Term Care Insurance?8 How Can You Buy Long-Term Care Insurance? 8 Individual Policies 9 Policies From Your Employer 9 Federal Government 9 State Government 10 Association Policies 10 Policies Sponsored by Continuing Care Retirement Communities 10 Life Insurance Policies 11 Long-Term Care Insurance Partnership Plans12 What Types of Policies Can I Buy?
14 How Do Long-Term Care Insurance Policies Work? 14 How Benefits Are Paid 14 Pooled Benefits and Joint Policies 16 What Services Are Covered 16 Where Services Are Covered 17 What Services Are Not Covered (Exclusions and Limitations) 17 How Much Coverage You Will Have 19 When You Are Eligible for Benefits (Benefit Triggers) 19 Types of Benefit Triggers 20 When Benefits Start (Elimination Period) 21 What Happens When Long-Term Care Costs Rise (Inflation Protection)? 24 Additional Benefits 24 Other Long-Term Care Insurance Policy Options You Might Choose 25 What Happens If You Cannot Afford the Premiums Anymore?26 Will Your Health Affect Your Ability to Buy a Policy?27 What Happens If You Have Pre-Existing Conditions?27 Can You Renew Your Long-Term Care Insurance Policy?28 How Much Do Long-Term Care Insurance Policies Cost?30 What Options Do I Have to Pay the Premiums on the Policy?31 If You Already Own a Policy, Should You Switch Plans or Upgrade the Coverage You Have Now?32 What Shopping Tips Should You Keep in Mind?36 References37 Glossary45 Worksheets 45 Worksheet 1: Information About the Availability and Cost of Long- Term Care in Your Area 47 Worksheet 2: How to Compare Long-Term Care Insurance Policies 52 Worksheet 3: Facts About Your Long-Term Care Insurance Policy 54 Worksheet 4: Long-Term Care Riders to Life Insurance Policies 56 Personal Worksheet60 List of State Insurance Departments, Agencies on Aging and State Health Insurance Assistance Programs