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Long Term Care Health Insurance in Texas

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.

What is the Purpose of Long-Term Care Insurance in Texas?

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.

  • Nursing home care - These are services that help old people dress, feed, getting out of bed and so on.
  • Home health care - This is the provision of adult care services such as companionship, reminders for medication, meal preparation, etc., at the policyholder’s home.
  • Day care (personal or adult) - This is the provision of custodial care to adults who are very dependent

According to the Texas Department of Insurance, long-term care insurance in the state does not cover:

  • Conditions that are pre-existing: The Texas Insurance Laws define a pre-existing condition as an illness diagnosed or treated in the past six months. That is, six months before the date of purchase of LTC insurance.
  • Care by the policyholder’s family members: Many LTC insurance companies in Texas do not pay relatives as caregivers of the policyholder. However, a few companies may cover the cost of training a family member to be a certified caregiver.
  • Nervous and mental disorders: As a rule in Texas, long-term care insurance must cover Schizophrenia, Alzheimer's Disease, Major Depressive Disorders, and other age-related illnesses. Many other mental disorders may not be covered.

What is Long-Term Care Health Insurance for in Texas?

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.

What are the Types of Long-Term Care Insurance in Texas?

In Texas, there are two main types of long-term care insurance, namely:

  1. Traditional Long Term Care Insurance Policies: These cover the long-term cost of caring for the policyholder. In this plan, benefits are paid out when the insured can no longer perform at least two activities of daily living. For instance, an insurer will pay out benefits when the insured can no longer walk and use the toilet themselves. Apart from that, benefits will also be paid should the policyholder become impaired cognitively, e.g., Alzheimer's. Under this plan, the insured gets daily benefits that cover whatever long term care is needed such as Nursing home care, hospice care, et.c
  2. Hybrid Long Term Care Insurance Plans: This is also known as Asset-based LTC insurance as it merges two different types of coverage in one policy. The two coverage types are life insurance and a qualifying annuity. Life insurance concerns a policyholder leaving a certain amount of money or assets to a beneficiary. Qualifying annuities are savings that were financed with pre-tax money. Hence, the Hybrid version of this coverage will ensure that policyholders leave money for their beneficiaries after they die, but before then, they can afford whatever long-term care service they need.

Do You Need Long-Term Care Insurance in Texas?

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.

  • Health status: Individuals who are considering long-term insurance in Texas should examine their lifestyle and family health status. For example, persons from a family with a history of hemophilia should strongly consider long-term care insurance. An individual's gender is also to be considered. Seniors with relatives who can care for them may also not care for this policy.
  • Assets and Income: Intending policyholders earning below the poverty line may find long-term insurance costly. Also individuals should examine their annual incomes and assets to plan for the possible changes in the future
  • Availability of alternative care: For example, people living below the poverty line are covered by Medicaid and may find long-term care unnecessary

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.

How Much Long-Term Care Insurance Do You Need in Texas?

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.

What Long-Term Care Insurance Coverage Do You Need in Texas?

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:

  • A monthly benefit is the amount of coverage the person gets every month. (The price for this depends on the insurance company).
  • The duration of the benefits, which is also known as the benefit period (This will depend on the company too).
  • The elimination period determines when the monthly benefit will start.
  • Optional benefits, known as riders, are also allowed. The most common rider people go for is the inflation protection rider. This feature will boost the monthly benefit to remain balanced even as the cost of living rises.

The following are some common features of a hybrid long-term care plan:

  • Since it includes two types of coverage, the value of the policy is spread over life insurance/annuity and LTC insurance. This means that a person with a total benefit worth $600,000, with $400,000 budgeted for long-term care, will have an outstanding $200,000 to be paid as a death benefit.
  • Premiums do not increase.
  • More flexibility as a policyholder can decide to pay the premiums in a single payment plan or bit by bit.
  • Underwriting, which will determine policy price, is less strict.
  • Premiums are refundable.

To determine the insurance coverage you need, it is best to contact a licensed health insurance agent in Texas.

Is Long-Term Care Insurance Required by Law 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.

How Does Long-Term Care Insurance Work in Texas?

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.** **

What Does Long-Term Care Insurance Cover in Texas?

