How does private long-term care insurance work if you’re retired, living at home and need in-home care?

As everyone else has said, it all depends on the policy. Mother had a LTC policy that she purchased in like 1990 - it was a very generous policy (that is no longer sold today) because it had no cap on dollars nor time. However, in order for the policy to kick in, she had to qualify by meeting certain requirements, including - unable to bath herself, unable to dress herself, unable to prepare a meal for herself, and a couple others for a total of 6 - and she had to meet at least 3 of those to qualify for the LTC to kick in. THEN, she/we had to pay for the first 90 days before the LTC would start paying. And even then, they had a dollar limit as to how much could be billed. So, yes, it all depends on the policy. FYI, I didn't hire an atty to read through the numerous pages, but I did go through it, reading line by line, highlighting important lines, and making notes/writing down questions, which I then contacted the policy issuer to ask them to clarify. It took several days of reading it (at a very slow pace and only a few sections at a time).

Contact the insurance company about this answer. It really depends on the policy.

One more thing - many LTC policies stop charging the annual premium once your LO has filed a claim and enters an AL or SNF facility. My mother’s policy has that provision. It also pays for qualifying home care BUT she is still charged the annual premium. Not sure if the logic behind that.

Uunoxy: If in fact you do possess a LTC insurance policy, perhaps you will want to retain an elder law attorney to read through it WITH you and advise you about the fine print.

Are you saying you have a LTC policy?

If you do, then read it, and you will see what is provided. There will be a number on your policy to discuss what provisions it will make for care, as well.

If you do not already have a LTC policy then it may be too late to get one. They vary a lot. Will wish you happy reading.

Mom had LTC with Fortis which sold to John Hancock. She had put in a claim at 82 and it paid for licensed caregivers at her home. She received $80 a day for their salary and we paid the rest. When she went into Memory Care, the insurance paid $80 a day towards her $9600 monthly bill. She stopped paying premiums at age 80.
Hope this helps.

My LO purchased LTC at the age of 68 back in 1993.  
It covered lifetime benefit – unlimited
Daily nursing home benefit - $100
Daily professional service level 1 - $50
Daily basic services level two - $50 
Lifetime therapeutic device benefit -$10,000
Lifetime home health care benefit – unlimited
Maximum daily adult day care benefit -$25
Maximum lifetime adult day care benefit – 365 days
Each ambulance trip - $250
Maximum number of trips – 4 trips

As of 2016 the premium was $7,638.70
As of 2017 the premium was $9,326.80

In 2017 the LTC premium was schedule to change 
2019 for $11,387.90
2021 for $13,904.80

July of 2017 I discontinued the LTC policy due to the increase premiums. She was 93 yrs. old, we never filed a claim.  

The LTC company which is now called Transamerica Life offered a Contingent Nonforfeiture Benefit when the policy is dropped during the year of scheduled premium increase due to inability to pay.

Contingent Nonforfeiture Benefit means the policy holder receive a percentage of premium money paid. In my LO case it was about $90,000.

She died in 2012 at the age of 98+, we never filed claim.

Be aware of inflation. When the policy was purchased in 1998 it may have covered the cost. In 2012 it only covered a portion of cost due to inflation.

I hope this give you ideas of what to ask.

Please set an appointment with an Elder Law Attorney who can refer you to an LTC agent, if you don't already have one. They can help you plan for the future with or without a policy; attorneys are really astute in reading "the fine print."

Strange thing about our health, we can be as healthy as a horse one day and down for the count, the next day: Covid showed us that we can't count on anything: here today and gone tomorrow.

