Understanding Long Term Care Insurance

This article assumes that you already have long term care insurance (also known as LTC) and now you need to use it. This article explains how to read and understand the benefits that you are entitled to under a long term insurance policy and use it for home care services. Please note that most long term insurances also pay for assisted living but that is beyond the scope of this article.

You took the right first step by getting long term care insurance. With advancing medicine, people are living longer and that means they need care and assistance for a longer period of time during their advancing years.

When the time comes to activate your long term care insurance policy, its important that you understand what benefits you qualify for and are taking the necessary steps to maximize your benefits. Understanding and navigating your long term insurance policy can be tedious and confusing, specially since your focus most likely at that time is to start the care and not to worry about the paperwork. Here is a quick guide to help you focus on the key aspects of any long term care policy and ask the right questions to your insurance company.

  1. Elimination Period – Most long term policies will stipulate a time frame (usually the first 30 or 90 days) during which you are responsible for paying the full cost of your long term care. Insurance will only kick in once that period is over. That is why it is very important to contact your long term insurance company and activate the policy as soon as you require care, otherwise you will pay more out of pocket.
  2. Maximum Daily Benefit – All long term care insurance policies have a maximum daily benefit. This is the maximum amount that your policy will cover for each day of care. You need to know this amount to be able to figure out how many hours of care per day you can cover through your insurance benefits.
  3.  Lifetime Benefit Limits – Find out what is the lifetime maximum benefit that your insurance covers. Use this amount along with the maximum daily benefit amount to figure out the best way to optimize your benefits.
  4. Claim Processing – Most insurance companies will either reimburse you for the long term care expenses or they will work directly with the home care agency that provides care and pay them for the services they provide. If you like to manage and monitor the use, it is recommended that you use the reimbursement approach, however in that case you will have to pay from your pocket to the home care agency and will get reimbursed from your insurance company at a later date depending upon your insurance company’s reimbursement schedule. This approach also works well in cases where your total hours of care is more than what your insurance covers, that way the home care agency bills you the full amount and you manage what you submit to the insurance company for reimbursement versus what you pay from your pocket. The other approach of having the home care agency bill directly to the insurance company works best if you don’t want to get into the hassle of dealing with paperwork and keeping track of all the back and forth with the insurance company and submitting claims in a certain format. Home care agency will take on Assumption of Benefits on your behalf and will bill the insurance company directly. Please note that not all insurance companies and home care agencies support this second approach.
  5. Scheduling Care – Most long term insurance companies would want you to work with bonafide, licensed and established home care agencies versus directly working with private providers. Its a good practice to call a few home care agencies in your area and do your research while you are working with your insurance company to activate your benefits. That way you are not wasting any time once the benefits are approved. Your insurance company will let you decide which agency you want to use for care, as long as the agency meets their requirements.
  6. Services Provided – Long term insurance covers personal care and hygiene, light housekeeping, transportation, meal prep, specialized care such as dementia and Alzheimer’s and any assistance needed with activities of daily living. Here is a more detailed list of services that you should expect to receive under long term care.
  7. Starting Care – Once you pick a home care agency to provide care, they will schedule a home visit to fully understand the care needs and will provide a careplan to you and the insurance agency. Once the careplan is reviewed and signed, the agency will start providing care according to the plan. Good agencies will review the careplan every few months and update it as needed, since client’s health condition can change very frequently with advancing age.

While most people know that they need health care insurance in their advancing years, not that many people think about the need of long term care and the fact that regular health insurance doesn’t cover long term care needs. By the time most people realize that they need some kind of long term care, its already too late and exorbitantly expensive to sign up for long term insurance. By having a long term care insurance, you have taken the right step in making sure that your needs are taken care of in your golden years and that you don’t become a burden on your family and loved ones.

We can review your long term insurance policy for free and help you understand your benefits under the policy. If you would like our assistance in understanding your long term insurance care policy or if you need us to provide care through your long term care benefits in Greater Houston, Sugar Land or Beaumont Triangle, you can call us at 832-612-0472 or email us at info@lifefoundationhomecare.com to get connected with a qualified advisor. Here is a list of long term insurances that we accept.

You made the right decision by electing to go for long term insurance, now make sure that you are getting maximum benefits that you are entitled to under the policy.

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