An accelerated death benefit is when a life insurance policyholder gains access to a portion of their death benefits before death, usually to pay for long-term care or other medical needs.
Long-Term Care Glossary
The Glossary provides a quick review of the important terms and acronyms frequently used in long-term health care. This resource includes many commonly used terms for patients, families, and staff employed in long-term health care.
These definitions are intended to give you a broad understanding of the most commonly used terms used in long-term care. Always review an official definition as listed in a policy.
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A
Activities of daily living (ADLs) are learned activities that each person performs to live a normal life.
An actuarial certification is a formal recognition that a Long-Term Care Insurance company's premiums meet federal standards.
An actuary uses data to analyze and evaluate risk. They commonly work with insurance companies, businesses, and government entities.
Acute care involves urgent medical services, often expected to be short-term or rehabilitative.
Adult day care centers (ADCC) provide long-term health care to individuals during the day. They can help provide mental, social, and physical stimulation and fulfillment to aging or disabled adults.
Aging in place describes when an individual receives care in their home or community. This care aims to extend the time individuals can remain at home, delaying a transfer to a traditional long-term care facility.
An alternative care benefit is a Long-Term Care Insurance provision that provides benefits not explicitly outlined within the original policy.
Alzheimer's disease is a common form of dementia. This disease affects a person's thinking, remembering, and functioning ability. Most people with Alzheimer's will need long-term care support.
In a Long-Term Care Insurance policy, an ancillary service covers skilled care or therapy.
An annuity is an insurance contract that acts as a savings vessel, providing stable income in old age.
Arthritis is a term used to describe significant joint pains or diseases.
A cognitive assessment is a measurement of an individual's mental functioning. Insurance companies use these tests to determine eligibility for a new Long-Term Care Insurance policy.
An asset-based long-term care policy combines life insurance or annuities with Long-Term Care Insurance. This provides coverage for long-term care and death benefits (or annuities) and allows for more flexible use.
An assisted living facility is a residential building with long-term care support services. Assisted living facilities can be a good fit for anyone needing a minor to moderate level of care and wanting to maintain independence.
B
Bathing is an activity of daily living, generally defined as the ability to wash oneself.
A bed reservation benefit in Long-Term Care Insurance allows you to keep your room or bed in a care facility during temporary leaves. This prevents extra charges or unavailability for a limited number of days.
A beneficiary is a designated entity or individual that receives insurance benefits after the insured individual passes away.
The benefit period is the minimum period of time policyholders can receive Long-Term Care Insurance benefits.
A benefit trigger is a requirement that must be met before accessing Long-Term Care Insurance benefits. Once someone meets the benefit trigger requirements, they can file a claim and receive their benefits.
C
A caregiver is an individual who cares for another individual who cannot take care of themselves, often due to aging, disability, or illness.
Case management is a structured approach to long-term care planning. Individuals will work with a professional to coordinate different care services and providers into an efficient plan.
Cash benefits are when insurance benefits are paid out to the insured in cash instead of as a regular reimbursement to care providers.
A certified nursing assistant (CNA) provides mostly basic and custodial care to individuals in several care settings.
Chronic care is care expected to last a long time, usually longer than 90 days. Chronic care is often used interchangeably with the term "long-term care."
Chronic illness riders are a type of insurance add-on for life insurance policies. Many people mistake these riders for Long-Term Care Insurance. However, chronic illness riders don't offer the same coverage as Long-Term Care Insurance.
A chronically ill individual is a person who meets specific legal criteria, which can be summarized as a prolonged or long-term disability, illness, or condition that inhibits daily life.
A claims offset is a provision that increases remaining Long-Term Care Insurance benefits.
A class is a group of Long-Term Care Insurance policyholders with a common trait.
Co-insurance is when a policyholder covers the difference between the actual cost of care and the amount their policy covers with benefits.
Cognitive impairment involves a loss of or problems with memory, learning, concentration, and decision-making.
Community-based services occur outside of long-term care facilities. These services support individuals in their homes and community.
Companion care is when a caregiver provides emotional support and connection to an individual.
A compound inflation rider increases Long-Term Care Insurance benefits by a set percentage each year. Because this percentage is compounded, the benefits increase based on the new total. This can help offset increasing care costs.
