Blog

The Long Term Care Insurance Conundrum

December 22, 2020
If you are lucky enough to have a long term care insurance policy, you have most likely been paying for it for many years.  You invested wisely to help eliminate emotional, physical and financial stress when you might need it way in the future – on that rainy day.  So what happens when that rainy day comes?  Do you use your policy?  The short answer is yes.
 
It’s best to ask yourself “what are my goals?”  No one wants to spend money unnecessarily.  Many of us want to remain in our home.  We all want to remain healthy.  So what’s going to keep you healthy, independent and at home?  Maybe it’s accessing those policy benefits and hiring some extra help at home.  If those benefits can help relieve you of challenging household chores, help you with your own Activities of Daily Living (self-care tasks such as bathing, dressing, transferring, toileting, etc.) or a needy spouse, make sure you are taking your meds and getting appropriate nutrition, hydration and exercise and perhaps most importantly, keeping you from falling and breaking a hip, leg or arm.  A fall is your quickest ticket out of your home and into the hospital or nursing home or maybe worse.
 
I have seen far too many people over the years reluctant to access their Long Term Care benefits or spend a few dollars on home care only to suffer a preventable disaster and end up right where they never wanted to be – in a nursing home.  Why take the chance?  What are you waiting for?!
 
It’s easy to access your Long Term benefits.  First check your policy to make sure it is still in force.  Next, determine your daily benefits, lifetime benefits, elimination period (if any) and benefit triggers – typically needing help with a few Activities of Daily Living, cognitive impairment and possibly a certification of medical necessity from your physician.  Then ask your insurance carrier who is qualified to provide care and how to initiate your claim.
 
If all is in order, contact a qualified and reputable in-home care provider.  They will help you clarify your daily needs and determine how much care you can get with your daily benefits.  (You may need more care than your benefits will cover.)  They should also be able to provide your insurance carrier an initial nurse assessment, Plan of Care, copies of invoices and daily nurse notes to support your claim.  It generally takes a few weeks for the insurance company to get things in order and then they will pay your benefits to you on a regular basis.  Unlike health insurance, most Long Term Care insurance companies pay you directly and not the provider.  Since the services you require may exceed your daily benefits, this simplifies the billing and collection process. 
 
So if your goals include independence, health and remaining in your home, and you could use some extra help to achieve these goals, you may want to consider using your Long Term Care benefits to support a level of in-home care.  You have paid for it, so you might as well use it to your benefit while you still can.  If you have questions, BrightStar Care can help.