When Do My Long Term Care Insurance Benefits Start?

A question on the minds of many looking at long term care insurance is "when do my long term care insurance benefits start?" Long term care insurance is designed to help pay for the needs of individuals who need long term care for normal living activities. Given this, insurance companies look at what activities an individual can or cannot do for themselves to decide whether to start paying policy benefits or not.
In technical terms insurance companies refer to Activities of Daily Living, or ADL’s and the number of these activities that an individual can do on their own to help the company decide when they will begin paying long term care policy benefits to a policy holder. The activities that make up the ADL’s are (in alphabetical order): bathing, continence, dressing, eating, toileting, and transferring.

Activities of Daily Living – What Can’t You Do For Yourself
Long term care insurance companies will begin to pay benefits when you can’t do some number of the 6 ADL’s. It is important that you check with your insurance company of with the companies that you are comparing to make sure that you clearly understand what triggers you have to meet regarding ADL’s in order for you to begin receiving benefits.
In some cases you may be able to get benefits if you only need to have someone watching you, and in other cases it will be necessary for someone to physically assist you in performing one of the ADL’s. Again, make sure you are clear on what your policy or potential policy says.
There are other cases that may need to be met in order for your benefits to start that you need to pay particular attention. These situations include mental incapacity or cognitive impairment, doctor certification due to medical necessity, and (older long term care policies) – upfront hospitalization (similar to the 3 day hospital stay requirement that Medicare has).

Alzheimer’s Disease And Other Mental Incapacity – Are They Covered?
In the case of mental incapacity such as Alzheimers Disease, it is possible that you will still be able to perform all of the ADL’s, but yet dangerous for you to be unattended. For this particular situation you will want to make sure that you are covered for the onset of memory loss – dementia – Alzheimer’s and what conditions surrounding the ADL’s you must meet to get benefits.
Once you have met the ADL requirement you are on your way to receiving benefits. However, you will still have to deal with the deductible or waiting period associated with your policy. This period is called the elimination period. Learn more about the elimination period.

The Bottom Line Of When Your Long Term Care Benefits Will Start
Coverage and benefits start for your long term care policy in many cases based on what you can and cannot do for yourself on a daily basis. Insurance companies rely on the number of ADL’s, Activities of Daily Living, that you have to get assistance with, or need supervision with to determine whether they’ll start paying your benefits. It is important that you know these benefit triggers before you decide on a policy, or if you are reviewing your policy.
Check with your insurance company or make sure you compare insurance company requirements surround ADL’s or you could be in for a rough go when it comes time to start getting your benefits.