Frequently Asked Questions

What is long-term care?

Long-term care is a variety of services and support to meet health or personal care needs over an extended period of time. You may need long-term care if you:

• Develop a prolonged or chronic illness.
• Sustain a serious injury or disability.
• Develop a cognitive impairment that causes memory loss or disorientation, such as Alzheimer’s.
• Need assistance due to the normal frailties of aging.

Who needs long-term care?

Long-term care is not just for the elderly, and it’s not just about nursing homes. Roughly 40% of all long-term care insurance claims are made by people younger than 65. And most people receiving long-term care live in their own home or a family member’s home.

About 70% of people over age 65 will require some type of long-term care services in their lifetime. Of those, more than 40% will need care in a nursing home.

What is the Texas Long-Term Care Partnership program?

The Texas Long-Term Care Partnership was created by the Texas Legislature to give Texans like you the information and tools you need to plan for long-term care. The Partnership is a collaborative effort between private long-term care insurance providers, their authorized agents, and state government agencies, including the Texas Department of Insurance, the Texas Health and Human Services Commission, and the Texas Department of Aging and Disability Services.

How is a Texas Partnership-qualified policy different than other long-term care insurance policies?

Only a Texas Partnership-qualified policy offers dollar-for-dollar resource protection, which is an important feature should you ever need to apply for Medicaid. That’s because for every dollar that a Partnership-qualified policy pays out in benefits, a dollar of your financial resources will be set aside when determining if you qualify for Medicaid.
In addition, all Texas Partnership-qualified policies must offer:

• Inflation protection to make sure your coverage keeps up with rising costs.
• Tax qualification which means you may be able to deduct part of your premiums from your taxes as a medical expense.
• State-to-state coverage (reciprocity) which is designed to make the Medicaid-related benefits of a Partnership-qualified policy effective in other participating states.

Also note that not all insurance companies can sell Texas-Partnership-qualified long-term care insurance policies.

Won’t Medicare, Medicaid, my health insurance, or disability insurance pay for my long-term care?

Very few government programs will help pay your long-term care expenses. Those that do, have strict eligibility requirements and limits on what is covered. And even though Medicaid is the major payer of long-term care services, most people won’t qualify. As a result, you shouldn’t depend on Medicare or Medicaid to pay for your long-term care expenses.

Health insurance does not cover long-term care. Health insurance pays for services that focus on the prevention and treatment of medical conditions, whereas long-term care services are designed to help you maintain your current lifestyle at a time when you may not be able to be fully independent.

Disability insurance is designed to replace a portion of your income on a tax-free basis should a sickness or illness prevent you from working and earning money. It does not pay your long-term care expenses.

What does long-term care cost?

Long-term care is expensive. For example, one year of care in a nursing home based on the 2008 Texas average costs more than $43,000 for a semi-private room. One year of care at home from a home health aide for an average of three hours a day, three days a week would cost just over $13,000 a year. Long-term care costs can vary greatly by the type of service as well as the city in which the service is provided.

What does long-term care insurance cost?

Depending on your specific needs, you may be able to get a long-term care policy for less than you think. Your premium rate will depend on:

• Your age.
• Your health.
• Policy features such as the elimination period, benefit amount and duration you choose.
• Other factors such as where you live and any optional benefits you choose to include in your policy.