Long-term care

Do benefits cover in-home care?

Long-term care policies sold in Oregon since 1992 must provide benefits for in-home care, assisted living facilities, adult foster care, and nursing home care.

Nursing home benefits must cover personal care services, nursing care, intermediate nursing care, and skilled nursing care, depending on the patient’s needs.

All long-term care policies must pay for treatment of Alzheimer’s disease and other kinds of dementia, whether in a memory care facility or another location.

Insurers must offer inflation protection so that benefits grow as the cost of covered services increases over time.

When does my policy start paying benefits?

In Oregon, patients must be unable to perform two or more activities of daily living or have a cognitive impairment such as dementia to qualify for benefits. Common activities for daily living:

    • Eating
    • Dressing
    • Mobility
    • Bathing
    • Toileting
    • ​Continence (bowel/bladder control)

A new policy must begin covering pre-existing conditions beginning six months from the effective date of coverage.

Also, your policy’s “elimination period” is a deductible or waiting period from the time you make a claim to when the policy pays benefits. You decide on the length of this period when you buy coverage. The shorter the waiting period, the higher your premium. Elimination periods range from zero to 180 days.

How much will my policy pay?

  • Benefit amount: Policies normally pay a fixed amount by the day, week, or month. For example, a policy might pay a daily nursing home benefit of up to $200 per day. The amount may vary depending on the type of care you need.
  • Benefit period (lifetime benefit maximum): Most policies limit the total benefit they will pay over the life of the policy. For example, a policy may pay benefits for one year or for five years.
  • Nonforfeiture option: This option means that you won’t lose all of your benefits even if you stop paying premiums.

How long do insurers have to pay claims? 

For policies issued or renewed after July 1, 2012:

  • Insurers have 30 days from the time they receive a claim to do one of the following:
    • Pay or deny the claim.
    • Send a written notice requesting additional information. The company must pay or deny the claim within 30 business days of receiving any additional information.
  • The company may owe interest if it fails to handle claims within the required deadlines.

How can I make sure I don't miss a premium notice?

You have the right to designate another person to receive notice of premiums due and payments missed so you won’t accidentally miss a payment.​

Key links

Rate information
Medicaid
Ombudsman
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Talk to an insurance expert

Call: 1-888-877-4894
Email: cp.ins@state.or.us

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