Ask The Expert: What expenses are not typically covered by Long Term Care Insurance?

posted by: Chris Lynch MBA, CLTC, LTCP

Expenses that are not usually covered are specific to each policy type and sometimes by state.  This is where working with a long term care specialist can be of tremendous benefit to you and your family.  In order to find out the specific exclusions, ask to review a specimen policy for the policy that you are considering.  Your agent can provide this and you can review the exact language and exclusions that are pertinent to you or your family. 

The biggest expense that you should be aware of is the elimination or waiting period.  During this time, you are responsible for all expenses.  These can be counted as days of care received or calendar days.  Knowing this can save you thousands of dollars. 

Other typical exclusions include war, suicide attempt, drug addiction, alcoholism or a preexisting condition.  Basic items of comfort such as toiletries, television rental, beauty and hair charges are generally excluded.  Prescription drug charges are generally excluded, as well. 

There may be exclusions as to the payment for services that is given by family members. 

This is a partial list of typical exclusions.  Be aware that policies and benefits do change.  Additionally, many policies have a provision that allows for the payment of excluded benefits if they are petitioned for and approved in advance as part of an approved care plan. 

Your relationship with a knowledgeable, caring agent will go a long way to determining and understanding the important exclusions and benefits pertaining to the policy that you are considering.  Once a claim needs to be submitted, their assistance in the claims process can be invaluable in ensuring a smooth process.


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