Medicare, Medicare supplements and major medical health insurance generally do not pay for long term care expenses. Statistics reflect national average and costs vary widely across the country. Policies provide coverage on either a reimbursement of cost basis, or flat rate per day basis. Both are limited to the maximums of the policy. All policies contain provisions that determine if and when benefits are paid.
Some policies use more then one trigger to determine benefits.
The most common method for determining benefits is based on the insured s inability to perform ADL s. These are bathing, dressing, eating, toileting, continence, and transferring. Typically, you must be unable to do one or two ADL s out of six. This provision provides benefits if an insured is unable to pass certain tests assessing his or her mental function. This is especially important if a person has Alzheimer s disease or one of the many forms of senile dementia.