Does My Long Term Care Insurance Policy Cover Palliative Care?

Long Term Care Insurance

November is both Long Term Care Insurance and Palliative Care awareness month, but what is the difference? Long term care insurance covers a broad array of difficulties from rehabilitation due to injury, immobility due to aging factors, to diagnosis of a cognitive impairment such as Alzheimer’s, which requires supervision. It is care received on a custodial basis by a care professional who does not have to be a doctor or nurse. Care is needed when a doctor states that the client has had the inability to perform two of six activities of daily living: bathing, continence, dressing, eating, toileting, or transferring for at least 90 days, or has been diagnosed with a cognitive impairment.

Palliative care however, is care offered to prevent and/or relieve suffering, and to support the best possible quality of life for residents and their families, regardless of the stage of a disease, or the need for other therapies. Palliative care expands traditional disease-model medical treatments (hospice care) to include the goals of enhancing quality of life for patient and family, optimizing family functioning, assisting with decision making, and providing opportunities for mental and spiritual growth. It can be delivered concurrently with life-prolonging interventions or as the main focus of care.

Where palliative care programs and hospice care programs will differ greatly is in the care location, timing, payment, and eligibility for services. Currently, hospice programs far outnumber palliative care programs. Generally, once enrolled through a referral from the primary care physician, a patient’s hospice care program, which is overseen by a team of hospice professionals, is then administered in the home. Hospice often relies upon a family caregiver, as well as a visiting hospice nurse. Hospice can provide round-the-clock care in a nursing home, a specially equipped hospice facility, or, on occasion, in a hospital, but the latter is not the norm.

You must generally be considered to be terminal or within six months of death to be eligible for most hospice programs, or to receive hospice benefits from your medical insurance, including most long term care insurance contracts. Before considering hospice, it is vitally important to check on policy limits of payment. While hospice can be considered an all-inclusive treatment in terms of payment (hospice programs cover almost all expenses), insurance coverage for hospice can vary. Some hospice programs offer subsidized care for the economically disadvantaged, or for patients not covered under their own insurance. Some hospice programs are covered under Medicare.

Most hospice programs concentrate on “comfort” rather than aggressive disease abatement. By electing to forego extensive life-prolonging treatment, hospice patients can focus on getting the most out of the time they have left.

On the other hand, palliative care teams are made up of doctors, nurses, and other professional medical caregivers, often located at the facility where a patient will first receive treatment. While palliative care can be administered in the home, it is most common to receive palliative care in an institution such as a hospital, extended care facility, or the nursing home that is associated with a palliative care team.

Unlike hospice care, diagnosis of a terminal illness is not a prerequisite, and palliative care can be received by patients at any time, at any stage of illness whether it be terminal or not (the basic requirement is often a letter from the primary care physician). This is the main distinction between the two. Since this service will generally be administered through your hospital or regular medical provider, it is likely that it is covered by your regular medical insurance, but will not be through most long term care insurance contracts. This is due to the fact that palliative care is essentially skilled or acute care, and that is not the foundational purpose of long-term care insurance, whereas custodial care is.

It is also important to note that with palliative care, each service will usually be billed separately, just as they are with regular hospital and doctor visits. If you receive outpatient palliative care, prescriptions will be billed separately, and they are only covered as provided by your regular insurance. In-patient care however, usually does cover prescription charges. For more details, make sure you check with your insurance company, doctor, or hospital administration.

Since there are no time limits on when you can receive palliative care, it acts to fill the gap for patients who want and need comfort at any stage of a disease, whether terminal or chronic. It provides broader services than hospice care, but so broad in a way that its coverage is beyond the scope of being paid for by most long term care insurance contracts.

It is important to note, however, that there will be exceptions to the general dictates outlined here. There are some hospice programs that will provide some life-prolonging treatments, and there are some palliative care programs that will concentrate mostly on end-of-life care. It is always best to consult your physician or care-administrator for the best service for you. This will also be true regarding long term care insurance custodial benefits.

Long term care insurance and palliative care may seem complicated, we are here to help you navigate through all the information. Please call the PivotCare team at 1-800-651-1953 to discuss your needs and we will find the right solution for you. 

About the author: Kyle McDonald holds FIC, FICF, FSCP® & CLTC designations. His viewpoint on life insurance is simple, “Anyone with a family must have life insurance. In the end, life insurance is for others you care about, not you.” He is ready to help you and your family get the best option available. Contact Kyle today at   1-800-651-1953 or KMcDonald@Pivot.com.