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FAQ: Long Term Care Insurance Options in WA

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What are the differences between corporate long term care insurance and Washington Cares?

Washington State has one of the nation’s best long term care systems in the United States. The WA Cares benefit will allow all beneficiaries access to high quality, trained and certified long-term care providers, and services like installing a wheelchair ramp or grab bars, medical transportation, and respite for family caregivers.

People pay WA Cares Fund premiums only when they are working, whereas corporate long term care insurance premiums are owed until a claim is made, which could be decades after retirement. Retirees, regardless of age, do not pay the premium in the WA Cares Fund. The premium is a predictable cost of 0.58% of earnings, regardless of workers’ age or health status.

With WA Cares, people do not have to pay when they are between jobs, out of the employed workforce, or after retirement. As long as they have worked and contributed to the fund for at least ten years or three of the past six years, they will be able to count on the WA Cares benefit whenever they need it in the future.

Corporate insurance companies use “underwriting.” This means they will do a physical exam and review health records before offering coverage. Rates for women can be up to 50% higher than for men. People with pre-existing conditions or disabilities may have to pay more or may not be able to get insurance at all. Private insurance premiums often get more expensive over time and when the subscriber’s health worsens. In the WA Cares Fund, gender and pre-existing conditions do not impact access to the same benefit.

Table comparing WA Care and Insurance options

When you are participating in the WA Cares Fund, you can add additional coverage through private long-term care insurance at any time. The Long Term Care Commission that oversees WA Cares is currently working with insurance providers to develop private insurance policies that supplement WA Cares Fund and provide wrap-around coverage.

Downloadable Fact Sheet (pdf)

How does the WA Cares contribution compare to the cost of corporate long term care insurance?

WA Cares benefits will be much more affordable than corporate coverage for almost everyone. An average private long term care policy in Washington will cost a single, healthy 50 year old man $1,894 annually, and cost a single, healthy 50 year old woman $2,277 (six to seven times more expensive than WA Cares payments for a median-wage worker). You have to pay monthly without interruption for corporate insurance until you die or become disabled enough to use it, often in their mid-80s. If you miss a payment, your insurance is canceled leaving you nothing for all the years you paid in.

To do an individual comparison between private insurance or the WA Cares Fund, multiply the annual premium for private insurance by your life expectancy (the average person is expected to live to age 85), and for the WA Cares Fund multiply your annual earnings by 0.0058, and multiply that number by the number of years you expect to continue working.

You vest in WA Cares plan by paying in for at least ten years or three out of the six previous years. Then you will not have to worry about losing coverage if you lose your job or retire— you will not have to pay anything when you are not working.

How much does the WA Cares benefit pay?

In 2026 each person who is eligible to receive the benefit can access services and supports costing up to $36,500, enough to pay for four hours of care in the home every day for a year. Families will get to choose how and when to spend the benefit. The benefit will grow with inflation. Take this quiz to see if WA Cares is the right option for you.

Can the WA Cares benefit be used to pay a family caregiver?

Yes. Many people prefer to be cared for by family members, but family caregivers often cut back on work and lose their regular source of income. Unlike most corporate insurance, WA Cares helps pay family caregivers to offset lost income while they are providing care. The benefit can be used to pay the caregiver of your choosing, including a spouse, as long as they meet training requirements. Training ensures both the caregiver and the person they care for stay safe from infection, lifting injuries, and other caregiving challenges.

Can I use both WA Cares and private insurance?

Yes. You can purchase long-term care insurance to add to their WA Cares benefit. WA Cares may help pay for services during the waiting period built into many private insurance policies. The WA Cares program is helping the insurance industry to develop supplemental coverage to work in coordination with the WA Cares benefit.

When will I qualify to use the WA Cares Fund?

Workers permanently “vest” to use the benefit after making payroll contributions for ten years. Those ten years don’t have to be all at once–workers can take time out from the workforce and pick up their contributions when they return. Part time work can qualify.

There is also a shorter vesting period for people who experience a disability while they are working or right after they stop working. If they contribute for three years and start the benefit within three years of their last day of work, the WA Cares fund will help pay for their long-term care needs.

How is the WA Cares Fund financed?

Beginning July 2023, Washington workers will pay up to $0.58 per $100 of earnings, in small contributions in each paycheck, similar to contributions for Medicare and Social Security. The median income for Washington workers is $52,075, so the annual premium would be $302. For every $50,000 a worker earns, they will pay in approximately $24 per month into the Fund. Retirees and unemployed individuals do not pay premiums into the WA Cares Fund.

Is purchasing long term care insurance more cost effective than paying into the WA Cares Fund?

For the vast majority of Washingtonians, the WA Cares fund will provide a much more affordable and reliable benefit. Anyone considering purchasing long-term care insurance should do their own research to evaluate their individual situation.

Insurance companies are currently marketing policies for the purpose of tax avoidance. Anyone purchasing long-term care coverage should carefully consider their decision, asking whether the policy provides adequate benefits, and whether they can afford to pay premiums, whether premiums will increase in the future, and whether the policy has exclusions that might make it hard to use the benefit.

