What are the triggers for long-term care insurance benefits? (2024)

When you purchase long-term care insurance, you're taking a step to plan for the additional cost of care that you may face later in life. And, that's an important considering that long-term care services can be pricey.

But, just purchasing the policy isn't enough. It's important to understand exactly what you're buying. Insurance policies typically have triggers that start benefits. For example, in an auto insurance policy, one of those triggers may be a car accident. So, when a car accident happens, your benefits kick in.

But, how do those triggers work when it comes to long-term care insurance benefits? And, how long will you have to wait after those triggers take place to receive your benefits? That's what we will examine below.

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What are the triggers for long-term care insurance benefits?

"Triggers have become standardized now," explains Keith Bercun, regional sales director for the financial services firm, OneAmerica Financial Partners. That means, for the most part, the triggers that lead to benefit coverage in long-term care policies are the same across the board. Here are the typical benefit triggers associated with long-term care insurance:

Activities of daily living

From a standardized standpoint, your benefits will be triggered when you're "unable to complete two out of six activities of daily living for 90 days or longer," says Bercun. Those six activities of daily living include:

• Bathing: This includes being able to get in and out of the bathtub or shower and being able to wash yourself while in the bathtub or shower without assistance.
• Continence: This involves being able to control your bladder or your bowels.
• Dressing: This involves more than simply putting clothes on. It also involves an ability to select appropriate clothing and maintain your appearance.
• Eating: This involves meal preparation as well as being able to feed yourself.
• Toileting: Toileting is inclusive of being able to sit onto or get off of the toilet on your own as well as properly using a toilet and being able to clean yourself.
• Transferring: This involves getting in and out of resting furniture, like a bed or chair.

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Cognitive impairment

Another trigger that's standardized in the industry today is known as cognitive impairment. But, not all cognitive impairments will trigger long-term care coverage. You'll qualify for your long-term care benefits if "you have a severe cognitive impairment such that you can be dangerous to yourself or others," says Bercun.

For example, if your cognitive impairment means that you may walk out of your home and forget how to get back to safety, you will likely qualify to receive your long-term care insurance benefits.

Standby assistance

"Standby assistance will trigger a claim with some carriers, but not all," explains Bercun. So, this is not a standardized trigger, but it's important to look for as you shop for a policy. "Let's say for example, in the beginning stages of Parkinson's, you start losing balance and you need someone to stand by because you can hurt yourself." In this case, you may qualify for coverage with some policies. So, if you're shopping for long-term care insurance, it may be worthwhile to look for a policy with a standby assistance trigger.

How long does it take to receive benefits after a trigger?

It's also important to note that your benefits may not be available as soon as you meet the triggers above. Instead, long-term care insurance triggers typically start an elimination period - or period of time that you're expected to cover your cost of care before benefits begin.

"All carriers have different elimination periods, but the one that seems to be the most standardized is 90 days," explains Bercun. "Several carriers have waivers of elimination periods that you can buy as an additional rider. Many carriers offer a waiver of the elimination period for free built in if you start off at home."

It's also important to consider how those elimination periods are calculated.

"Some of them are calendar days and some of them are service days," says Bercun. "A service day means an elimination period day is only satisfied on a day when somebody is actually providing long-term care services. So, elimination periods can be tricky. You have to really look and see how the policy is structured on that."

So, if you're shopping for long-term care insurance now, be sure to consider elimination periods and how they're built.

The bottom line

There are multiple events that can trigger long-term care insurance benefits. An inability to complete two of the six activities of daily living for 90 days or longer or a cognitive impairment will typically act as triggers. Also, depending on your policy, the need for standby assistance may be a benefit trigger. But, keep in mind that benefits don't always start as soon as they're triggered. You may have an elimination period to consider. Chat with a long-term care insurance agent about your coverage and elimination period options now.