When a loved one needs assistance at home to continue to live independently, or needs to move into a care facility, long-term care insurance (LTC) can be a big help in making that care more affordable. Unfortunately, accessing the benefits can be challenging, especially at a time when families are often already feeling overwhelmed.
Many people don’t realize that long term care insurance can often help cover the costs of remaining independent and having in-home care. Some families don’t even know if their loved ones have a policy or not, so the first place to start is to try to find any records of policies, premium payments, etc.
If a policy was purchased some time ago, it probably does not have a death benefit – which means if you don’t use it, you lose it. And since Medicare does not cover most of the costs of care, it’s important to take advantage of those benefits if you have them, so it’s worth the time and effort to find the policy information.
If your loved one does in fact have a LTC insurance policy, the next step is to clarify all of the specifics of that policy. Since most families are overwhelmed enough just trying to secure help for their loved one, it can be beneficial to have someone else who can help navigate this process. Some care providers will offer to call your insurance company either for you or with you, so if you have already hired an agency, or are considering possible agencies, check with them to see if they offer this as part of their service. If they do, you’ll need to sign an authorization that gives the agency permission to speak with your insurance company on your family’s behalf.
Whether it’s you, or your care provider, who contacts the insurance company, here is a list of preliminary questions to ask:
- How much is our benefit? LTC is written in a daily/weekly/monthly benefit, and your benefit may be $100 a day, $300 a day or more. The first thing to find out is exactly how much money you can receive.
- How long is that benefit going to last? Will it cover the next 3 years? 5 years? Or the rest of the policy holder’s lifetime? This is important to know for your long-term planning.
- What kind of care does that policy cover? Does it just cover in-home care? Facility care? Adult day care? There are many care options available, so it’s important to know what your policy will cover.
- Is there a waiver of premium? Most policies have a waiver of premium, which means once you start claiming care, you no longer have to pay the premium. Annual premiums typically increase every year and can be expensive, so be sure to ask if you have a waiver.
- What is the elimination period? Like a deductible on health insurance, this is usually a period of time that you will need to pay your care costs out-of-pocket before your insurance kicks in. Some plans have a zero-day elimination period, so you can begin receiving benefits immediately, but others have 60-day, 90-day, or even 120-day elimination periods. If your policy has a longer elimination period, you might still end up needing to pay a large sum of money out-of-pocket, so it’s important to know this detail before you submit your first claim.
Once you have all of this information, you and your family can make a much better decision about your care options.
When you are ready to initiate a claim, you will need to fill out an initial claim packet. Every company is different, but this usually includes: a policy holder statement (that explains why the patient needs care), a provider statement (proving that your care provider is properly licensed); a physician statement and/or nursing assessment that prove the patient needs care; HIPAA forms and more. Once that initial claim packet has been sent to the insurance company, you often have to wait up to 30 business days to be approved or denied.
Managing long term care insurance claims is not easy. But knowing what benefits are available to you, and finding an informed care provider who can help you maximize those benefits, will help you choose the best care plan for your loved one and your family.
Lisa Vogel is the owner and founder of The Lisa Vogel Agency (www.lisavogelagency.com), an in-home care provider based in Stevenson, Maryland.