How much does LTC insurance pay for care received in different care venues?

How much does LTC insurance pay for care received in different care venues – e.g., in a Skilled Nursing Facility, in an Assisted Living Facility, or at home?

As a general rule, the stated daily benefit amount applies to care received in a skilled nursing facility (SNF). Accordingly, it is important to understand what benefit amount is paid if care is received either in some other kind of residential care facility (e.g., and assisted living facility). Many plans pay the same monthly benefit for ALF care as for SNF care, but some plans tie the ALF benefit to the home care amount.

LTC insurance coverage typically describes any home care benefit in terms of a percentage of the daily benefit for SNF care. This percentage is applied to the daily benefit amount – not the cost of covered services for the day. Thus, if you have a plan with a $300 daily benefit amount that pays 75% for home care, then the most you can receive for a day of care at home is $225. If your cost of home care for the day is $225 or more, you will receive that full $225.

Historically, many LTC plans paid a lesser benefit for home care than for SNF care, on the assumption that SNF care included housing costs, which are already covered if one receives care at home. However, because most people prefer to receive care at home, most modern LTC plans pay 100% for SNF, ALF, and home care. There is even one carrier that offers a 150% benefit for home care.

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