A comprehensive Long-Term Care Insurance policy covers a majority of long-term health care services. These policies are regulated by federal laws and industry guidelines.
Continence is an activity of daily living that refers to the ability to control one's bowel or bladder.
A contingent nonforfeiture benefit is when policyholders can keep the same premium with reduced benefits in the event their premiums rise above a predetermined percentage.
Continuing care retirement communities are residential communities for those with varying care needs who wish to age in place. Residents can move to different sections of the community as their care needs change.
A convalescent care facility helps individuals who need medical or custodial care over a long time period, usually due to a chronic illness.
Coordination of benefits prevents an individual from receiving excess insurance benefits from multiple sources. It keeps policies and insured individuals honest, prevents fraud, and helps insurance companies dictate which entity pays benefits.
Countable assets are owned items or money evaluated when determining Medicaid eligibility.
CPI-based inflation is an add-on for Long-Term Care Insurance policies that increases insurance benefits based on the Consumer Price Index (CPI).
Criminalization describes a series of laws that made it illegal to knowingly and willfully dispose of assets to meet Medicaid’s eligibility requirements.
Custodial care involves help with activities of daily living or other personal care needs. This care is typically non-medical. The need for custodial care usually arises due to illness, disability, accident, or age.
D
The daily benefit for an LTC Insurance policy is the maximum amount of benefits the policy will pay for long-term care services on any given day of an active claim.
A death benefit is a large amount of money paid to one's loved ones or beneficiaries after an insured individual passes away.
A deductible is an amount of money you’re required to pay out-of-pocket before your insurance policy will start covering the cost of care.
The Deficit Reduction Act was a law that created stricter Medicaid requirements for long-term care and expanded Long-Term Care Insurance partnership program benefits.
Dementia is a life-altering condition that deteriorates an individual's mind. This condition often affects an individual's memory, reasoning, and overall living ability.
Dressing is an activity of daily living that refers to one’s ability to select and put on clothing.
Durable medical equipment are tools used for medical purposes like wheelchairs, walkers, or hospital beds.
E
Eating is an activity of daily living that refers to the ability to consume food and beverages.
An elimination period is a time between qualifying for Long-Term Care Insurance benefits and receiving them. These are also referred to as waiting periods.
Emotional support is an empathetic and compassionate type of care that focuses on creating connections and improving emotional well-being.
Estate recovery is when the government takes part of an individual's estate after they pass away to reimburse itself for the cost of Medicaid long-term care.
An exception or an exclusion is a defined situation where a Long-Term Care Insurance company does not have to pay long-term care benefits to the insured individual.
Exempt assets are those that Medicaid does not consider when determining your eligibility for Medicaid long-term care benefits.
F
A facility-only Long-Term Care Insurance policy only pays benefits toward care received in a licensed long-term care facility.
A financial advisor is a licensed professional that offers help with financial decisions.
A free-look period allows individuals to review their Long-Term Care Insurance policy, usually for 30 days, without obligation.
A future purchased option allows individuals to increase their benefits in the future on a regular basis.
G
Geriatric refers to a field of medical care primarily focused on elderly individuals.
A guaranteed renewable policy cannot be canceled by an insurance company without justifiable cause. All Long-Term Care Insurance policies that meet federal guidelines are guaranteed renewable.
H
Hands-on assistance describes a type of care where a caregiver must physically help an individual with daily tasks.
The Health Insurance Portability and Accountability Act (HIPAA) was an important law that set specific standards for tax-qualified Long-Term Care Insurance policies.
Health savings accounts (HSAs) are tax-free savings accounts that can help pay for qualified medical expenses.
A high-deductible health plan (HDHP) is a type of health insurance with a high out-of-pocket deductible, usually with a low monthly premium.
A home health agency provides in-home care services to those in need.
Home health aides help individuals with their long-term care and personal care needs. These professionals are also known as personal care aides.
Home health care is custodial or skilled care that takes place in the care recipient’s home instead of a traditional long-term care facility.
Homemaker services involve help with non-medical tasks like cooking, cleaning, and household chores.
Hospice care is short-term, holistic care that supports chronically ill individuals and their families.
A hybrid Long-Term Care Insurance policy combines life insurance (or an annuity) with Long-Term Care Insurance. These policies offer comprehensive long-term care benefits.
