When Am I Eligible To Use Long-Term Care Insurance?

Last updated: October 7, 2015

Meeting Your Benefit Triggers

Most policies will require you meet certain criteria, called “benefit triggers”. This is usually one of the following:

1. You suffer from severe cognitive impairment

                            OR

2. You are unable to perform at least two Activities of Daily Living (ADLs) on your own.

  • ADLs include bathing, eating, dressing, toileting, transferring in and out of chairs or beds, care for incontinence, and care for cognitive limitations due to Alzheimer’s disease or another form of dementia.

Be sure to read your policy and understand what benefit triggers you must meet in order to receive long-term care coverage.

What Is Not Covered 

Kansas laws allow policies to have these exclusions: 

  • Pre-existing condition — A pre-existing condition is an illness or disability for which you received medical advice or treatment during a specified period before applying for insurance. Most long-term care policies will not pay benefits for these conditions for a certain length of time, usually 6 months, after you become insured. 
  • Care by family members — Most policies will not pay members of your family to take care of you. Some policies will pay to train family members to be your care provider. Check with the insurance company.
  • Mental and emotional disorders or disease, other than Alzheimer’s disease.
  • Alcoholism and drug addiction.
  • Illness or accident caused by an act of war or a felony.
  • Treatment already paid for by Medicare or any government program except Medicaid.
  • Attempted suicide or intentionally self-inflicted injuries

This article is published on KansasMoney.gov. Find more information by contacting these state agencies: