Long Term Care (LTC) insurance is a valuable tool for preserving health and independence as we age, but using these benefits to their full effect is a little different than other forms of insurance. The following article explains how LTC insurance works, and how a policyholder can make the most of their coverage.
What is Long Term Care Insurance?
Most health insurance is designed to pay for treatment of a specific illness or injury. LTC insurance is different because it is designed to pay for services like in-home care that protect a policyholder and ensure their ability to care for themselves is not impacted by an illness or cognitive decline.
LTC insurance focuses on a policyholder’s ability to complete Activities of Daily Living – day-to-day domestic tasks that ensure long-term health and independence. These tasks fall into six categories:
- Toileting and continence care
- Transfers (getting into or out of bed, into or out of a wheelchair or other seat, etc.)
- Ambulation (getting to and from places, both in and outside of the home)
- Feeding (not meal preparation, but the actual act of eating a meal, like using utensils)
LTC plans can be activated once a policyholder demonstrates an inability to perform at least two of these tasks or if they are experiencing memory loss and thus cannot reliably perform these tasks daily.
How long does Long Term Care coverage last?
Unlike traditional health insurance that pays for treatment of a specific illness and ends when the policyholder is healthy again, LTC insurance provides ongoing coverage for in-home services unless the policyholder regains the ability to complete Activities of Daily Living themselves, or the plan’s benefits are fully depleted.
When and how to activate an LTC policy
Many Long Term Care policyholders hold out until the last possible moment to activate their coverage, but this “rainy day” approach often backfires. In-home care is designed to preserve a client’s wellbeing and prevent further decline, so starting services early will have the greatest impact on a client’s long-term health outlook.
When considering beginning in-home care through LTC coverage, it is totally normal to experience some personal reluctance about asking for help.
One way to ease this process is to have a conversation with your doctor, financial planner, family members or other retirement support team members and have a frank discussion about your future health outlook, the availability of family support, your financial position and at-home challenges that can increase in severity without assistance.
When strategizing how to use an LTC plan, it is important to understand the exact details of your plan. To learn these details, contact your LTC provider and request a “preview of benefits,” which will describe your daily/weekly/monthly/annual spending allowances, as well as the maximum benefit amount covered by the plan.
To activate LTC coverage, the policyholder or their appointed representative will need to contact their insurance provider and request to begin a claim.
Beginning a Long Term Care Claim
When calling to begin a claim, you may feel pressure from the LTC representative to put off the process. Remember, you and your loved ones understand your condition better than anyone else, and if you feel you need help, you should be able to receive the benefits you have paid for.
Making a claim alone can be a challenge, so it is highly recommended that you have a family member or trusted friend join you on your call to provide support.
Another strategy is to contact possible home health care or in-home care agencies and discuss these concerns with a home health care specialist. Many agencies, including SelectCare, can help you prepare for the call to your insurance provider and even participate in the conversation with your LTC representative with your permission.
During the call, the representative will ask you why you believe you need in-home assistance and allow you to explain your needs. They will also likely go through the list of ADL’s with an eye to whether or not you need assistance in at least two of the ADL categories listed above.
With your call completed, the LTC provider will send the policyholder documentation they will need to complete and return outlining their needs, usually with substantiating information from the policyholder’s physician.
Making the most of your Long Term Care Coverage
The LTC approval process can take between 30 and 45 days from your initial call to benefits becoming active, so planning ahead and starting coverage early will ensure you have full access to your benefits should your condition suddenly change for the worse.
In-home care is designed to expand as your needs increase, so one easy way to keep your coverage active and ready to expand should your needs suddenly change is to only schedule a few hours of service per month initially.
This strategy also means that you can test your chosen in-home care provider early, determine your likes and dislikes, and potentially shop for an alternate provider if you are unsatisfied with their performance before your needs become more complex.
Benefits of early LTC Coverage
By having a caregiver in the home, even for just a few hours, an LTC policy holder will enjoy several significant benefits likely to improve their long-term health outlook:
- A new set of eyes regularly in the home can help identify changes in a client’s condition over time, possibly keying in on changes in the client’s wellbeing long before a scheduled doctor visit or observation by a family member.
- Oversight from a home caregiver and a home care agency’s nursing staff means assistance is either already in the home, or a phone call away, providing better peace of mind for the client and their loved ones.
- A small amount of assistance from a home care agency can offer family caregivers much needed support and confidence that their loved one is being cared for if the family caregiver is unable to be in the home.
- In the event of a sudden medical or household emergency, a home caregiver can immediately call for assistance and ensure the client receives timely emergency care.
- If a patient’s condition suddenly worsens or they fall ill, the existing, ongoing relationship with both a home care agency and individual caregivers will take much of the guesswork out of expanding home health care coverage. Since the patient is already familiar with their caregivers, they will face much less anxiety if their in-home care needs suddenly increase.
SelectCare hopes you have found this Long Term Care Insurance and Home Health Care guide helpful. Trying to fully understand your Long Term Care coverage in good health can be challenging enough, and the added anxiety of a sudden illness, emergency or hospitalization can make the task feel insurmountable without good support.
If you or a loved one are curious about the specifics of your Long Term Care coverage or are unsure where to find and advocate or guide, consider calling SelectCare, where our team has helped New Yorkers remain healthy and happy in their long-time homes for nearly 40 years.