Long-term care health insurance or LTC in Texas is a policy that covers long-term care of policyholders as they age. Long term care does not provide medical care covered by regular health insurance policies such as doctor and hospital visits, prescription drugs, surgeries, and medical devices. Rather, purchasing a Texas long term care health insurance plan protects you when you require assistance with Activities of Daily Living (ADL). The main ADLs covered include eating, contingency, toileting, moving from one place to another, bathing, and getting dressed.
In Texas, the target age range for long-term care insurance coverage is 65 years and above. Typically, the federally-sponsored Medicare insurance does not cover custodial care and extended nursing home care. To fill this significant gap, it is recommended to buy a long-term care health insurance plan or a combination of life insurance and long-term care insurance policies.
Texas long-term care insurance follows the principle of the younger you are, the lower the cost of buying the policy. On average, LTC health insurance claims in Texas usually begin between 75 years and 80 years. As such, it is better purchased when the intending Policyholder is in their 50’s or 60’s. Purchasing LTC too early is not exactly cost-effective because the policyholder will be paying premiums for a longer period of time.
Long-term care insurance provides more options to U.S seniors who are at risk of suffering from a protracted or long term illness. Some of these options include, more flexibility, more daily benefit and access to quality health. While Medicare, Medicaid, and Medigap insurance policies serve to assist individuals, aged 65 years and over, to meet their hospital, medical, and other health needs, they offer limited benefits. Long-term care insurance provides the following as the policyholder loses independence and begins to require round-the-clock supervision.
According to the Texas Department of Insurance, long-term care insurance in the state does not cover:
Long-term care insurance is for senior Texans who require direct patient care in a long-term care setting. According to the Department of Health and Human Services, an estimated 7 in 10 seniors will require some form of LTC before they die. The daily average cost of long-term care in Texas is approximately $200 per day. This figure amounts to over $5,000 monthly.
In Texas, LTC health insurance pays for nursing care, therapeutic care, social care, educational care, and supervision of policyholders.
In Texas, there are two main types of long-term care insurance, namely:
The short answer to this question is — it depends. Generally, most Texas seniors will need long-term care insurance as they age. However, it is best to consider certain factors before deciding if buying this insurance is best for you.
Due to these varying factors, it is best to speak to a licensed health insurance agent in Texas for information on the amount of protection you need.
You need long-term care insurance in Texas to protect personal savings/assets and maintain your quality of life.
In Texas, the amount of long-term care insurance that a person needs, depends on age, health, lifestyle, gender, location, amount of personal savings, etc. The estimated daily cost for a nursing-home room in Texas is less than $200 and a long-term care plan can cover this cost for you.
LTC is not only needed by seniors (65 and above) as residents with disabilities or chronic diseases also purchase it.
The needed long-term care insurance coverage for Texas residents will generally depend on the person's health status and ability to afford the coverage. Below are some common features of the traditional long-term care plan:
The following are some common features of a hybrid long-term care plan:
To determine the insurance coverage you need, it is best to contact a licensed health insurance agent in Texas.
No, Texans are not mandated by law to purchase long-term care insurance. However, the Texas Department of Insurance offers a long-term care partnership program, making it easier for Texas residents to get LTC insurance.
For Texans to purchase long-term care insurance, those interested will need to complete an application form. Generally, the insurance company will request the person's medical records and conduct an interview via a phone call or face to face.
The individual will choose the desired coverage amount, then after approval, the contract is presented, signed and the insured starts paying the premiums. As the policyholder ages and health declines, the insurer takes care of the policyholder's long-term care needs. Long-term care insurance typically sets a daily benefit amount for its policyholders. This amount generally ranges between $50 and $500 based on the policy. This coverage allows the insured to decide how long (in years) they want to keep getting the benefits.** **
Long-term care insurance in Texas generally covers the following:
In Texas, long-term care insurance is good for maintaining your quality of life as you age and become more dependent. For instance, not every person likes to stay in a nursing home. With an LTC plan, such people can have their caregivers living with them. Unlike most government programs, this coverage provides high-quality health services to its policyholders. Information on the right plan for your needs can be obtained from a licensed Texas health insurance agent.
Long-term care insurance coverage in Texas typically includes a wide range of health care packages at a specialized facility or home. The specifics of the coverage will depend on the policy. Hence it is good to see a licensed health insurance agent to help you make the right decision.
Long-term care insurance in Texas covers both people who are 65 or older and people suffering from chronic diseases that require constant treatment. E.g. individuals with Alzheimer’s or chronic diseases like asthma, arthritis, cancer, and so on. If you come from a family with a history of health problems, long-term care insurance is for you.
Long-term care insurance in Texas covers items such as treatment for Alzheimer's, cancer, etc. c. For instance, most old couples would like to be cared for under their own roof for as long as possible. This is a good reason to get this coverage because unlike other similar plans, long-term care insurance has this.
Yes, long-term care insurance covers assisted living in Texas. Assisted living is a housing facility for seniors needing help with basic chores. The estimated cost for assisted living in Texas is approximately $4,000 per month and due to its high cost, most government funded insurance rarely covers it to the same level as long-term care insurance.
Yes, long-term care insurance covers assisted living in Texas. On an average, assisted living across Texas costs upwards of $4,000, and this can be covered with an LTC policy.
Yes, long-term care insurance in Texas covers memory care for people with dementia and other mental ailments. On average, memory care in Texas costs around $5,000 per month, and this usually includes 24-hour supervised care. However, most LTC insurance companies do not offer a plan to individuals that have Alzheimer’s at the time of purchase. Hence, if you are in danger of developing Alzheimers and want to consider the options for “down the road”, you should speak with a licensed health insurance agent.
