Long-term-care (LTC) insurance addresses qualifying help with daily activities or supervision for cognitive impairment, such as serious problems with memory or judgment. Supplemental policies pay defined benefits for specified services, illnesses, or events. Neither automatically replaces comprehensive medical coverage.
This final unit teaches you to identify the event or condition required for payment (trigger), payment method, benefit limit, and gap a product is designed to address.
Learning path
- Long-Term Care Insurance: Eligibility triggers, activities of daily living, cognitive impairment, levels and settings of care, elimination period, benefit period, and inflation protection.
- Supplemental Health Policies: Dental, vision, specified-disease, cancer, critical-illness, accident, hospital-indemnity, worksite, and short-term medical products; benefit triggers and limitations.
Apply the unit
A consumer wants protection for both routine medical bills and a possible long-term care need.
- Major-medical insurance: Pays covered medical expenses under its terms, with applicable member costs and limits.
- LTC insurance: Pays under its care-eligibility and benefit rules, which may address help that medical insurance does not cover.
- Hospital-indemnity insurance: Pays a stated benefit for a qualifying hospital stay; that payment may differ from the actual bill.
- Identify each policy's trigger and the costs that could remain unpaid.
Study checkpoint
- Can you explain the difference between skilled, intermediate, and custodial care?
- Can you identify an LTC trigger and elimination period?
- Can you explain why a fixed supplemental benefit may not equal reimbursement of the full expense?