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Navigating the Long Term Care Insurance Maze – 5 Tips to find your way to Funds!

The rainy day has come and your loved one needs care. Thankfully, there is a Long Term Care (LTC) insurance policy to rely on. But as you start reading the complex, bureaucratic document, you are not confident you fully understand all the terms and conditions. How much care is needed? What type of care is needed? Are eligibility criteria met? Will the policy allow a private independent caregiver? What is the preparation for an insurance assessment visit? What kind of ongoing paperwork is going to be needed to support the policy? Aging Life Care™ Professionals are experts in helping their clients navigate these policies so that the LTC insurance benefit can be efficiently and successfully converted to fund home care or facility care. Here are 5 Tips to help you find your ways to the funds! 

 

1. Carefully review the LTC policy for a certificate of coverage and documents supporting that premiums have been paid and are up to date.

2. Clarify the benefit – how much is it paying? Is it a daily dollar amount or is it a fixed amount over a time frame? How long will the benefit last? Is there a maximum benefit  limit in years or is there a maximum total dollar amount that will be paid out? This is important for planning purposes. For example, if a loved one has mild Alzheimer’s disease and the policy has a limited time frame, it may be best not to use the policy until the later stages when care needs will be greater. 

3. Know the eligibility criteria. Most policies require that the insured must need hands-on physical assistance with at least two activities of daily living (ADL’s) such as bathing, toileting, dressing or ambulation. If the insured is physically strong but cognitively impaired, the deficits must be acute enough to warrant constant in-person supervision for safety reasons.

4. Clarify the services covered as policies vary greatly. Does the policy cover both in- home caregiver services and facility care? If home care services are covered, does the policy allow the flexibility of covering an independent care provider or must the caregiver be staffed from a home care agency? Are care management services covered? What is the elimination period? Clarify the time period that has to be paid out before the benefit is in effect. Remember, if it’s a period of days and your loved one can suffice with a few hours of care a day, every day regardless of the hours counts toward the elimination period.  

Consider the services of an Aging Life Care™ Professional to advocate for coverage and to be present during an LTC insurance evaluation so that accurate information is gathered on the care needs of your loved one.

ANNE C. SANSEVERO, RN, MA, GNP, CCM
Nurse Care Manager, Founder and CEO
HealthSense LLC, an Aging Life Care™ management consulting practice