Long Term Care (LTC) Insurance: Will it pay for in-home senior care? How do I get started?

 The short answer: Yes, most Policies pay for in-home care. Here’s some more info on filing, qualifying and using the policy.

If you (or loved one) purchased and are paying for Long Term Care (LTC) insurance, you likely can use the Policy to pay for licensed, in-home care.  In-home care may be called Home or Community Based Services and is differentiated from a “skilled” facility (ie Assisted Living, Memory Care and Skilled Nursing).

Benefits of Home Senior helps over 20 clients with LTC insurance.  Feel free to call us with your questions.

Does it pay?

First step is to read the policy or call the LTC insurance company to confirm coverage.

  1. IF the policy pays for in-home care and
  2. How much does it pay (usually a daily rate)

Understanding the Process and the Policy

LTC Insurance is NOT managed like Health Insurance. The Policyholder must file. The insured, spouse or Power of Attorney (POA) must initiate the “process” and file the claim, similar to auto or home. Nothing happens until you contact the LTC insurance company and file a claim.

Key Terms (that aren’t exactly obvious)

 Elimination Period:  The number of services days the LTC will NOT pay for approved services.  Ninety (90) “care visits” is the norm but it can range from 0 to 180 days.

Policy Benefit Term:   Number of total days/years the Policy will pay for benefits from first payment date.  This Term is important to understand to maximize the benefit.  Three to five years is normal; however, some older policies have lifetime payout and will pay until death or the Maximum Policy Benefit

Maximum Policy Benefit:  Maximum $$ amount the Policy will pay over the Policy Benefit Term (includes all payments to Facility and In-Home Care providers).

Qualifying for Coverage

 The Policyholder MUST qualify for benefits as defined in the Policy. Qualification is a typically defined as a deficiency in 2 out of 6 Activities of Daily Living OR significant cognitive diagnosis. A physician or licensed provider must certify the need.

Claim Process

After telling the LTC company you want to file, the insured will receive a letter from the LTC insurance company with SPECIFIC DOCUMENTATION and MEDICAL RECORD REQUESTS.  DO NOT IGNORE THESE REQUESTS.

The key document will be a “Certification of Need.”  A licensed provider (doctor, NP, etc) must sign off that the insured has specific ADL deficiencies or cognitive impairment.

Claim Approval

 Once all the documentation is submitted, it usually takes 20 business days to review and approve (presuming Certification of Need meets the requirements).  Services CAN usually be started and applied retroactively.

Billing and Payment

 Benefits of Home submits all the paperwork to LTC and the LTC pays the insured.  Since we do not know the Policy payment amounts, the insured pays BOH.

We do this for over 20 clients, and it runs like clockwork once the claim is approved.

Call us at 913-422-1591 with any questions!