long-term care insurance
Financial Planning

What disqualifies you from long-term care insurance?

Prior to purchasing a long-term care insurance plan, be aware of any possible disqualifications.

Long-term care insurance is a type of insurance coverage that provides financial assistance for services associated with elderly individuals. This can include nursing home care, assisted living, in-home health care, or adult day care.  Long-term care is often needed for elderly individuals suffering from a debilitating condition that limits their ability to care for themselves independently.  The policy will then pay out benefits to help finance their medical care.  

Who Can Purchase Long-Term Care?

People can purchase long-term care insurance at any age. However, most people seriously start to consider getting a plan around the age of 50.  Health insurance plan premiums tend to be cheaper when you sign up for long-term care insurance at a younger age.  The younger you are when you buy a plan, the longer you will be paying for coverage, as the benefits will not kick in until you are of a certain age.  As such, it is always important to conduct your due diligence when evaluating when you start a long-term care insurance plan. 

Important Factors to Consider When Deciding on Long-Term Care Insurance

According to the most recent U.S. census, the baby boomer generation has contributed to a 38.6% increase in citizens over the age of 65.  As the senior citizen population has grown, so has the need for long-term care.  The costs for nursing homes and assisted living facilities increase every year.  Many people want to get coverage so they do not feel like a burden on their children and family.  When considering an insurance plan, it is important to know the rates, benefits, and when and how you would be able to claim benefits.  Most long-term care insurance claims begin when the policyholder is in their 80s.  Do you think you will need benefits sooner?  Speak with an insurance specialist to find a plan that will work for you.  

Disqualifications from Long-Term Care Insurance

Many long-term care insurance companies have eligibility requirements.  One common reason a person may be denied eligibility is that they have a pre-existing condition. Another common reason for denial is age.  In fact, the largest percentage of insurance denials tend to occur in the over-70 age bracket.  

Others may qualify for coverage but may be denied benefits for their long-term care claims.  But why are some claims denied? One of the most common reasons a long-term care insurance claim is denied is insufficient evidence or documentation. Insurance companies must be provided with sufficient medical documentation and records to validate a claim.  If your claim was denied due to this, then you must resubmit evidence, file an appeal, or both.  

Another reason someone may be denied is that the policy has a “prior confinement” provision. These may state that a policyholder is required to have a recent prior hospitalization confinement or a nursing home stay to qualify for benefits.  However, now, most states have prohibited such provisions.  As such, immediately contact an attorney if you have been denied a long-term care insurance claim.  They can help you!

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