Can I still participate in the Trust if I have long term care insurance?

Yes. WA Cares will provide benefits in addition to any private long-term care insurance you have or purchase in the future. You can add additional coverage from private insurance at any time. If you apply for an exemption from the WA Cares Fund, you will no longer be eligible to opt back in, regardless of whether you maintain your private policy.

Will my corporate long term care insurance cover the same services as the WA Cares Fund?

Unfortunately, no. One of the reasons the Washington State Legislature passed the Long Term Care Trust Act in 2019 was because long-term care insurance policies were not meeting the needs of aging Washingtonians, the majority of whom prefer to stay in their homes or communities as long as possible. Most private long term care insurance plans in Washington only pay for long term care in nursing facilities. This means people must leave their homes to get the services they need, in a facility that may cost more than their coverage.

WA Cares empowers people to determine how, where, and from whom they receive long term care. If the person chooses to receive care at home from a family member, the Fund will pay for those services and will even pay for the required training to certify the family member as a long-term care provider. Paid family caregiving is a lifeline for working families, who on average lose $300,000 in income to stay home and care for their loved ones.

Who is eligible to receive WA Cares benefits?

People who have a need for long term services and supports may begin applying for benefits in January 2025. To qualify for benefits, you must have met the WA Cares contribution requirements by the time you apply. You must also need help with activities of daily living.

To be eligible to receive benefits, you must be over 18 years old, a current resident of Washington, and need assistance with at least three activities of daily living, such as: 

  • Medication management
  • Personal hygiene
  • Eating
  • Toileting
  • Cognitive functioning
  • Transfer assistance
  • Body care
  • Bathing
  • Ambulation/mobility
  • Dressing

What are the vesting requirements for the benefit?

To qualify for benefits from the WA Cares Fund, you must have worked and contributed to the fund for:

  • At least ten years at any point in your life without a break of five or more years within those ten years, OR
  • Three of the last six years at the time you apply for the benefit; and
  • At least 500 hours (or 25% of full time) per year during those years.

If I am fully vested and need to use my benefit, how does the state determine if my current condition meets the criteria for needing long term care?

Eligibility is not determined by condition, but by how many daily activities you need support with. You must need assistance with at least three activities of daily living, such as:  

  • Medication management
  • Personal hygiene
  • Eating
  • Toileting
  • Cognitive functioning
  • Transfer assistance
  • Body care
  • Bathing
  • Ambulation/mobility
  • Dressing

I’m self-employed. How can I participate in the program?

You can opt-in as early as January 2022. Opt-in applications will be available in January. If you’re considered self-employed for Paid Leave, you’re also considered self-employed for WA Cares.

How are WA Cares benefits paid out?

WA Cares Fund pays providers of services and/or supports directly. Cash payments are not made to beneficiaries.

What’s an elimination period and how long is it?

Elimination period is a term used to refer to the time period between application for benefits and the receipt of benefit payments. WA Cares Fund will make a determination on the individual’s application and begin paying benefits within 45 days of application receipt. 

Private long term care insurance companies typically have an elimination period of 120 – 180 days and are known to fight claims for much longer. If a person has both WA Cares benefits and long term care insurance, the WA Cares benefit could help fill the gap with services during the elimination period.

If I live in a nearby state but work for a Washington employer, will I have to pay into the program? Will I get to use the benefit?

Yes, you will have to pay in if you work for a Washington employer but live in another state. You will only be able to use the benefit if you are a current resident of Washington State at the time you apply for and receive benefits. WA Cares does not pay for services or supports outside of Washington State.

I’m nearing retirement, and am required to pay into the Fund, even though I will not meet the vesting requirements to receive the benefits. What options do I have?

You can purchase corporate long-term care insurance before November 1, 2021 and apply for exemption through the Employment Security Department by December 31, 2022. However, if you are financially able, we encourage you to not opt-out and pay into the Fund to help other Washingtonians who can’t afford traditional long term care insurance policies.

Why was WA Cares created?

The WA Cares Fund is a new contributory state program which will help people pay for long term care, including assistance with eating, bathing, dressing, managing medications, and other activities of daily life. Until now, the only way families can get help paying for long term care is to spend down to poverty to qualify for Medicaid. WA Cares will help families with these costs regardless of their income or assets.

To provide affordable long-term care services for all working Washingtonians in the setting of their choice, whether that be their home, an assisted living facility, an adult family home or a nursing home. Seven out of 10 Washingtonians will need long term care at some point in their lives, but most do not have enough savings to pay for it.

Medicare does not cover long-term care, which leaves people left to spend down their life savings in order to qualify. Once people are impoverished, Medicaid pays for long-term supports and services.

The WA Cares Fund starts to fix this flawed system by providing financial resources to families quickly.  The WA Cares benefit will be all the help about half of families need.  For those who need more extended services, the WA Cares fund will give them time and resources to figure out a longer-term plan.