Understanding how health insurance works is difficult enough. But Tara Siegel Bernard of the New York Times writes today about just how much some seniors and their caregivers are struggling with long-term care insurance.

Some families have policies purchased decades ago, when plans were more restrictive and, in some cases, from companies that are now defunct.

Siegel Bernard writes:

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“Everything is not rosy,” said Jesse Slome, director of the American Association for Long Term Care Insurance. “When insurers stop selling or exit the business, many of them hire these third-party administrators to adjudicate claims, and that is where interpretations don’t seem to be as liberal.”

Insurance agents who have specialized in long-term care policies for a couple of decades, however, said most top-rated insurers pay claims without issue. An estimated 264,000 people got long-term care benefits at the end of 2012, Slome said, and $6.6 billion in benefits were paid that year.

Still, “the process can be pretty daunting for people,” said Bonnie Burns, a policy specialist at California Health Advocates.

Siegel Bernard outlines the major pitfalls, including endless documentation and the nuances of eligibility. (One policyholder could receive benefits if she required help in bathing, but not if she could manage the job after being assisted into the shower.) A common problem, she notes, is that many policies were written before assisted-living facilities become common, so benefits applied only to nursing homes.