Long-term care insurance in Texas generally covers the following:

  • Adult nursing home care
  • Health services including nursing care in your home
  • Social and educational activities
  • Therapeutic care and supervision at a daycare facility
  • Hospice care (depends on the policy and insurer). Hospice care refers to the provision of compassionate care for seniors so that their last days are as comfortable and enjoyable as possible.
  • Respite care (depends on the policy and insurer) Respite care concerns the provision of a short relief for specific caregivers.
  • provision of a helper for household chores
  • caregiver training for the policyholder’s family.

What is Long-Term Care Insurance in Texas Good for?

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.

What Does Long-Term Care Insurance Typically Include in Texas?

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.

Who is Covered by Long-Term Care Insurance in Texas?

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.

What Types of Items Does Long-Term Care Insurance Cover in Texas?

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.

Does Long-Term Care Insurance Cover Assisted Living in Texas?

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.

Does Long-Term Care Insurance Cover Assisted Living in Texas?

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.

Does Long-Term Care Insurance Cover Memory Care in Texas?

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.

Does Long-Term Care Insurance Cover Independent Living in Texas?

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.

What is Not Covered by Long-Term Care Insurance?

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.

What Does Long-Term Care Insurance Typically Exclude?

Long-term care insurance typically excludes:

  • Care received from family - if you have old parents showing signs of forgetfulness and you decide to stay with them, taking care of household chores, LTCI cannot reimburse you for the service.
  • Mental and Nervous Disorders - Illnesses such as depression, neurosis are not usually protected
  • Pre Existing conditions - Certain LTC insurers may deny protection to persons that have certain conditions already (e.g. Alzheimer). However, an insurance company can accept a person with conditions that are not fatal, although in this case premiums prices will be hiked.

What is an Example of Long-Term Care Insurance in Texas?

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:

  • People from ages 55-65
  • Persons dealing with chronic diseases requiring constant attention.

What is the Most Common Use of Long-Term Care Insurance?

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.

What is the Difference Between Long-Term Care and Disability Insurance?

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.

What is the Difference Between Long-Term Care Insurance and Medicaid in Texas?

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.

Do I Need Long-Term Care Insurance if:

Do I Need Long-Term Care Insurance if I Have Medicaid?

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.

Do I Need Long-Term Care Insurance if I Have Medicare?

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.

Do I Need Long-Term Care Insurance if I Have a Pension?

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.

What Happens if You Don't Use Long Term Insurance?

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.

Who Can Get Long-Term Care Insurance in Texas?

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.

Who Qualifies for Long-Term Care Insurance in Texas?

The following are people who qualify for long-term care insurance benefits in Texas:

  • An individual with a chronic ailment
  • An individual aged 65 and above

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.

Who Needs Long-Term Care Insurance?

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.

What are the Benefits of Long-Term Care Insurance in Texas?

The benefits of long-term care insurance in Texas include:

  • Tax-free and tax-deductible premiums- tax-deductible premiums means that the money a person pays for the policy is either taken from pay pre-tax, or gets subtracted from the total taxable income.
  • The insured's family do not have to be the caregivers - With the right policy, the policyholder will be able to afford quality in-house care or assisted living when necessary
  • Flexible benefits - the policyholder can select an extensive range of policy options with protection against inflation. This means the insurer will consider inflation when paying out benefits.

Consult with a Texas-licensed health insurance agent, to get professional advice according to your needs.

Why is Long-Term Care Insurance Good?

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.

Why is Long-Term Care Insurance Bad?

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:

  • Rise in the cost of providing health care,
  • People live longer and require more coverage over a longer period of time.

Speak with a licensed Texas health insurance who is appointed with multiple LTC carriers, to discuss the best options to fit your needs.

Is it Worth Getting Long-Term Care Insurance?

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.

What Happens if You Don't Have Long-Term Care Insurance?

Without this insurance plan, adults who need long-term care services can pay for it through:

  • Medicare (which offers limited services)
  • Medicaid (comes with requirements and is limited)
  • Out-of-pocket (you pay for the services with your money)
  • Care from family or relatives.

Why is Long-Term Care Insurance Important for Texas?

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.

What Happens When Your Long-Term Care Insurance Lapses?

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.