I
Incontinence is the inability to maintain bowel or bladder control.
Indemnity benefits are a fixed amount of money a policyholder receives when they need care, regardless of the actual care cost.
Inflation protection is a Long-Term Care Insurance add-on that regularly increases the policy's benefits to keep up with rising care costs.
Informal care is when family or friends help individuals with their care needs. These informal caregivers are not usually trained or compensated for their care.
Inpatient care is when an individual needs intense overnight treatment for a serious or life-threatening health condition.
Instrumental activities of daily living are tasks necessary to live, like cooking, paying bills, or taking medications.
Integrated care combines many types of care and services to create a comprehensive care plan. This care plan should address all of a long-term care recipient’s needs.
An intermediate care facility provides care for those with stable conditions who need daily, institutional care but do not need 24-hour supervision.
This is a health facility that provides medically related services to persons with a variety of physical or emotional conditions requiring institutional facilities but without the degree of care provided by a hospital or skilled nursing facility. This is care for stable conditions requiring daily but not 24-hour nursing supervision.
International benefits allow LTC Insurance policyholders to receive benefits outside the United States.
L
A lapse is when a Long-Term Care Insurance policy terminates due to missed premium payments.
Lapse protection prevents individuals from losing their Long-Term Care Insurance policies after missing a premium.
A letter of decline is a formal notification of an insurance company's decision not to insure the applicant.
A licensed practical nurse (LPN) provides various levels of care in many settings. They also act as the link between patients, families, and the health team to ensure comprehensive, quality care.
A lifetime limit or a lifetime maximum benefit is the total amount of benefits available within a Long-Term Care Insurance policy. This amount can change with inflation benefits.
The same as “Lifetime Limits”. This is the maximum amount of benefits which a Long-Term Care Insurance policy will pay over the life of a policy. Generally, this is a dollar amount which can grow with inflation.
A limited payment option is a payment plan that sets a specific period of time the policyholder will pay a premium.
Long-Term Care Insurance specialists are expert Long-Term Care Insurance professionals. Specialists often help people find the best LTC Insurance coverage for their needs.
Long-term care addresses the medical and non-medical needs of individuals with chronic illnesses, disabilities, or dementia who cannot care for themselves. Long-term care is legally defined as care expected to last at least 90 days. Long-term care is often abbreviated as "LTC" and may also be referred to as "long-term health care."
A Medicaid look-back period is a five-year period where Medicaid evaluates your estate to determine if you qualify for coverage.
M
Medicaid is a government-funded medical aid program. Medicaid aims to help low-income individuals pay for medical and long-term care.
Medically necessary care is essential for effective diagnosis, treatment, and follow-up care.
Medicare is health insurance primarily for people 65 or older, those with certain health issues, or those who qualify for disability. This federal tax-supported program becomes an individual’s primary health insurance at age 65.
Medicare supplements, or Medigap, are private insurance policies that cover coinsurance or deductibles not traditionally covered by Medicare.
Mental and nervous disorders are medical conditions induced by nonorganic means.
Minimum asset and income allowances are the total amount of countable assets and income an individual (and their spouse) may have to meet Medicaid long-term care benefits requirements.
N
Nonforfeiture provides additional benefits and options to those who have lapsed their policies for various reasons.
This is a facility which provides skilled, intermediate or custodial nursing care which must be state- licensed.
A nursing home is an intensive long-term care facility that provides support and supervision 24/7.
O
Outpatient care involves skilled care that does not require the patient to remain overnight.
P
Palliative care is assistance that addresses both emotional and physical needs.
The partnership program protects assets from Medicaid spend-down for those with a partnership Long-Term Care Insurance policy.
Personal care involves assistance with custodial or non-medical needs.
A plan of care is a strategy that explains what type of care an individual needs and who will provide that care.
A pool of money is the total amount of benefits available within a Long-Term Care Insurance policy. This amount can change with inflation benefits.
Post-claim underwriting occurs when an insurance company reevaluates a policy after a claim. They may raise the premium, change benefits, or cancel the policy altogether. Post-claim underwriting is illegal for federally qualified Long-Term Care Insurance policies.
A pre-existing condition is a health condition that an individual had before they applied for Long-Term Care Insurance.
A premium is the amount of money a policyholder pays to an insurance company to keep their policy active.
