Exclusions in Long Term Care

Exclusions are basically defined as the things that are not going to be covered by your policy. Exclusions are losses for which benefits will never be payable. Exclusions are important with any type of insurance policy. However, when it comes to long term care, exclusions are even more important to consider. Long term care is very expensive if you have to pay it out of pocket, and government programs like medicare and medicaid do not cover much expense, so knowing what your exclusions are is going to make a big difference in your ability to afford long term care.

When you apply for long term care insurance you will want to ask your insurance provider what they have as exclusions. They may have exclusions other than the ones listed below:

What are some typical exclusions in an LTC policy?
- Injury or sickness for which benefits will be payable under any worker's compensation claim or occupational disease law. So, in other words, if your sickness is covered by a different type of insurance, it isn't covered by long term care insurance.
- Injury from declared or undeclared war, so if you get hurt while fighting for your country, sorry you are out of luck, no long term care benefits for you.
- Suicide, attempted suicide, or self-inflicted injury. Well, if you commit suicide you won't need long term care, but I guess they just put it in to cover themselves. However, if you try to kill yourself and you fail, and have injuries that would require long term care as a result of this, you won't get the benefit.
- Injury resulting from alcoholism, drug abuse, or narcotics addiction. Substance abuse and related injury is not covered.
- Injury resulting from participation in a felony, riot, or insurrection. If you are at risk for needing long term care, do not participate in any riot, insurrection, or felony that might cause you enough harm to require long term care. Or, if you are young and naïve, don't do something stupid while committing a felony that will require long term care because your insurance will not cover it.

Depending upon the policy you purchase, there will be other exclusions. Different insurers will have assorted exclusions depending on the home state compliance regulations under which each policy is written. So, do not assume that you are covered in many events. You will just want to assume the above are exclusions your insurer will have, and ask about others.

Long term care has a lot of exclusions, and can be very difficult to qualify for, but this is because it is extremely expensive. Some long term care facilities cost several hundred thousand dollars per year. Others are less, but an average is $50,000 per year. This is an amount most people can not cover from their own assets.