How to use your long term care insurance
According to AARP, roughly 80% of adults 50 and older would like to keep living in their current homes as long as possible. Whether it’s in-home nursing, home health aide services, or palliative end-of-life care, custodial support can allow them this freedom. Of course, the expenses can add up, especially when care is required for an extended period, which is where long term care insurance comes in.
Long term care insurance (LTCI) covers some or all of the costs of a senior’s ongoing medical needs. Sometimes called nursing home insurance, individuals usually pay a monthly premium for this type of healthcare policy.
WHEN SHOULD I START USING MY INSURANCE?
Now that you have a policy in place and are making monthly payments toward the premium, you might be wondering when to start using it. There’s no one-size-fits-all age or time to activate LTCI, but the following statistics can provide some insight.
Some people require ongoing care at age 70, while others may be self-sufficient until they’re 90 years old. Upwards of 95% of long-term care insurance claims are filed by individuals over 70, and 70% of all claims are filed by people 81 years and older.
It’s not just about age-related mental and physical decline, either. An injury, chronic illness, or a change in their living situation could mean someone needs care sooner rather than later.
HOW TO ACTIVATE YOUR LTCI
If you’ve determined that you or a loved one need long-term care, the next step is to activate the insurance policy. TrustHouse offers in-house expertise and support for those looking to verify and activate their insurance policies. Below are the steps in this process.
Benefit Eligibility
LTCI policyholders have to meet specific criteria (also called benefit triggers) to receive their benefits. While eligibility requirements vary among policies, benefits are typically available when the individual needs assistance with two or more ADLs (activities of daily living). These basic self-care tasks include bathing, grooming, grocery shopping, and health maintenance.
Some insurance providers accept the need for standby assistance as a benefit trigger. This means the policyholder needs someone else present for transfers and to help prevent falls.
To determine eligibility, a LTCI company may:
Review the policyholder’s medical history
Interview the policyholder or a close family member
Conduct a face-to-face assessment
Conduct a physical or a cognitive test
Contact the policyholder’s healthcare provider
Review notes or referrals from physicians
Some insurers are more meticulous, requiring several steps to determine eligibility, while others may go off a single doctor’s note. If you’re unsure about the criteria or need help presenting proof of eligibility, please reach out to us for complimentary help.
SUBMITTING A CLAIM
Once you are approved, you can begin receiving long-term care services and have peace of mind knowing the costs are at least partially covered, if not fully covered. As with the eligibility requirements, the process of submitting a claim varies among insurance providers. However, you can expect to provide certain information and documents.
To file a LTCI claim, you will need:
The insurance company’s name and contact information
The insurance policy number
An invoice for medical services received
Proof of payment for medical services
A form authorizing the release of the policyholder’s information
A statement from the LTC provider detailing the care plan
A signed policyholder statement (also called a claimant’s statement or insured’s statement)
An attending physician statement verifying LTC is necessary
Some insurance companies may also request a detailed care summary with each claim, but for others, an invoice might suffice once the initial paperwork is in. Claims can usually be submitted by mail, email, fax, or through an online form.
Seniors with dementia or physical impairments (as well as those who may not be tech-savvy) may struggle to file a claim. A loved one can assist with the process, but working with an LHCSA like TrustHouse can help the process go much more smoothly.
HOW TRUSTHOUSE CAN HELP WITH BENEFIT ADMINISTRATION
Typically, a policyholder submits a claim after receiving and paying for long-term medical services. Once the insurance company processes the claim, the policyholder receives reimbursement via a mailed check or direct deposit.
This works for some people, but it’s not always easy to front the money, especially for intensive, ongoing care. Additionally, the filing process alone can be tricky to navigate and create an unnecessary burden for individuals and their families.
TrustHouse handles the benefit verification process to help our clients get the care they need without having to worry about filing a claim. Our team will review your policy to help you determine your benefits, whether in-home services are included, and what portion of care will be covered.
With your signed permission to speak on your behalf, we’ll then work with your insurance company on reimbursing our agency for claims, so you don’t have to front the costs. If your policy covers 100% of your LTC, you won’t have to pay anything. If it covers a portion, you will pay the difference once TrustHouse is reimbursed.
KNOWING YOUR CARE CHOICES
Though LTCI policies vary, you can generally expect your benefits to include care received at nursing homes and adult daycare centers. What many don’t realize is that most also cover at-home services, such as support from a home health aide, nursing care, or palliative end-of-life care. Plans often include expenses for chronic medical conditions and disabilities.
This is crucial for many, as most adults would prefer to continue living in their homes while getting the medical support and ADL care they need. Knowing your LTC options can empower you to make the best choice for your unique situation.
TrustHouse is a premier, bespoke in-home care provider that delivers personalized services tailored to meet the exacting standards of discerning families. With rigorously vetted, trained, and certified private duty nurses, we guarantee superior care, better health outcomes, and enhanced peace of mind.
To request care or learn more about TrustHouse, please contact us at 212.776.4390.