September 12, 2016
Currently there are more than seven million people with long-term care (LTC) insurance, and more than a quarter million are receiving benefits. As claims grow, a key question emerges: What is the actual experience of insureds as they seek benefits under their policies? In this study we survey a cross-sectional sample of claimants in 2015 and 2016 to ascertain their experience with the claim filing process, their views about their coverage, the influence they believe it has on their use of services, the quality of the care they are receiving, and their overall level of satisfaction with their policy. In addition, we uncover the relationship between policy characteristics and people’s level of satisfaction. Finally, we analyze the coverage that claimants have in order to provide a coverage profile for in-force policyholders. Where possible, we compare findings in this study with those from a 2005 Department of Health and Human Services (DHHS) study that looked at individuals who were beginning to receive benefits.
Eleven major LTC insurance companies participated in the study by providing a random sample of claimants for the research team to interview. A telephonic survey was conducted, consisting of 34 questions and taking roughly 15 minutes; 1,291 surveys were completed (a 37 percent response rate). The sample was comprised of individuals receiving home care (45 percent), in assisted living (31 percent), in nursing homes (17 percent), and in other settings (about 7 percent). On average, individuals had been receiving benefits for two years, and the average value of total claims paid at the time the insurance companies pulled their data was $118,986 per person. The average total payment to individuals in a nursing home totaled $134,731, for those in assisted living $95,589, and for those receiving paid home care services $76,784.