Cost Effective LTC Insurance

You must determine whether other health care coverage, including LTC insurance, is cost effective following policies and procedures provided in the MHCP Eligibility Policy Manual (EPM).

More information:
In most cases, when an LTC insurance policy is paying for LTC services, the insurance company does not require premiums to be paid. However, when a client, who is receiving LTC benefits from a policy, is required to pay a premium for a certain number of days prior to benefits beginning (an elimination period) or premiums do not stop when benefits begin, determine if the premium should be paid for the client, deducted from the LTC income calculation or used meet a medical spenddown. Regardless of whether or not the client is paying a premium, the client cannot drop the coverage when it is paying out benefits.

A client must maintain the other health care coverage, including an LTC insurance policy, when a policy is determined cost effective. For an MA-LTC client the cost of that coverage may either be paid:

By the client and used to reduce the client’s income or meet a medical spenddown, depending on the type of income calculation being used.
By the county. Coverage paid for by the county cannot be used to meet a spenddown or used to reduce income.

The LTC Insurance (PDF) handout also lists this information.

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LTC Insurance

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