Critical illness insurance and Long Term Care

People are living longer, so they’re more apt to experience serious illnesses or injuries that can temporarily put them out of commission. A critical illness plan covers more than just one condition. When you don’t need disability insurance (because you expect to be back on your feet), critical illness insurance steps in to fill the void. In general, although benefits vary from plan to plan, critical illness insurance pays you a lump-sum benefit if you suffer one of the covered critical illnesses or injuries.

Catastrophic Coverage and Long-Term Care

Catastrophic limit is another way to refer to maximum outof- pocket. In fact, major medical insurance is sometimes called catastrophic insurance. Major medical insurance may pay over an extended period for hospitalization costs and other health services that exceed the maximums your basic plan provides.

Most insurance plans, whether public or private, don’t cover home health care at all. If they do, the services they cover may be very limited. Some plans, for example, won’t pay for a care provider who is a member of the immediate family. One way to enhance coverage for catastrophic illness is to purchase a catastrophic coverage policy. These policies are designed to pay for hospital and medical expenses that exceed a very high deductible, perhaps $20,000 or more. Such policies may also provide for a fairly high maximum lifetime limit.

Another approach is to add a living insurance rider to a life insurance policy. A living insurance rider provides benefits to the insured while the insured is still living in case of a catastrophic illness.

Long-term care insurance policies are special policies that provide coverage for nursing home stays and home health care for a period established when you buy your policy. These policies are also called convalescent care or nursing home insurance. The policies are usually indemnity-type policies, meaning that they pay an established amount for each day of coverage you spend in a nursing home, regardless of the actual cost you incur.

Home health care

The goal of home health care can be to maintain, improve, or restore a person’s health. Usually, a doctor orders home health care and writes a plan of care, or instructions for the patient and the caretakers. In addition to registered nurses and licensed practical nurses, many other kinds of care providers may play a role, including the following:

- Home health aides and visiting nurses

- Homemakers from an outside service (housekeeping duties; no medical-related duties)

- Nutritionists

- Personal care attendants (PCAs meal preparation, bathing, laundry, light housekeeping, and so on)

- Physical, speech, and occupational therapists

- Social workers

Patients may also need certain pieces of equipment at home, such as hospital beds and accessories, respirators and oxygen tanks, wheelchairs, and walkers. Major medical policies usually cover these expenses.

Nursing home care

Nursing homes are characterized by the type of services they provide:

- Custodial care homes: These facilities are intended to maintain and support the individual’s current level of health, while trying to prevent any further decline. People in custodial care homes usually need a place to live and help with activities of daily living, which nonmedically trained professionals can provide. This type of nursing home is the lowest level and least expensive of the three.

- Intermediate care facilities: These facilities provide planned, continuous programs of nursing care for residents who can’t live alone. These programs are preventive and rehabilitative.

- Skilled nursing facilities (SNFs): A doctor must prescribe care for people in these facilities. Registered nurses and other medical personnel provide specialized medical care 24 hours a day.

Major medical coverage may cover the cost of a skilled nursing facility, but not the cost of a custodial care facility. See the Medicare and Medicaid sections in other articles for more information about catastrophic coverage and long-term care.