Understanding Catastrophic Insurance and Home Health Care

Catastrophic Health Insurance plans are valuable resources found in many employee and retiree benefit packages that often go overlooked when they are needed most.         

What is Catastrophic Health Insurance?

When considering this coverage, most people think of sudden injuries, like a car crash or serious fall, but these plans also cover medical costs for serious illnesses or expensive surgical procedures. Remember, the phrase “catastrophic” refers more to the price associated with a medical event, not the nature of the event itself. For older adults, a catastrophic event could be a knee replacement, ongoing cancer treatments or recovery from a hip fracture.

If you are reviewing your insurance coverage, it is recommended that you keep a copy of your plan’s Preview of Benefits on hand and familiarize yourself with the exact terms of your plan.

When to File a Claim and Documentation

Unlike Long Term Care plans, most catastrophic plans are activated when medical expenses meet the monetary deductible of the plan. The monetary deductible is not the amount paid from your pocket, but the total cost of the medical expenses incurred by the catastrophic event. Hospitals itemize all costs and send a notice to Medicare or other patient insurances. The list of the total costs (not just your responsibility) is required for most catastrophic claims to meet the deductible.Woman at a computer

Be sure to keep copies of your billing statements for any treatment you receive related to your claim, as you will need to submit these to your insurance representative when beginning your claim.

While your claim process can begin immediately, remember that there will be a waiting period (up to 45 days) before your claim is approved, so keep copies of medical bills from this period for later reimbursement.

Remain Independent with Catastrophic Insurance-Funded Home Health Care

An injury or illness that triggers your catastrophic insurance might be sudden, but the long-term effects of that event can have an ongoing effect on your ability to live independently.  Fortunately, catastrophic insurance benefits can be applied to home health care services, bringing a caregiver into the home to assist with everyday activities needed to remain safe and healthy at home.

Two important things to consider when using catastrophic insurance to fund ongoing home care:

First, catastrophic plans pay benefits for a certain period of time, measured in months or years, rather than having a monetary cap like other insurance plans.  Once you have reached the end of your coverage time period, you may be able to reapply for coverage if you meet the deductible amount in subsequent out-of-pocket medical expenses.

Second, review the premium requirements.  Some catastrophic plans will continue to charge you a premium while your claim is active and you are receiving benefits.  Remember to stay on top of your premium expenses to ensure your plan stays active in the event you need to reapply for coverage.

Navigating health 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.