With many policies, your benefits won’t start the first day you go to a nursing home or start using home care. Most policies have an elimination period (sometimes called a deductible or a waiting period). That means benefits can start zero, 20, 30, 60, 90, or 100 days after you start using long-term care or become disabled. Elimination Long-Term Care Insurance Benefits periods for nursing home and home health care may be different, or there may be a single elimination period that applies to any covered service. How many days you have to wait for benefits to start will depend on the elimination period you pick when
you buy your policy. You might be able to choose a policy with a zero-day elimination period, but expect it to cost more.
Some policies calculate the elimination period using calendar days, while other policies count only the days on which you receive a covered service. Under the calendar days method, every day of the week would count in determining the elimination period regardless of whether you received any services on those days. Under the days of service method, only days when you receive services will count toward the elimination period. This means if you only receive services three days a week, it will take longer for your benefits to start, and it could mean that you have more out-of-pocket expenses before your benefits begin. Also, some policies have an elimination period that you only need to satisfy once in your lifetime, while other policies require that you satisfy the elimination period with each “episode of care.” Some policies allow you to accumulate non-consecutive days toward satisfying the elimination period, and some policies require consecutive days. Make sure you know how the policy defines the elimination period.
During an elimination period, the policy will not pay the cost of long-term care services. You may owe the cost of your care during the elimination period. You may choose to pay a higher premium for a shorter elimination period. If you choose a longer elimination period, you’ll pay a lower premium but must pay the cost of your care during the elimination period.
For example, if a nursing home in your area costs $150 a day and your policy has a 30-day elimination period, you’d have to pay $4,500 before your policy starts to pay benefits. A policy with a 60-day elimination period would mean you’d have to pay $9,000 of your own money, while a policy with a 90-day elimination period would mean you’d have to pay $13,500 of your own money.
If you only need care for a short time and your policy has a long elimination period, your policy may not pay any benefits. If, for example, your policy had a 100-day elimination period, and you received long-term care services for only 60 days, you would not receive any benefits from your policy.
On the other hand, if you can afford to pay for long-term care services for a short time, a longer elimination period might be right for you. It would protect you if you need extended care and also keep the cost of your insurance down.
You may also want to think about how the policy pays if you have a repeat stay in a nursing home. Some policies count the second stay as part of the first one as long as you leave and then go back within 30, 90 or 180 days. Find out if the insurance company requires another elimination period for a second stay. Some policies only require you to meet the elimination period once per lifetime.
