Long-Term Care Insurance and Home Care in Pennsylvania
Long-Term Care Insurance and Home Care in Pennsylvania
Short answer: Long-term care insurance helps pay for non-medical home care in Pennsylvania, but coverage depends entirely on your specific policy terms. Each policy sets its own benefit triggers and limits. Pennsylvania also offers a Long-Term Care Partnership program that protects your personal assets if you eventually need Medicaid.
- Check your policy for benefit triggers, elimination periods, and daily or monthly maximum payouts.
- The Pennsylvania Long-Term Care Partnership program offers dollar-for-dollar asset protection.
- Partnership policies allow you to keep assets above the standard Medicaid limits.
- Ask New Century about the invoices and visit records your insurer needs.
How Long-Term Care Insurance Pays for Home Care
Every long-term care policy is different. To understand how your coverage applies to in-home care, you must check your specific policy terms.
Look closely at the benefit triggers. Check what the policy requires to show that care is needed, for example a doctor’s documentation of help needed with activities of daily living (ADLs) such as bathing, dressing, transferring and toileting.
Check the elimination period. This is the waiting period before the policy starts paying for services. You pay out of pocket during this time.
Review your daily or monthly maximums. The 2025 CareScout Cost of Care Survey reports the Pennsylvania median cost for a non-medical caregiver is $34 per hour, or $6,483 per month. Compare your policy limits against the expected cost of your loved one’s care.
Finally, check if your insurer requires you to use a licensed home care agency. New Century Home Care is licensed by the Pennsylvania Department of Health.
Pennsylvania’s Long-Term Care Partnership
The Pennsylvania Long-Term Care Partnership is a joint federal-state program. It encourages residents to buy private insurance by offering special Medicaid asset protection.
For every dollar a qualifying Partnership policy pays in benefits, you can keep a dollar of assets that would normally need to be spent down. The Pennsylvania Insurance Department uses this example: if your policy pays out $300,000 in benefits, you can keep $300,000 in assets when you apply for Medicaid.
This protection directly affects financial eligibility for Medicaid. Normally, an unmarried applicant can only keep $8,000 in resources. A Partnership policy raises that limit by the exact amount the policy paid out.
The protected assets are also exempt from Medicaid estate recovery. Pennsylvania can recover the costs of home and community-based services from the estates of recipients aged 55 and older. The assets protected by your Partnership policy can be left to your heirs without state recovery.
Comparing Care Costs and Medicaid Limits
To understand why the Pennsylvania Long-Term Care Partnership is helpful, compare the state’s median care costs against the standard Medicaid resource limits.
| Category | Pennsylvania Amount |
|---|---|
| Median Cost of Non-Medical Caregiver | $6,483 per month |
| Median Cost of Nursing Home (Private Room) | $164,250 per year |
| Medicaid Resource Limit (Unmarried Applicant) | $8,000 |
| Medicaid Resource Limit (Community Spouse Minimum) | $32,532 |
Filing a Claim for Home Care in Pennsylvania
Filing an insurance claim requires specific documentation. Follow these steps to start using your benefits:
- Review the policy: Confirm the elimination period and verify that non-medical home care is covered.
- Get medical documentation: Ask your loved one’s doctor to provide the required forms certifying the need for help with ADLs.
- Hire a licensed agency: Select a home care provider that meets your insurer’s criteria.
- Submit invoices: Send the agency’s billing records and care logs to the insurance company for reimbursement.
If you have questions about your rights or a denied claim, contact the Pennsylvania Insurance Department or consult an elder law attorney.
What New Century Provides for Policyholders
New Century Home Care provides non-medical services, including personal care, companionship, and respite care. By Pennsylvania definition, personal care covers help with bathing, dressing, toileting, and ambulation. Companionship provides socialization and support with daily tasks.
We can provide invoices and visit records. Ask us about the specific documents your insurer needs.
If you are ready to start services, call New Century Home Care at 215-974-0000 or contact us online. Choose “I am a client” and then “I need services” on our form. Our office staff speak English, Russian, and Ukrainian.
No Policy? Other Ways to Pay
If your loved one does not have long-term care insurance, you have other options for care.
Many families use private funds, veterans benefits, or Medicaid. The Community HealthChoices (CHC) waiver pays for Personal Assistance Services for adults who meet the clinical and financial requirements. If you apply for the CHC waiver, the process involves an assessment by your local Area Agency on Aging. In Philadelphia, this is the Philadelphia Corporation for Aging (PCA).
Read our guide on how to pay for home care to explore all available programs.
Call New Century Home Care at 215-974-0000 or fill out our online form to discuss your needs. Select “I am a client” and “I need services.”
Frequently asked questions
What is the biggest drawback of long-term care insurance?
The main drawbacks are the cost of premiums and the policy limits. Premiums can change over time, and policies cap the daily or monthly amount they pay. Read the Pennsylvania Insurance Department consumer guide to understand the costs before buying a policy.
Can a 70-year-old buy long-term care insurance?
Yes, a 70-year-old can apply, but approval depends on the insurer’s medical underwriting. Insurance companies review your health history and may deny coverage for pre-existing conditions. Speak with a licensed insurance agent or the Pennsylvania Insurance Department for guidance.
Does long-term care insurance cover a family caregiver?
Some policies pay family members to provide care, while others require you to use a licensed home care agency. You must read your specific policy terms or call your insurance provider to find out if family caregivers are covered.
Non-medical home care in Philadelphia, Bucks, Montgomery, Delaware and Chester counties. Medicaid CHC (Keystone First), VA programs and private pay. We speak English, Russian and Ukrainian.
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