More than half of Americans aged 65 and up will eventually need some type of long-term care, according to a 2022 study from the U.S. Department of Health and Human Services. Although many seniors have included long-term care insurance in their retirement planning, families often struggle to determine when and how to activate coverage.

At New Horizons at Marlborough, a not-for-profit senior community in MetroWest Boston, we share the following key tips with our residents to help them make the most of their coverage.

1. Know what long-term care insurance covers

Long-term care insurance offsets the cost of non-medical assistive services, which are not covered under standard health insurance or Medicare. In the case of injury or prolonged illness, for example, an individual might need help eating, bathing, or getting dressed each day. This supplemental coverage reimburses a portion of the cost of that daily assistance. Although many policies cover such services regardless of where they are performed (e.g., at home, a nursing home, an assisted living community, or adult daycare), policy holders should read their documents carefully for potential exclusions.

2. Don't put off using the benefit

Seniors often pay into long-term care insurance for years, only to hesitate when it comes time to reap the benefits of their careful financial planning. Industry experts advise activating coverage when assistive services are first needed, rather than saving it for a potential catastrophic injury or illness down the road. Many seniors lose out on this benefit when they opt to wait for a future health incident that never occurs.

Others delay activating coverage out of fear that accepting help will compromise their independence. A person may be capable of performing routine activities independently. If doing so causes pain, takes an extended amount of time, risks potential injury, or otherwise compromises quality of life, however, a conversation with your medical practitioner can help you determine whether it is time to activate coverage and begin benefiting from assistive services.

3. Engage an advocate

The documentation associated with long-term care coverage can be daunting, as the insurance provider will require a monthly accounting of all qualifying covered services received. The significant cost savings, however, merit the paperwork. Seniors who are uncomfortable dealing with the insurance company directly or unsure how to navigate the process, should consider asking a trusted family member or friend to act as their advocate.

At New Horizons, for example, our teams liaise on behalf of assisted living residents, helping to ensure that the insurance provider receives the documentation required to substantiate each month's claim. Having an advocate who is familiar with the process allows seniors to realize the benefits of their policies without getting tied up in the paperwork.

4. Start the waiting period early

Most long-term care insurance policies have a mandatory waiting period of 90 to 100 days between the start of assistive services and the activation of the benefit (e.g., when the policy holder becomes eligible for reimbursement). Reimbursement rates are subject to variation, and the rate for services received in an assisted living community is often higher than the rate paid for at-home care. Seniors often opt to "start the clock" on this waiting period while preparing for such a move so they will be eligible for greater reimbursement upon their arrival in a new community.



About New Horizons

New Horizons at Marlborough offers a continuum of care, including independent living, assisted living, memory care, and geriatric-psychiatric programs. The heavily wooded 40-acre campus is just off US Route 20, about 13 miles west of I-95 and Route 128.

Thanks to a unique rate-lock policy, incoming new residents at New Horizons are guaranteed no increases to their rent and board for at least their first six years. These fees include all charges for lodging, gourmet meals, water, heat, air conditioning, basic cable TV, local telephone service, parking, and regular maintenance.

All faiths and denominations are welcome at New Horizons, and daily on-site Mass and communion services provide its large Catholic population with multiple opportunities each week to practice their faith as part of a community, without leaving home. The resident population currently includes more than 20 members of male and female religious orders. On-campus weekly Protestant and Jewish services are also offered.

Prospective residents and their families are encouraged to contact New Horizons at Marlborough at 508-460-5200 to arrange a time to tour the campus, meet current residents and staff, attend Mass, and sample a home-cooked meal. More information about New Horizons is available at CountryCommunities.com.



Betsy Connolly, MS, is the executive director of New Horizons at Marlborough.