Woman Studying Her Long-Term Care Policy

As people grow older, they often require long-term care and support. Although the cost of these services can be quite high, some of this can be mitigated with the help of long-term care insurance. This type of insurance is designed to cover the specific service and supports many elderly individuals need.

What is Long-Term Care Insurance?

A long-term insurance policy will cover a certain amount of money each day, week or month that will help to cover the cost of certain services. This allows people to choose the support options that best fit their needs, whether it is an assisted living facility or more independent at-home care.

A long-term care policy is not the same as health insurance. Traditional Medicare typically does not cover the services of a home health aide unless it is specifically for bathing pursuant to a doctor’s prescription. Some Medicaid Advantage plans do cover a homecare aide, but generally only in short stints during recovery from a fall or surgery.

The most common long-term care insurance companies include Banker’s Life, Brighthouse, Continental Casualty, Genworth, John Hancock, Kanawha, MetLife, Mutual of Omaha, Northwestern Mutual, Penn Treaty and Travelers. Several of these companies no longer issue new policies, or have folded their long-term care benefits into a combined life and long-term care policy. Nonetheless, policy holders who previously purchased their insurance through any one of these or other state-guaranteed companies will have no trouble using the benefits.

Some unions include long-term care benefits to there members as part of their retirement package. Teachers, EMTs, police officers and firemen often have benefits they don’t even know about. The Veterans’ Affairs department also provide long-term care benefits to its members through a variety of programs.

What Does Long-Term Care Insurance Cover?

Long-term care policies are typically used to pay for the daily assistance aging individuals need. This can range from paying for an assisted living facility to, more commonly, a home health aide. 

The periodic benefit amount can vary wildly, and is heavily dependent on the individual policy. In some cases, the periodic benefit will rise in line with inflation. Some long-term policies have a maximum lifetime payout amount, and if a person exceeds that, their payments will cease, though only 13% of policy holders (and only 7% of those using their policy for homecare) exhaust their benefits.

Because of the unlikeliness of exhausting lifetime benefits, a long-term care policy should not only be seen as an asset of last resort. Using a policy to hire a home health aide can not only help aging individuals maintain their independence in their own home, but can also ensure proper nutrition by preparing meals, reduce the chance of falls by decluttering the house and assist with shopping and errands.

Often, a policy will have ancillary benefits in addition to the direct care, such as grab bars for the bath or shower or geriatric care management. Your insurance agent or an LTC policy consultant can help you catalogue and understand your full range of benefits.

When and How Can I Claim Benefits Under My Policy?

An aging individual is typically eligible to begin claiming benefits under their long-term care insurance policy once they need assistance with at least two Activities of Daily Living, which include walking, getting dressed, bathing, getting in and out of bed or a chair (transferring), toileting and eating

Many policies include an elimination period, which serves as a deductible and requires the policyholder to pay out of pocket for the first 30, 60 or 90 days of service. Hospital or rehab stays covered by Medicare may count toward your elimination period, and a homecare agency or nurse registry may be able to work with you to make the elimination period slightly less painful on your wallet.

The mechanics of claim filing can take multiple forms and get quite complex given the documentation involved. The easiest way to manage this is by working with a nurse registry or home health agency that will file the claims directly on your behalf. Alternatively, a client can choose to pay out of pocket and be reimbursed by their insurance company. 

One additional wrinkle confuses many policyholders: some policies are structured as “indemnity policies” and pay a fixed amount to the policyholder each period regardless of the services used. Many holders of such policies assume that they have to file for these benefits directly. However, an agency or registry can still file your claim, and are responsible for passing back to you any amounts in excess of the services provided. If your preference is to have the homecare company file your claim but you have an indemnity policy, only work with a reputable company.

Work with a Long-Term Care Insurance Specialist

We all deserve to live the happiest and most comfortable life possible. If you’ve been paying premiums on a long-term care policy, you deserve not only to enjoy the benefits but also to maximize the services to which you are entitled under your policy.

A homecare company like Boca Home Care Services can help you get the most out of your policy. We’ve been helping our neighbors in Palm Beach and Broward Counties maximize their benefits for over 25 years. If there’s any aspect of your policy you’re unsure of, from the daily benefit to the elimination period, from qualification requirements to the filing process, give one of our benefits specialists a call today for a free consultation. We would be happy to assist; even if you are not ready to begin using your policy, it’s always helpful to understand what you have.