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Long-Term Care Insurance: Oversight of Rate Setting and Claims Settlement Practices

GAO-08-712 Published: Jun 30, 2008. Publicly Released: Jul 23, 2008.
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As the baby boom generation ages, the demand for long-term care services, which include nursing home care, is likely to grow and could strain state and federal resources. The increased use of long-term care insurance (LTCI) may be a way of reducing the share of long-term care paid by state and federal governments. Oversight of LTCI is primarily the responsibility of states, but over the past 12 years, there have been federal efforts to increase the use of LTCI while also ensuring that consumers purchasing LTCI are adequately protected. Despite this oversight, concerns have been raised about both premium increases and denials of claims that may leave consumers without LTCI coverage when they begin needing care. GAO was asked to review the consumer protection standards governing LTCI policies and how those standards are being enforced. Specifically, GAO examined oversight of the LTCI industry's (1) rate setting practices and (2) claims settlement practices. GAO reviewed information from the National Association of Insurance Commissioners (NAIC) on all states' rate setting standards. GAO also completed 10 state case studies on oversight of rate setting and claims settlement practices, which included structured reviews of state laws and regulations, interviews with state regulators, and reviews of state complaint information. GAO also reviewed national data on rate increases implemented by companies

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Baby boomersBest practicesClaims processingClaims settlementConsumer educationConsumer protectionElderly personsFederal regulationsstate relationsInsuranceInsurance claimsInsurance cost controlInsurance premiumsLong-term careLong-term care insurancePolicy evaluationPrices and pricingProgram evaluationProgram managementRatesRisk managementStandardsStandards evaluationState governmentsStrategic planningPolicies and procedures