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Simplifying The Complexities of Long-Term Care Insurance

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Though extremely helpful, long-term care insurance can be quite complex.

Long-term care insurance can provide great peace of mind, but utilizing those benefits can wind up being a complex undertaking for seniors and their family members. To help lead families through the process, CareFor offers the following informative overview.

Which services are covered?

Ahead of submitting a claim, it is essential to carefully go over a copy of the long-term care insurance policy so that you can gain an understanding of the types of services the policy covers. If you do not have a copy of the policy, get in touch with the insurance company to ask for one.

While all policies vary in what they cover, long-term care insurance typically covers non-medical services at home, as long as aid is needed with at least two or more activities of daily living, or the policyholder has been diagnosed with some type of cognitive difficulty, such as Alzheimer’s disease. Examples of the type of care that long-term care policies might cover include:

  • Personal hygiene needs, such as bathing/showering and getting dressed
  • Ambulation and transfers
  • Using the toilet and incontinence care
  • Meal preparation and feeding
  • Housework
  • And more

If you or a senior loved one needs help with understanding the details of the policy, an insurance agent, elder care attorney or financial planner may be helpful.

Does coverage include all of the costs for care?

Though individual plans vary, each plan outlines the permissible monthly coverage, which is identified as the “present daily allowance,” and often includes a lifetime maximum cap. Policies also typically identify a specified amount of time during which the benefits are accessible, such as five years, or if the coverage is in effect for the remainder of the policyholder’s lifetime.

It’s also important to review the long-term care plan’s elimination period. The elimination period is the time during which the cost of care needs to be paid out-of-pocket to begin with, until a specific amount of time has passed. Although some plans identify a zero-day elimination, which means that cost for care and coverage begin immediately, other policies may require as much as 120 days of care first.

Choose your care provider very carefully.

If you plan on filing a claim for long-term care insurance, it’s vital to partner with a home care agency which has experience in billing long-term care insurance providers; otherwise, there is the possibility that the claim may not be fully reimbursed. CareFor has experience with helping families access their long-term care insurance benefits and can provide the documentation necessary to help clients file claims properly.

What is the process for filing claims?

In order to file a long-term care insurance claim, the following documents are normally necessary:

  • A claimant’s statement (or policyholder statement) explaining the causes for the claim
  • A physician’s statement provided by the doctor, verifying that care is needed
  • A prescribed plan of care and nursing evaluation
  • A provider statement, completed by the home care agency
  • An authorization form

Once the claim is completed and submitted, a phone interview is arranged with the insurance company’s claims department, and then the claim is either accepted or denied.

If you are seeking to access home care services through a long-term care policy, reach out to CareFor today at (512) 338-4533. You can rest assured in knowing that we have years of experience in not only delivering specialized care in the comfort of home, but also in helping families with long-term care insurance claims receive the most out of their plan. To learn more about our preferred elder home care services in Austin, TX and the other communities we serve, please visit our Service Area page.