Resources from the Law Office of John L. Roberts

Could Long Term Care Insurance Work for You?

By Attorney John L. Roberts

Many consumers have purchased long-term care insurance thinking that they will qualify for the asset recovery exemption that protects their homes, because their policies meet the requirement for 730 days of coverage. What they may not know is that use of their policy to pay for community care at home, prior to entering a nursing home, they may by disqualifying themselves from the Massachusetts estate recovery exemption!

To solve this problem, the Massachusetts Chapter of the National Academy of Elder Law Attorneys is asking for a new law that would allow seniors who buy long term care insurance and use the coverage to pay for community at home care without suffering a disqualification from MassHealth if they end up needing nursing home care. Under current law, people who have a two year (730 day) policy are only allowed the home exemption if they have not used any LTC insurance benefits for home care before the date of admission to their nursing home.

Allowing seniors to use their long term care insurance for community-based care would enable more elders to remain in their homes, rather than forcing them into institutional care.  The proposed law, To Encourage the Use of Long Term Care Insurance for Elders is sponsored by Representative Fallon. To show your support, please call your state representative and state senator and ask them to support HD 2573. For More Information on the significance of this proposed law, and more information on Long Term Care Insurance, Click to Read the Continuing Education Outline Prepared by Attorney Roberts:

Long Term Care Insurance is a valuable part of an estate plan for people who have substantial assets, savings and income. If you can afford long term care insurance, compare policy offerings and consider:

• What are the policy's limitations on home care?
• Does the policy pay family members for care giving?
• Does the policy pay for 24 hour a day home care? (most do not)
• What level of physical and mental impairment does it take to get the policy to pay benefits?
• How many months or days of care will the policy pay for?
• What is the daily benefit amount paid for care?
• Does the policy comply with the Division of Insurance notice and disclosure regulations? 211 CMR 65.09(1)(e)(2).
• Does the policy satisfy the MassHealth/Medicaid Regulation 130 CMR 515.011(B) exception to the estate recovery? Subsection (3) indicates the long term care policy must meet the requirements of 130 CMR 515.014 (benefit coverage of at least 730 days in nursing home (130 CMR 515.014(A)(3)) on the date of admission. You must have the full 730 days minimum coverage when "you enter a nursing home" to qualify for the estate recovery exemption.