When caring for an aging loved one, there may come a time when they need assistance to continue living safely and independently, whether that be at home or in an assisted living care facility. If you or a loved one have a current Long Term Care Insurance (LTCI) policy and needs an increased level of care, it is important to educate yourself on how to file a claim and understand the benefits that are offered. In this article, we will discuss how this program works and how this can benefit aging adults.
What is Long Term Care Insurance?
A long-term care insurance policy helps with the cost of assistance if you have a chronic health condition or disability. This is especially important for aging adults because regular health insurance does not cover long-term care. Most policies today offer coverage for home care, assisted living, respite care and nursing home care.
Under most long-term care policies, you will qualify for benefits once you need assistance with at least two out of six ADL’s (activities of daily living)- bathing, caring for incontinence, dressing, eating, toileting (getting on or off the toilet) or transferring (getting out of a chair or bed). Benefits can also be received if the individual suffers from cognitive impairment like dementia or Alzheimer’s.
If you are considering utilizing long-term care insurance for yourself or a loved one, you’ll want to assess the individual’s care needs to see whether it might be time to get some extra help if the person is living independently. These signs may include lack of desire (or inability) to clean their living space, decline in hygiene practices, reluctance to leave the house, declining driving skills, difficulty getting around, losing track of medications or losing interest in meals.
Filing a Claim
If you suspect that you or your aging loved one has LTCI coverage, you’ll want to first locate evidence such as a certificate of coverage or any records of premium payments. An insurance company will also review any medical documents from your doctor, or in some cases, send in a nurse to do an evaluation before the insurer can approve a plan for care. Then, you can contact the insurance company to see if this policy is still valid. If so, it is important to clarify specifics of their coverage, such as:
1. How long will my benefits last?
2. Does this policy expire?
3. What services are covered? How are cognitive disorders covered such as dementia or Alzheimer’s?
4. Does the policy have a maximum length of coverage for each service provided?
5. Do I pay out of pocket for services during the elimination period? (Most policies require that you pay for long-term care out of pocket for a certain period of time, such as 30-90 days before you begin receiving reimbursement)
It is important to note that every insurance company is different, and their offerings are unique, so be sure to have a solid understanding of your individualized plan.
Informing Care Provider of Your Long-term Care Policy
Once you have made the decision on which provider(s) are needed for your long-term care needs, you’ll want to inform them of your LTCI policy. In some cases, the care provider may initiate a claim, otherwise, you or another family member may be responsible for initiating the claim. You want to be sure that you and your care provider are aware of the elimination period process and the possibility of payment delays under your policy. This will also help you or your loved one keep track of cash flow and payments for care.