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Private long-term care insurance benefit eligibility triggers: The implications of alternative definitions
(Archived Project)
Investigator (PI): Alecxih, Lisa Maria B; Lutzky, Steven
Performing Organization (PO): (Current): Lewin Group
Supporting Agency (SA): American Association of Retired Persons (AARP), Public Policy Institute
Initial Year: 1996
Final Year: 1997
Abstract: Long-term care insurance is a fairly recent innovation, and consumers have had numerous concerns about whether this product provides a meaningful benefit. In response, insurance companies have enhanced their policies, while states implemented quality standards. Researchers and regulators have paid less attention to the likelihood that a policyholder who needs long-term care would qualify to receive services under the various restrictions of his or her policy. Insurance policies generally do not allow consumers to decide when an insurable event has occurred. Instead, companies use a variety of eligibility criteria, referred to as triggers, to determine eligibility for benefits. However, there is little information on the efficacy of the alternative eligibility triggers. In addition, consumers are concerned that slight differences in eligibility criteria may produce large discrepancies in whether a policy will trigger payment of long-term care benefits. This report outlines the various benefit triggers that 18 insurance companies currently use to assess eligibility for long-term care. It examines both functionally-based triggers and those based on measures of cognitive impairment. The study incorporates national survey data to estimate the number of people who would be eligible to receive long-term care services under alternative benefit triggers. It also assesses the number of potentially eligible older people among those receiving long-term care services, and evaluates the potential effects of underwriting.
MeSH Terms:
  • Data Collection
  • * Eligibility Determination
  • Insurance, Long-Term Care /standards
  • Organizational Policy
  • Quality Assurance, Health Care
  • United States
Keywords:
  • research support, non-U.S. Gov't
Country: United States
State: Virginia
Zip Code: 22031
UI: 95400040
Project Status: Archived