Long-Term Care (LTC) Insurance and Home Care: Must-Know Facts for Families and Clients
Insurance is a bit of an abstract product when compared to tangible goods like televisions and automobiles. In fact, in some ways it’s actually more of a service than a product. Many consumers are therefore confused by insurance processes and have questions regarding “covered” events and claims submissions.
Long-Term Care (LTC) insurance can be especially perplexing for many clients and their families. After all, it’s usually not accessed until someone is in urgent need of extensive personal care. It’s also a product that’s often bought decades in advance, so the policy’s details and clauses may be forgotten altogether.
While LTC policies and client situations are unique, the following cheat sheet can provide a basic understanding of LTC coverage, how it relates to home care services and the process for submitting a claim.
What is LTC Insurance?
To understand LTC insurance, one must first understand that Medicare and health insurance do NOT cover “non-medical” home care services except in very limited situations. Essentially, there’s a care gap for folks who need the help and supervision of an in-home caregiver. LTC insurance was created to provide a safety net for people concerned about their future care needs.
How Does LTC Insurance Pay for Home Care?
If a LTC insurance company accepts a claim as valid, it will then provide coverage for home care services pursuant to the policy’s terms.
What Are the Requirements for Submitting a LTC Claim?
The basic conditions that must be met to file a successful LTC insurance claim are fairly universal across all companies.
What Else Should You Know About LTC Insurance?
As with most insurance policies, the fine print is very important to understanding LTC insurance benefits.
How Can BrightStar Care Help Clients with LTC Insurance?
Final Thoughts
Seniors who are fortunate enough to have long-term care insurance policies may benefit from significant financial assistance when accessing home care services. But uneducated consumers often find there’s red tape that can slow things down when submitting a claim.
Contact us for complimentary support in understanding your policy’s benefits and receiving the benefits you’ve already paid for!
If you’re in need of home care services for yourself or a loved one, be sure to take advantage of BrightStar’s complimentary Registered Nurse (RN) consultation. BrightStar is an award-winning caregiver provider in West Los Angeles, Santa Monica, Marina del Rey, Torrance, Manhattan Beach, Redondo Beach and Palos Verdes. Call: (310) 944-6985 or email: losangeles@brightstarcare.com today!
Insurance is a bit of an abstract product when compared to tangible goods like televisions and automobiles. In fact, in some ways it’s actually more of a service than a product. Many consumers are therefore confused by insurance processes and have questions regarding “covered” events and claims submissions.
Long-Term Care (LTC) insurance can be especially perplexing for many clients and their families. After all, it’s usually not accessed until someone is in urgent need of extensive personal care. It’s also a product that’s often bought decades in advance, so the policy’s details and clauses may be forgotten altogether.
While LTC policies and client situations are unique, the following cheat sheet can provide a basic understanding of LTC coverage, how it relates to home care services and the process for submitting a claim.
What is LTC Insurance?
To understand LTC insurance, one must first understand that Medicare and health insurance do NOT cover “non-medical” home care services except in very limited situations. Essentially, there’s a care gap for folks who need the help and supervision of an in-home caregiver. LTC insurance was created to provide a safety net for people concerned about their future care needs.
- LTC insurance will pay for a person’s home care or senior living needs per the terms of the policy.
- LTC policy terms usually set daily and “lifetime” benefit limits.
- LTC policy terms also detail the conditions that must be met with regards to a client’s “need” for assistance.
How Does LTC Insurance Pay for Home Care?
If a LTC insurance company accepts a claim as valid, it will then provide coverage for home care services pursuant to the policy’s terms.
- Clients will be reimbursed for home care services by the insurance company.
- Home care agencies may bill insurance companies directly.
- Insurance companies may require clients to utilize services from “licensed” agencies only.
- Clients with significant care needs may need to supplement LTC coverage with out-of-pocket contributions.
What Are the Requirements for Submitting a LTC Claim?
The basic conditions that must be met to file a successful LTC insurance claim are fairly universal across all companies.
- Clients must require help with at least two activities of daily living (ADLs) or be diagnosed with severe cognitive impairment (Alzheimer’s, dementia, etc.).
- ADLs generally include: bathing, dressing, toileting, transferring and eating.
- Claims submissions require medical documentation confirming a client’s need. Typically, a nurse will conduct an in person assessment of the patient in order to verify the need.
What Else Should You Know About LTC Insurance?
As with most insurance policies, the fine print is very important to understanding LTC insurance benefits.
- Most policies have a 60 or 90-day “elimination period”. This can also be thought of as the policy’s deductible.
- Elimination periods may constitute either calendar days or days of care (the latter can greatly delay onset of benefits).
- Claims should always be filed ASAP to avoid delays in care/reimbursement.
- LTC insurance companies may waive the elimination period in certain circumstances, like clients being admitted to hospice care.
How Can BrightStar Care Help Clients with LTC Insurance?
- BrightStar Care provides expert guidance to clients/families throughout the claims process.
- BrightStar communicates directly with the LTC insurance company once the client has authorized access, and BrightStar submits all necessary paperwork.
- BrightStar accepts “assignment of benefits,” which allows for direct invoicing of the LTC insurance company and direct receipt of corresponding payments.
- BrightStar assists clients/families who are working to obtain necessary medical documentation from doctors and also provides internal documentation relating to caregiver duties that support need for ADL assistance.
- BrightStar submits ongoing care notes required by LTC insurance companies to justify continued ADL assistance.
- We have worked with the largest LTC insurance companies including Bankers Life, CalPERS, Genworth Financial, MassMutual, Mutual of Omaha, New York Life, and Northwestern Mutual.
Final Thoughts
Seniors who are fortunate enough to have long-term care insurance policies may benefit from significant financial assistance when accessing home care services. But uneducated consumers often find there’s red tape that can slow things down when submitting a claim.
Contact us for complimentary support in understanding your policy’s benefits and receiving the benefits you’ve already paid for!
If you’re in need of home care services for yourself or a loved one, be sure to take advantage of BrightStar’s complimentary Registered Nurse (RN) consultation. BrightStar is an award-winning caregiver provider in West Los Angeles, Santa Monica, Marina del Rey, Torrance, Manhattan Beach, Redondo Beach and Palos Verdes. Call: (310) 944-6985 or email: losangeles@brightstarcare.com today!