How to Use Long Term Care Insurance for Home Health Care

When financially planning for retirement, Long Term Care Insurance plays a major role in offsetting expenses associated with maintaining long-term health and independence through home health care.  This blog will discuss Long Term Care Insurance coverage, how to access these benefits, and strategies for making the most of these plans.

What is Long Term Care Insurance?

Long Term Care Insurance refers to a group of supplemental insurance plans meant to cover the cost of ongoing assistance in the home.

Unlike traditional health care, Long Term Care Insurance is not initiated by a specific illness, but rather by a demonstrable need for assistance with everyday domestic tasks known collectively as Activities of Daily Living (ADL).

Activities of Daily Living fall under the following categories:

  • Dressing
  • Toileting and continence care
  • Transfers (getting into or out of bed, into or out of a wheelchair or other seat, ect.)
  • 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)
  • Bathing

The benefits of a Long Term Care insurance plan can be accessed when a policyholder demonstrates they need hands-on assistance, standby assistance (caregiver observes patient for safety) or reminders to perform at least two of these six tasks.

Alternatively, evidence of memory loss is also considered an acceptable triggering event to begin Long Term Care coverage, as this condition directly impacts a person’s ability to reliably complete ADL’s.

Unlike other health insurance policies, this plans will continue until a policy holder requests to end service, the benefit from the plan is fully depleted or the patient regains the ability to perform ADL tasks independently.

Using Long Term Care Insurance Benefits

Many Long Term Care policyholders choose to save their plan “for a rainy day” and miss out on many of the preventative benefits of in-home care. Additionally, it can take between 30 and 45 days for a LTC coverage request to be approved, making advanced planning all the more important.

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 a policies daily/weekly/monthly/annual spending allowances, as well as the maximum benefit amount covered by the plan.

To use Long Term Care Insurance to pay for home care, the policy holder and/or their representative must contact their insurance representative and initiate a claim.

Making the Call

There are two elements that can make calling a Long Term Care insurance provider challenging: a sense of pressure from the LTC representative to avoid beginning a claim, and a reluctance from the policyholder to admit that they need help in the home.  woman at the computer

Admitting you need assistance can be a challenge at any age, but these are services a policyholder has paid for year after year and can ultimately be their best tool for remaining safe and independent in their home.

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.

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.

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 Insurance-Funded Home Care

Long Term Care Insurance plans are designed to keep a policyholder’s health, independence and in-home well being stable for as long as possible by preventing more severe injuries or illness due to an inability to complete any or all Activities of Daily Living. 

Because home care is used to prevent serious illness or injury and an LTC claim can take between 30 and 45 days to go into effect, it’s most useful when activated early.

One simple way to maximize the benefits of home health care and an LTC policy economically is to begin with a small amount of service per month.  Most policies require a minimum of one invoice per month to demonstrate the ongoing need for in-home assistance, so having a caregiver in the home for just a few hours initially can be enough to keep active 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 hoped 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 more than 35 years.