A private nurse is a care professional that individuals can hire directly to provide personalized care.
Q
A quote is a cost estimate for an insurance policy provided by the company.
R
A rate class is a category assigned to insurance applicants based on how risky they are to insure. These categories determine how much individuals pay for Long-Term Care Insurance coverage. There are three main rate classes: preferred, standard, and sub-standard.
Rate increases on existing Long-Term Care Insurance policies may be sought by an insurance company only if they prove a substantial need based on actuarial reasons and impacting a "class" of individuals. They may never increase a premium to just one policyholder due to changes in health or claim's status.
Rate Stability Rules require companies to follow new guidelines to keep premiums stable and fair.
A registered nurse (RN) maintains a leadership role, often coordinating, providing, and overseeing care services and patients within their jurisdiction.
A rehabilitation center is a place for individuals to receive skilled and custodial care directly after an injury, illness, or surgery. The goal of rehabilitative care is to help the individual return to a previous state of good health following a medical event.
Reimbursement is the standard way that a Long-Term Care Insurance policy will pay the policyholder (or provider) at the time of claim. The insured or a care provider submits a claim for the charges for the care delivered, and the claim is paid up to the daily or monthly maximum specified in the policy.
In a Long-Term Care policy Respite Care is a paid caregiver provided to the policyholder in order to give relief to an informal caregiver in order to give them a break or relief. Most Long-Term Care policies pay for Respite Care, usually limited by a certain number of days in a year.
Restoration of benefits is a Long-Term Care Insurance rider that allows policyholders to fully restore a partially used benefit if they no longer need care for a specified time frame.
A return of premium rider in Long-Term Care Insurance can return paid premiums to beneficiaries after a policyholder’s death.
A reverse mortgage allows homeowners to convert part of their home equity to cash to pay for long-term care expenses.
An insurance rider, often simplified to “rider,” is an extra benefit provision available to add to Long-Term Care Insurance policies. Riders usually increase the cost of the premium by adding benefits or other features.
S
The sandwich generation describes individuals who care for their elderly parents while trying to raise their own children. These individuals often find themselves sandwiched between caring for two generations.
Section 7702(b) is an integral Long-Term Care Insurance regulation that offers consumers protections and defines how and when policies should cover long-term care.
Severe cognitive impairment is a loss or deterioration of mental functioning comparable to Alzheimer’s Disease or dementia.
Shared care is a Long-Term Care Insurance option that allows couples to share insurance benefits.
Short-term care insurance covers custodial care for short durations, usually up to one or two years.
Simple inflation is a Long-Term Care Insurance rider that increases benefits by a fixed amount per year based on the original starting amount.
Skilled care is medical care or assistance provided by a registered nurse or professional therapist. Skilled care is usually provided within a licensed facility, such as a nursing home.
A skilled nursing facility offers skilled care for those with complex care needs who may not be able to get the help they need at other care facilities.
Spend down is when an individual uses their savings and assets to pay for long-term care. The goal of spending down is to spend enough to qualify for Medicaid long-term care benefits.
Stability is how a condition affects an individual and how receptive that condition is to treatment and medications. A stable condition is one that can be well-managed with treatment.
Standby assistance is care that requires a caregiver to remain close to the individual in case they need help with daily tasks.
Step-down is when a Long-Term Care Insurance policyholder reduces their coverage to lower their premium.
Substantial assistance involves needing hands-on or standby assistance with at least two or more activities of daily living.
Substantial supervision is a need for continual supervision due to cognitive decline that could lead to the individual endangering themselves or someone else.
A survivor benefit allows a couple with LTC Insurance to stop paying premiums if one of the spouses passes away.
T
A tax-qualified Long-Term Care Insurance policy is a policy that meets federal guidelines. These policies are eligible for federal and state tax incentives and deductions.
Therapeutic devices are medical tools and equipment that make it easier for individuals to live with their health conditions.
Toileting is an activity of daily living, generally defined as the ability to use the bathroom effectively.
Transferring is an activity of daily living, generally defined as the ability to move from a standing to a sitting or lying position.
U
Underwriting is a process insurance companies use to calculate the risk of insuring new individuals.
W
A waiver of premium allows policyholders a break from paying premiums when they’re receiving Long-Term Care Insurance benefits.
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