You’ve been paying premiums on that Long Term Care (LTC) insurance policy for years. Do you know what it covers? How to file a claim? What to do if they deny your claim? Nothing is worse than paying into a policy and not remembering how to use it. And, remember, your benefits are basically use it or lose it. Waiting to tap into your benefits just reduces the amount you are likely to receive.
First, do you know where your policy is? There’s usually a 30-50 document that spells out all the details of your policy. If you can’t find it, call your insurance company and request a copy. Make sure your spouse and/or adult children know you have a policy and where it is. It’s not a bad idea to have them keep a copy of it too. Before filing a claim, carefully review your LTCI policy to understand its coverage limits, benefit period, elimination period, and any exclusions or limitations. Knowing your policy details will help you navigate the claims process more effectively.
Here are some key items to look for in your policy:
- Schedule of Benefits: Your policy will have a page that summarizes the key terms of your policy. This will give you the main points in a brief and simple format. Most LTC policies have benefits for home care services and assisted living communities.
- Qualifying Need: Make sure you understand the circumstances needed to be a qualified claim. They are usually very specific about what conditions they will, and won’t, pay for. For example, to approve home care or home health aide services, you typically need “standby” or “hands-on” assistance with a certain number of Activities of Daily Living (ADLs) from a list they provide (example: bathing, dressing, transferring, feeding, etc.) or substantial supervision due to cognitive impairment or dementia.
- Qualifying Care Provider: Most policies do not pay for family caregivers. They will only pay for licensed and reputable home healthcare agencies like BrightStar Care.
- Elimination or Exclusion Period: Many LTC policies have a deductible which requires you to pay a portion of the care costs before they start to pay. Typically, you pay for the first 30, 60 or 90 days of care. Make sure you know what triggers the period to start and how your policy counts the days. This can vary greatly. Some count only individual days of care while others count calendar days. Some policies will waive this deductible period in certain circumstances.
- Benefit Period: The length of time that benefits will be paid under the policy. Many policies have a time limit for how long they will keep paying.
- Benefit Amount: Most policies set a lifetime maximum amount of coverage. If you are lucky enough to have no lifetime max, congratulations!
- Maximum Benefit: While the benefit amount can be a huge number, most policies specify a maximum amount they will payout per day, week, or month. Do the math to see how long your coverage will last. For example, if you have a $200,000 benefit amount, and they will pay up to $200/day, it would take 1000 days of care to reach your benefit limit.
- Inflation Protection: You may have selected optional coverage that increases the policy's benefit amount and daily/weekly maximums over time to keep pace with inflation. If you have this protection, look at the date of your schedule of benefits and make sure you have the latest numbers.
If you would like assistance in reviewing your LTC policy or navigating the complexities of filing, your local BrightStar office would be happy to meet with you. Here in North County San Diego, CA, you can reach me at: dan.sweiger@brightstarcare.com, 760-448-1021. I’m happy to meet you for a free consultation.
Click here to read an excellent article in the Summer 2024 issue of Aging Well Magazine about how Jahnke Consulting helps people get the benefits they deserve: https://www.thisislivingwell.com/magazine
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About The Author:
Dan Sweiger is Co-owner and President of BrightStar Care of Carlsbad, CA. He has a bachelor’s degree in communications, MBA, and 20+ years leading marketing and brand management in Fortune 500 companies. He is an industry expert and public speaker who supports the healthcare community through participating in The National Aging In Place Council https://ageinplace.org/), serving on the board of the San Diego Dementia Consortium (https://sddementia.org/), partnering with the Alzheimer's Association of San Diego (https://www.alz.org/) and Parkinson’s Association of San Diego (https://parkinsonsassociation.org/), leading educational workshops at the Carlsbad Senior Center (https://www.carlsbadca.gov/), and more.
About BrightStar Care of Carlsbad, CA:
BrightStar Care of Carlsbad, CA is the #1 rated home care agency in the state of California by Home Care Pulse. We offer a wide range of in-home support services, including companion care, personal care and skilled nursing. We also specialize in care for people with Parkinson’s and dementia. Because BrightStar caregivers are trained and supported by a RN Nursing Director who watches over our clients and staff – something extremely rare for home care companies -- we can provide early detection and intervention when medical issues arise. In fact, BrightStar clients are 25% less likely to be hospitalized compared to clients of other home care companies.
For further information about our award-winning home healthcare services, call us at 760-448-1021