Really depends on the policy that you have. Most policies have some kind of limitation as to the number of hours or the number of days or the number of years that will be covered.. It is not indefinite. In my experience most policies will give coverage for about 3 years worth of care. You need to work with your long-term care provider. They will pick out the agency you work with; they will be billed directly for services rendered to you or your loved one. You need to read the fine print about what is covered. Generally speaking long-term care in the home or in a setting is only given to those who cannot complete tasks of daily living, i e. get dressed, feed themselves, take a shower etc etc If they can do these things then they won't qualify for long-term care. I know many people are frustrated by the coverage available through these policies because their loved one never qualifies. Most people end up paying something out of pocket for care in the home. And it ain't cheap! Many insurance companies have gotten out of the long-term care business because it is not profitable to them. I would look for a non-profit company that provides long-term coverage in your area. They are not so focused on making a dime! Also the The younger you are when you sign up for a policy, the less expensive it will be. My husband and I signed up for long-term care insurance when we were in our middle fifties, and paid for it for about 15 years before it was needed. But then it sure was needed and was worth every cent we had invested. That's the thing. You need to think of long-term care insurance as an investment. And be willing and able to pay for it for a long time before it's needed. If you wait until you're in your '70s to sign up for it it will be very expensive. I could go on and on about long-term care insurance! But I'll stop now.

I have a great LTC policy which is not sold anymore. I have a cap
of $600,000. It is a cash payout. I do not need to use any certified
agencies and the entire benefit can be used for in home care. I
can have a friend or significant other take care of me. I put this in
place when I was 55 years old and I am now 79. It is not the plans
that are a problem. It is that the need to be put in place when you
are much younger and the right policy needed to be put in place.
Now is too late. They lost money on my type of policy and do not
sell it anymore. You should look into a life insurance with a critical
care clause. This is very popular now. You can take the face of the policy
for care. Of course, this needs to be put in place when healthy. My
partner has this in place.

All of the policies are different. You're going to have to read the details of the one you purchased. One thing to pay attention to is the CAP. A coworker of mine had long term care insurance but it capped out at $400,000. Which I am sure seemed like a lot of money 20 years ago when they purchased it, but memory care units can be $10,000 to $15,000 per month. At that rate you would run out of coverage in 2-3 years. So she retired and kept her husband at home as long as she could. When it became dangerous (he was an escape artist) she had to place him and the clock started ticking on that $400,000 policy. Luckily he did not outlive the policy and she did not have to move him to another facility and apply for Medicaid. I don't mean that to sound cruel...he would not have wanted to live that way for a long period of time.

So I guess what I am saying is if your policy does cover at home care, what it does pay for will be nipping away at the cap, so watch your spend.

A down side is if the policyholder gets dementia and forgets to pay the premiums and loses the coverage

The only LTC policy that I would qualify for would pay a portion of the cost of in-home care after a 90 day wait period and only if the care needed exceeded 120 days. It would not pay for short-term home health care and it would cover less than half of the actual cost.

Uunoxy, Welcome to the Forum.

LTC insurance varies widely according to/dependent on the policy. All the information will be in the fine print, and in most cases there is a lot of it.

Do read your policy thoroughly, write down your questions, and then contact the policy number on your forms with your questions.

Wish you the best.

I hope u have a policy, because its too late now to get one. They are bought years in advance. At your age the premiums would be outrageous.

You need to read the terms of the contract, as many will cover in-home care. You should also call the company issuing the policy to verify the terms, and ask questions if anything isn't clear. I believe most policies require the care to be provided through an agency and they have a list of approved agencies in your area. My husband, who had Parkinson's, had LTC through MetLife which had bought out the original company he'd signed up with. We had to pay the agency weekly, then at the end of the month would submit copies of the bills to get reimbursed. To get started, the company had to have documentation of his need for in-home care. In his case, he'd been getting home health services through Medicare because he had an acute case of shingles that left him with nerve damage from his spine that basically paralyzed one leg so he couldn't walk (that fortunately did improve so he was able to walk again with a rollator). MetLife got his records from that agency and that was all they needed to start. About a year later, they did send a contracted nurse to recertify him. They also got records from the home health agency.

One pleasant surprise was that once my husband began using the LTC funding we no longer had to pay the annual premiums.