Whether preparing for your own future or helping a loved one transition to a senior living community, long term care insurance can be a valuable financial resource. While navigating policies and benefits may feel overwhelming, knowing what’s covered and what’s not covered can make all the difference. Let’s explore coverage basics, eligibility, and how to make the most of these benefits when you choose a PMMA (Presbyterian Manors of Mid-America®) community.
What is long term care insurance?
Long term care insurance helps cover the cost of services that support daily living as individuals age or experience health changes. It can cover assistance with tasks such as bathing, dressing, eating, and medication management also known as Activities of Daily Living (ADLs).
Unlike traditional health insurance or Medicare, long term care insurance is not focused only on medical treatment. It can support custodial care, skilled nursing, or therapies which are often provided in assisted living neighborhoods, memory care neighborhoods, or through in-home services.
Related: How to afford assisted living
Does Medicare pay for assisted living?
This is one of the most common questions families ask. In most cases, Medicare does not cover the cost of assisted living. It does not cover rent, dining services, or help with personal care because these are not considered medical expenses. Medicare may pay for short-term rehabilitation services after a hospital stay, but not the ongoing support provided in a senior living community.
That’s why long term insurance often plays an important role in helping cover the cost of assisted living.
What does long term care insurance cover in assisted living?
While each policy is different, many long term care insurance plans include coverage for services commonly offered in assisted living, such as:
- Assistance with Activities of Daily Living (ADLs)
- Medication reminders or management
- Support with mobility and transfers
- Meal preparation and dining assistance
- Supervision and safety monitoring
Some plans may also cover memory care in specialized settings. Most policies require documentation that the individual needs help with at least two ADLs, and benefits may not begin until after an elimination period (a waiting period before coverage starts). Policies may also set daily or monthly benefit limits, which means it’s important to read the terms carefully or speak with an insurance professional.
How long term care insurance works at a PMMA community
PMMA senior living communities work closely with residents and their families to help make the most of available benefits. Team members can assist families with care assessments, required paperwork, and coordination with insurance providers to ensure that required documentation is submitted.
Life Enrichment Directors, health care staff, and other team members collaborate to provide a seamless experience, from move-in planning to ongoing support. Each of our communities is committed to helping residents feel confident in their financial decisions and comfortable with the care they receive.
Related: From active independence to supportive care: the role of a life plan community
What if someone doesn’t have long term care insurance?
Long term care insurance can be helpful, but it’s not the only way to pay for assisted living. Some residents choose to use personal savings, retirement income, or long term care annuities.
Is long term care insurance worth it?
Deciding whether long term care insurance is the right choice depends on individual goals, health history, and financial planning. Some individuals purchase policies in their 50s or 60s to help protect retirement savings and prepare for future care needs. Others may find the premiums too costly or prefer to self-fund.
Policies can help cover non-medical care that Medicare does not pay for, such as assistance with daily activities. However, there are also limitations. Premiums tend to increase with age, making policies more expensive if purchased later in life. Some policies include benefit caps, waiting periods, or coverage exclusions. In addition, individuals with pre-existing conditions may face difficulties obtaining coverage or may be subject to additional requirements.
Plan ahead and ask questions with PMMA
When it comes to planning for senior living, understanding your financial resources can bring peace of mind along with better outcomes. Long term care insurance is just one piece of the puzzle, but it can make the cost of assisted living more affordable for many older adults. At PMMA, team members are available to help residents and families explore their options and make the most of available benefits. Consulting a financial advisor is also an excellent step in understanding your options. Download our FAQs guide to learn more about our senior living communities or speak to an advisor today.
