Does Long-Term Care Insurance Cover In-Home Care?

Managing the logistics of caring for a loved one can be overwhelming, stressful, and confusing. Financing in-home care can also be complicated, but long-term care (LTC) insurance can be a helpful resource to offset the cost of care. If you or your loved one have long-term care insurance, it’s important to understand the nuances and coverage aspects of your policy before filing a claim to pay for home care services.

What is Long-Term Care Insurance for Home Care?

Each long-term care (LTC) policy is different, but generally, they all require that the insured individual meets specific criteria to begin receiving benefits in the home or other setting. For example, you may be eligible for benefits if:

• You have a cognitive impairment or need help with two or more of these Activities of Daily Living: eating, dressing, bathing, toileting, getting in and out of a bed or chair, and bladder or bowel control. A care manager or nurse from your insurance company typically assesses the need and determines your eligibility.
•  You are past the “elimination period,” which is like other insurance deductibles except it’s measured in days instead of dollars. Whether your elimination period is 30, 60 or 90 days, you must cover the cost of any services for this time before your insurance company starts to pay.

Depending on your provider, policy differences dictate what services are covered for your loved one. When reviewing your policy to understand what’s covered, examine factors like the maximum amount paid per day of care, the maximum number of years the policy will pay for benefits and lifetime maximum payment amount. Because these factors vary greatly from plan to plan, it’s critical to be fully aware what your policy covers and how much you may need to pay out-of-pocket.

What Are the Types of Policies of LTC and Do They Cover Home Care?

Long-term care policies are generally offered as either a traditional stand-alone policy or a hybrid option alongside a life insurance policy. Some hybrid options, such as a linked benefit life insurance policy, allow you to access the death benefit of a traditional life insurance policy while your loved one is still alive and needs care. Other options, such as a long-term care rider add-on to a life insurance policy, have a separate portion of funds that are earmarked for long-term care benefits.

Many comprehensive policies cover services such as skilled nursing in-home care, support with activities of daily living (ADLs), occupational and physical therapy, as well as rehabilitation. However, more limited policies may not cover all of these services. Each policy has their own set of specifics that must be fully understood before submitting a claim. If you have questions about your policy, discuss them with your insurance provider to gain clarity and also confirm that your care provider-of-choice accepts your insurance and what options are available to you.

Filing a Claim for Home Care Services

Carefully review your policy or ask your LTC insurance provider:

• How many Activities of Daily Living do I need to require help with before I qualify? Does requiring help due to a dementia diagnosis count?
•  What is my elimination period? Is it calendar days or days of paid care that may be stretched out over several months? Are there a minimum number of hours per day I need to pay for in order for it to count as a day of care?
• Are a physician’s orders needed to qualify?
• What is my daily, weekly or monthly maximum? Do I have an inflation clause?
• Can I stop paying premiums once I activate the policy?
• If I stop needing care or am hospitalized, does the elimination period start over?

To learn more about how you can leverage your long-term care policy for home care services, contact your local BrightStar Care agency today.

Common Mistakes to Avoid When Filing a Claim

If it’s your first time using long-term care insurance, it can be a confusing process.  LTC insurance doesn’t always work the same as other types of insurance. The most common mistake made when filing a claim is not adhering to the policy’s “elimination period” – the waiting period before the policy will begin paying for services. During this period, the policyholder is expected to pay for services out-of-pocket. The elimination period is determined at the time of purchase and can vary from 30 days to a year or more. 

Other common mistakes to avoid are similar to those stumbling blocks that often materialize with more traditional forms of health insurance. When filing a claim, make sure to provide a clear, detailed account of your loved one’s level of function and their medical needs. Submit consistent and complete medical documentation to accompany each claim and make sure to file all claims on time.

Using Long-Term Care Insurance to Pay for Home Care

Knowing if your family member has a long-term care insurance policy and what type of policy it is means you have additional resources to support their care. If LTC insurance is an option for your family, here are some helpful tips to follow if you plan to use this insurance to help pay home care for your loved one. 

1. Review your policy: Familiarize yourself with the type of policy your loved one has, what services it will cover and how long it will cover their needs. If you have a hybrid plan, you’ll also want to consider how your particular LTC insurance may impact a traditional life insurance policy. 
2. Consult with your providers: Always follow up with your insurance provider to make sure you are clear on your policy’s coverage. You should also consult with your healthcare provider to gain access to all necessary documentation for your insurance claim.
3. Choose a licensed home care provider: Selecting a home care provider should include such considerations as their vetting and training practices, standard of care, licensing protocols and accreditation. 
4. Submit a claim: Follow your insurance provider’s process for filing a claim. Include all documentation and follow proper timelines to ensure timely payouts for services.
5. Monitor and adjust: Stay up-to-date on the particulars of your insurance coverage and what that means for the medical needs of your loved one. Both may change without notice, potentially leaving the door open for a gap in coverage when your loved one needs it most. Making sure you’re aware of any upcoming changes will allow you to adjust care and policy coverages as needed.

How to Maximize Your LTC Insurance Benefits

Navigating the complexities of long-term care insurance benefits can be complicated, but by asking the right questions of your insurance provider and healthcare professionals, you can develop a better understanding and reap the full benefits of your plan. Here are a few tips and strategies to help you make the most of your LTC policy:

• Work with a care manager: Having a care manager that is familiar with LTC insurance policies will help maximize your benefits. An experienced care manager has a working knowledge of various LTC insurance policies and can help you understand what options are available to you and for how long. They can also help you find additional resources to offset any costs not covered by your LTC insurance. 
• Use preferred home care providers like BrightStar Care: BrightStar Care has provided professional in-home care to individuals and families for decades. We’ve worked with a variety of insurance providers and can help you understand your coverage options. When you choose preferred care providers, your claim process can be easier and faster. 
• Opt for home-based care to reduce out-of-pocket costs: LTC insurance elimination periods vary from policy to policy, ranging from periods as short as 30 days to up to 1 year or longer. In-home care offers greater flexibility and tailored care solutions that are typically billed hourly, allowing individuals to only pay for the services they need on a part-time basis, rather than a fixed rate at a skilled nursing facility. Additionally, in-home care eliminates the added costs of upfront facility deposits or admission fees. These cost-saving factors make home-based care a more budget-friendly option during the waiting period before LTC insurance benefits kick in.

BrightStar Care: Your Trusted Partner in Navigating Long-Term Care Insurance

At BrightStar Care, we know that the experience of caring for an older loved one can be rewarding, but come with its own unique set of difficulties. Payment options like long-term care insurance gives you the peace of mind that your loved one will receive the care they need and helps ease the financial burden of paying for that care. 

With decades of experience in delivering compassionate, qualified in-home services, BrightStar Care is here to support you in navigating the complex world of choosing the right provider and understanding your coverage options. It might be your first time figuring all of this out, but we’ve been doing it for a long time and can help make the process easier on you and your loved ones. When you choose BrightStar Care, you’re selecting a trusted partner to provide your loved one with the personalized care that they deserve. Reach out today so we can help you review your policy and understand your benefits.