Many older adults rely on their personal funds or savings for long-term care costs, supplemented by purchasing an insurance policy or certificate that will provide additional funding.
To protect benefits, it’s essential that home care providers maintain consistent documentation and that any changes in functioning are communicated to long-term care carriers as this will assist in their reassessment processes.
Coverage
Long term care insurance policies cover an extensive array of home health services, from skilled in-home nursing care and occupational, speech, and physical therapy to assistance with activities of daily living such as bathing and eating; respite care that offers family caregivers a break; medication management assistance as well as transportation costs related to appointments or shopping trips – you should receive both an Outline of Coverage from your long term care agent as well as an outline policy during your first meeting with them.
Traditional long term care policies provide fixed coverage per day or month, as well as an elimination period (also called waiting period) that determines how long before receiving coverage – typically 90 days or longer. You also have the option to add inflation protection in your policy, enabling its benefit to keep pace with increasing home health care costs over time.
When purchasing an individual long term care policy instead of through your employer, be sure to select an experienced and knowledgeable agent as your point-of-contact for questions, modifications and claims filing. A reliable agent should also offer ongoing support and advice.
Along with selecting benefits, it is also necessary to determine whether or not to purchase an annual premium. These rates depend on various factors including your age and health when applying for the policy; gender; as well as any optional add-ons such as estate recovery riders or inflation protection you wish to add on.
One of the key aspects of making sure that your loved ones’ claims are processed quickly and correctly is consistent documentation. This means providing regular reports from professional caregivers detailing all hours worked and services rendered, filing these records promptly with your loved one’s physician, home care agency and long-term care insurance carrier.
Eligibility
Home care services are typically covered by both government programs like Medicare and Medicaid as well as private long term care insurance policies. Long term care (LTC) insurance plans tend to cover home care on an extended term, helping avoid out-of-pocket expenses that would otherwise incur.
Your LTC insurance choice depends on both the policy you select and your family’s financial circumstances, with various options ranging from standalone long-term care insurance policies to life policies with riders for long-term care coverage available to you. A good long-term care agent should be able to discuss each of them thoroughly so you can make an informed decision regarding which will work best in each circumstance for your loved one.
Many people have misconceptions about what long term care insurance covers. They may assume it will pay for home health aides or professional care services; however, in fact 80% of at-home care comes from friends and family who provide it without payment; additionally long term care policies often cover care in assisted living facilities or nursing homes.
Most long term care insurance policies contain both a benefit trigger and elimination period that must be fulfilled before payment for home care will start being made by insurer. A nurse/social worker assessment determines this trigger, while various policies vary regarding waiting periods (some requiring 90 days before benefits begin rolling in while others only requiring one day between visits/service).
Once home care begins, it is vital that the process for receiving insurance benefits be initiated immediately. That way, home care agencies can provide consistent and detailed documentation to their long term care insurance company throughout their care journey.
Make sure to provide the insurance company with all relevant medical documentation about your loved one’s home care needs, including physicians’ names, addresses, and phone numbers. Also provide all requested documents from long term care insurance providers (home care agency in this case) including an accurate and detailed explanation as to why he/she requires home care – this will speed up approval of their long term care insurance policy faster.
Requirements
Long term care insurance provides a pool of money that pays for home health care services such as bathing, dressing and meal preparation assistance. Policies may be purchased individually or included as part of group life plans; any particular state regulations may impact individual policies sold.
Insurance companies and agents must abide by a code of ethics that demands honesty, good faith and fair dealings with applicants. Insurance agents cannot misrepresent or oversell products to applicants, nor use high pressure sales tactics; additionally they must undergo special training in order to become licensed in selling long term care insurance policies.
Step one of obtaining long-term care coverage involves receiving an assessment from a licensed medical provider. This assessment must demonstrate the patient needs home health care services before qualifying for benefits from their insurer. They will then send a Plan of Care document which details both types and frequencies of services required – this standard document should be given to doctors, hospital discharge planners and home health agencies for use during care delivery.
Long term care policies often feature inflation riders that increase the benefit on an annual or compound basis – this helps keep in line with rising home care costs. Other policies may limit daily or monthly benefits or require specific caregivers provide services.
Based on the type of long term care policy you purchase in New York State, you may qualify for Medicaid coverage – this will exempt you from resource tests required for eligibility in other ways and allow some of your assets to remain. This consideration is especially pertinent given that long term care costs are quite costly and many do not have enough income or assets to pay outright for this expense.
Out-of-pocket expenses
Most long term care policies provide coverage for in-home care services, although not all policies offer equal coverage. Some only cover certain forms of in-home care while others cover more comprehensively; including at-home caregivers and home health aides. It is essential that you carefully read each policy in order to find one which best meets your needs and compare prices in order to find one which suits you.
Long term care insurance policies can help people protect against dependency on family and the possibility that Medicaid, which covers only a portion of home care expenses, might cover more. A financial advisor can assist in understanding how best to pay for and incorporate long term care coverage into an overall retirement plan.
Long term care insurance typically only covers home care provided by an agency that has been approved by their insurer. They will require evidence of your loved one’s need for in-home assistance such as medical records, doctor assessments and standardized tests such as Mini-Mental State Examination (MMSE) before giving approval.
Most long term care policies typically only kick in once two of six activities of daily living are no longer manageable alone (such as bathing or eating). Furthermore, many policies may also require you to provide clinical evidence of cognitive impairment through brain imaging or home visits by nurses.
Additionally, some insurance companies provide for home care with an “elimination period,” in which you are responsible for paying any in-home care before coverage kicks in – this period usually lasts 90 days but varies between companies.
Considering Long-term care insurance for home care needs? Consult an independent insurance agent. These professionals can assist in choosing a policy to fit your specific requirements, from coverage limits and elimination periods that suit you to helping navigate through the underwriting process which entails providing your full medical history and answering a series of health-related questions from insurers.
