Insurance & Benefits

Home » Decision Toolkit » Insurance & Benefits

INSURANCE & BENEFITS

LONG-TERM CARE INSURANCE

Many seniors and their families ask about long-term care insurance and what it covers.

It can cover home care and home health care services, assisted living, adult day care, respite care, hospice care, nursing home and Alzheimer’s facilities. Not all long-term care insurance policies cover all services, nor do they pay the same for similar services. This is something to investigate thoroughly before purchasing and to discuss with your insurance agent.

Assisted Living

Knowing the type of features and services that are important to you determines the best type of policy and insurance company for you.
Remember that some long-term care insurance policies stipulate that payment for assisted living is determined by a person’s ability to perform two or more “activities of daily living.” Some insurers may require a physician evaluation, with a physician of their choice to determine if your condition qualifies for coverage.

A “facility-only” policy covers care received in a licensed assisted living facility or skilled nursing facility, but not care in an unlicensed facility or your home. Integrated home care policies with 100% protection for care received either at a licensed assisted living facility or skilled nursing facility or an unlicensed setting, like your home are always an option worth investigating.

Nursing Homes and Alzheimer’s Care

Nursing home care and Memory Care is paid by long-term care insurance, but with stipulations. Policy terms may vary widely, so be aware of what is and isn’t included and the terms of coverage.

As always, this information does not take the place of the advice and counsel of your insurance agent and particular policy. But please let us know if we can help you review a policy and determine existing coverage.

BENEFITS & FINANCIAL ASSISTANCE

We also hear from seniors and loved ones who have questions regarding veterans benefits. This information will get you started. Please visit www.va.gov for more information, recent updates and contact information. We would be happy to assist you however we can.

If you are a wartime veteran or the surviving spouse of a wartime veteran, you may be entitled to a widow’s pension. The U.S. Department of Veterans Affairs offers two different special pensions called ‘Housebound’ and ‘Aid and Attendance’ (A&A).

Eligibility

To be eligible, the veteran must have served at least 90 days of active-duty military service, at least one day of which was served during a period of war. A longer time in service requirement may be required if discharged after September, 1980. The veteran need not have served in a combat area. The veteran’s military discharge must be other than dishonorable. Since pension benefits are based on need, the VA determines if net-worth is sufficient to meet the claimant’s basic needs without assistance from the VA.

Housebound

To qualify under the VA’s housebound category, you need to show that due to your disability you are substantially confined to your dwelling and the immediate premises. Additionally, a VA 21-2680 exam from must be completed by a Doctor and certify that the veteran or the surviving spouse is either housebound or needs the aid and attendance of some other person in order to perform daily functions.

Aid & Attendance (A&A)

To qualify under the Aid and Attendance, a veteran or surviving spouse must show one of the following:

  • Requires the aid of another person in order to perform personal functions required in everyday living, such as bathing, feeding, dressing, attending to the wants of nature, adjusting prosthetic devices, or protecting yourself from the hazards of your daily environment (minimum of two ADLs required), OR
  • Is bedridden, in that your disability requires that you remain in bed apart from any prescribed course of convalescence or treatment, OR
  • Is a patient in a nursing home due to mental or physical incapacity, OR
  • Is blind, or so nearly blind as to have corrected visual acuity of 5/200 or less, in both eyes, and concentric contraction of the visual field to 5 degrees or less.
Countable Income

VA must consider income from all sources when reviewing the application. This includes Social Security income, income from investments (interest income), retirement pensions or 401K, income from rental property, etc. If the veteran is married, the income from both is considered.

Some on-going medical expenses can be used to reduce countable income. This includes cost for assisted living care, in-home care, and medical supplemental insurances. If you have been rated ‘Housebound’ or in need of ‘Aid & Attendance,’ and you are paying for in-home care, the provider does not have to be a licensed health care provider for you to claim this deduction.