Long-term care insurance may cover independent living in Texas. Independent living in Texas costs about $2,500 per month, and may be covered by LTC insurance benefits. However, there are certain insurers that have requirements such as staff type, licensing, state laws, size of the independent living community, etc. before they would cover independent living. Therefore, it is advisable to speak to a licensed health insurance agent, who can help point you in the right direction and answer any questions you might have on the subject.
Long-term care insurance does not pay out claims for nervous and mental disorders, conditions existing prior to coverage, and for care provided to the insured by family members.
Long-term care insurance typically excludes:
Usually, long-term insurance is purchased by seniors who want to maintain their quality of life and/or do not meet the income limit on government-sponsored insurance policies (i.e Medicaid).
Generally, long-term care insurance plans are bought to facilitate care-giving for the senior residents when they can no longer care for themselves. Insurance plans usually cover adult daycare, nursing home or assisted living.
In Texas, long-term care insurance is commonly purchased by:
The most common use of long-term care insurance in Texas is for access to quality assisted living facilities at a fraction of the actual cost.
While disability insurance only reimburses (partly or fully) an individual for income lost due to an inability to work, long-term care insurance covers part or all of the care-giving expenses of a senior.
In Texas, Medicaid is a federal and state-funded program offering free or inexpensive medical and caregiving services to low-earners. On the other hand, long-term care insurance is offered by private insurers to people needing more options.
Medicaid is generally for lower-income earners in Texas. Long-term care insurance provides its policyholders with more services, e.g hospice care.
Yes, with an active Medicaid coverage a long-term care plan may be needed (specifically the hybrid long-type) if you want to secure a death benefit for your beneficiaries while paying for your care. With a Hybrid plan, when the insured loses at least 2 activities of daily living (eating, contingency, toileting, walking, bathing, and/or getting dressed) that individual starts to get benefits to fund long-term care. Also, after death, the beneficiaries will get benefits too.
Although Texas Medicaid offers assisted living, home healthcare, and home-nursing, it comes with an income-limit among other eligibility criteria. Hence, certain individuals may not be able to access it. Contact a Texas-licensed health insurance agent to receive professional advice on long-term care as it applies to your individual needs.
Although Medicare covers certain LTC services such as a nursing home and hospice care, it however does not pay for daily custodial care services i.e., assistance with dressing, eating and bathing. Therefore individuals that want to have access to this service still need long-term care insurance.
Yes, you need long-term care insurance even with a pension. This is because a pension does not connect policyholders to a network of credible health practitioners where specific services come at discounted prices. Generally, after receiving pension, it is on that individual to find a credible medical practitioner, unless the prior employers provided this type of benefit at retirement.
Those who purchased a “return of premium rider” in the policy and do not use the LTC insurance can get a refund of the premiums they paid. With the hybrid type of LTC insurance, those who do not use the coverage can get a life-insurance payout for their beneficiaries. Otherwise, the money that was paid in by you, is used on providing care for others, who are using the same insurer.
In Texas, the seniors and individuals living with chronic illnesses alone can get long-term care insurance. You can buy the plan while young but benefits are only paid out when you begin to lose independence. Consult with a licensed agent in Texas to help with finding the right plan.
The following are people who qualify for long-term care insurance benefits in Texas:
However, it is advisable to purchase the plan before any of those conditions becomes your reality. This is so that you are not considered too risky to insure and therefore rejected. Also if such a person is accepted the premiums will be higher. As reported by AALTCI (American Association for Long-Term Care Insurance) less than 50% of individuals aged 60-69 qualify to buy this coverage.
Long-term care insurance is needed by people who want to be able to afford quality care, as they grow old without the limitations that come with government or state-funded LTC plans. It is also a way to combine life insurance and LTC benefits under one plan (hybrid long-term care policies). With the help of a Texas-licensed health insurance agent, interested persons can find the best quotes and buy the LTC plan they need.
The benefits of long-term care insurance in Texas include:
Consult with a Texas-licensed health insurance agent, to get professional advice according to your needs.
Long-term care insurance is good because it provides its policyholders with access to quality healthcare, which in return helps prolong life expectancy and the quality of life.
The main drawback of long-term care insurance is that its cost is on the rise. The reason why long term care is getting costlier is mostly due to the:
Speak with a licensed Texas health insurance who is appointed with multiple LTC carriers, to discuss the best options to fit your needs.
Yes, long-term care insurance is worth it in Texas because the out-of-pocket cost of healthcare is not cheap and it becomes more expensive with age. In 2022, 1 year of long-term care in Texas averaged close to $80,000. By 2040 this price tag is expected to double.
Speak to a Texas-licensed health insurance agent to discuss the possible Long Term Care options.
Without this insurance plan, adults who need long-term care services can pay for it through:
Long-term care insurance is important because it helps protect the Texas residents’ retirement assets. It does so by covering long-term care-associated expenses, which otherwise must be paid out-of-pocket. By utilizing the available benefits of Long-Term Care insurance, an insured's long-term care becomes more flexible and more affordable.
When Long-Term care insurance lapses, the insured loses the right to be reimbursed for claims. Lapse in insurance coverage means that the Long-Term Care policy has expired and is terminated. Benefits such as assisted living, in-house adult care, hospice care, etc., are lost. Most health insurers allow for a 30-day grace period for the policyholder to renew the coverage. To do this, the individual must pay a renewal premium according to the pricing model of the selected insurer. A trusted, Texas-licensed health insurance agent can clarify any question concerning LTC insurers and how to avoid lapse of coverage.