Recent research by the US Department of Health and Human Services suggests that most Americans turning age 65 will need long-term care at some point in their lives.

Professional medical care, nursing homes, and home healthcare can be extremely costly. What would you do if you or someone in your family needed this type of care for a long period of time? Medicare and private health insurance pay for some types of care, but there are limits. 

Medicare, for example, only pays for short-term nursing home stays under very specific circumstances. And Medicaid is only available to seniors with very low incomes and few assets. Everyone needs a plan for how they will handle long-term care expenses. One potential way to help is long-term care insurance.

What Does Long-Term Care Insurance Cover in South Carolina?

Long-term care (LTC) insurance in South Carolina covers costs related to long-term medical and custodial care, which are not covered by Medicare. A long-term care insurance policy helps cover the costs of care when you have a chronic medical condition, a disability, or a disorder such as Alzheimer’s disease.

Most LTC policies provide coverage after the policyholder needs assistance with two or more of the designated Activities of Daily Living (ADLs): eating, bathing, dressing, transferring, using the toilet, and maintaining continence. Those with severe cognitive impairment may also be able to receive LTC benefits.

Long-term care policies have an elimination period. This is the number of days that the insured person must wait before they receive benefits. The typical elimination period is 30 days. 

Likewise, most policies stipulate a daily reimbursement limit. This will be specifically outlined in your policy and is usually around $150 per day or more. Benefits will be paid for a maximum number of days as outlined in the policy, typically between two years and ten years. Other policies state a maximum lifetime limit for benefits. 

Most LTC policies will reimburse the policyholder for care given in a variety of settings, including:

• At your home (including skilled nursing care, physical therapy, home health aides, and housekeeping services)
• At a nursing home
• At an assisted living facility or memory care facility
• At an adult daycare center

Comprehensive long-term care polices generally cover the following services: 

• Skilled nursing care
• Occupational, speech, physical, and rehabilitation therapy
• Personal care services, such as help with bathing and dressing

What Does Long-Term Care Insurance Not Cover in South Carolina?

First, most long-term care policies limit coverage to a certain length of time or a certain amount of money. Some policies pay for only two to five years, while others might pay for as long as you live with no dollar limit (but these policies are rare). 

People with certain preexisting conditions may not qualify for LTC insurance. Eligibility varies among insurance companies, but some of the most common reasons why you might be ineligible for buying a long-term care policy include: 

• You are currently using long-term care services
• You already need help with Activities of Daily Living 
• You have AIDS or AIDS-Related Complex 
• You already have Alzheimer’s Disease or any form of dementia or cognitive dysfunction
• You have a progressive neurological condition such as multiple sclerosis or Parkinson’s Disease
• You had a stroke within the past year to two years, or you have a history of strokes
• You have metastatic cancer 

Insurance companies also consider other health conditions when determining your eligibility. 

But keep in mind, if you develop one of the health conditions above after you purchase long-term care insurance, your policy will cover your care related to that condition. 

It’s important to understand that LTC policies don’t cover medical care costs (doctor visits, lab tests, and other services normally covered under Medicare or health insurance). Your medical costs are covered under Medicare or your private health insurance according to your policy.

Do I Need Long-Term Care Insurance?

It’s very hard to predict who will need long-term care and long-term care insurance. According to the US Department of Health and Human Services, an adult turning 75 has a 70% chance of needing some form of long-term care. What’s more:

• One-third of retirees may never need long-term care 
• 20% of retirees may need long-term care for five years or longer
• The cost of a private nursing home room is about $7698 per month, on average

Research by HHS also finds that women are more likely to need long-term care than men, because women statistically outlive men and in many cases may be alone. Other people more likely to need long-term care according to HHS include: 

• People with chronic illnesses that lead to disability
• People with a poor family health history
• People with poor diet and exercise habits 
• People with a chronic condition like diabetes or high blood pressure

If you’re thinking about purchasing long-term care insurance in South Carolina, here are some other things to consider:

• Regular health insurance doesn’t cover long-term care. 
• Medicare covers only short nursing home stays or limited amounts of home health care (skilled nursing or rehabilitation). Medicare does not pay for custodial care, which includes supervision and help with daily tasks.
• If you plan to pay for long-term care services by yourself, you’ll only receive help from Medicaid after you’ve depleted most of your personal savings. 

Do I Need an Agent to Purchase Long-Term Care Insurance in South Carolina?

Individuals in South Carolina who are interested in learning more about long-term care insurance will benefit from speaking with a local independent insurance agent. Independent agents can help you shop around for the right coverage for your needs. 

Local agents are members of your community and will get to know you. Independent insurance agents can offer expert guidance, service, and advice for all of your personal insurance needs.