Long term care insurance - the fine print
Here at Hearts of Gold Caregivers we regularly work with clients who have long term care insurance. Often, policies were initiated many years ago, and the all important policy document long since filed and forgotten. However, the policy is really the starting point for us in assisting the client to have their in-home care paid by their insurance.
The first thing to note is that all policies are different, and all insurance companies are different, but there are some common threads.
Typically, the policy will include an "elimination period". That means that the client is responsible to pay the first days of service themselves. A common elimination period is 30 days. It is important for the client to check with their insurance company as to the elimination period, and also what qualifies. For instance, you may have a policy that covers 3 hours a day - but you may not have to have 3 hours of care per day during the elimination period. That can save you money.
Also, the type of in-home care that you need is important. Most policies will only cover you when you need assistance with "activities of daily living" (ADL's). There can be subtle differences between companies on what counts as an ADL but most include bathing, continence, toileting, eating, transferring (e.g. between a bed and wheelchair) and dressing. Further, the policy will require the policy holder to need help with a given number of ADLs per visit. We usually see companies requiring 2 or 3 ADLs.
So, how do you know if your needs qualify under your policy? If you are employing an in-home care agency, they should come and do an in-depth assessment of your needs. This could take between 2 and 3 hours, and should be free. From there the agency should draw up a Care Plan based on the assessment, that stipulates exactly what is needed each time a caregiver visits. The Care Plan should be submitted to the insurance company with your claim - any reputable in-home care agency will do this for you, and liaise with the company, if you have long term care insurance.
Next time, we will talk about other things that you need to be aware of when considering if your long term care policy will cover in-home care services.
The first thing to note is that all policies are different, and all insurance companies are different, but there are some common threads.
Typically, the policy will include an "elimination period". That means that the client is responsible to pay the first days of service themselves. A common elimination period is 30 days. It is important for the client to check with their insurance company as to the elimination period, and also what qualifies. For instance, you may have a policy that covers 3 hours a day - but you may not have to have 3 hours of care per day during the elimination period. That can save you money.
Also, the type of in-home care that you need is important. Most policies will only cover you when you need assistance with "activities of daily living" (ADL's). There can be subtle differences between companies on what counts as an ADL but most include bathing, continence, toileting, eating, transferring (e.g. between a bed and wheelchair) and dressing. Further, the policy will require the policy holder to need help with a given number of ADLs per visit. We usually see companies requiring 2 or 3 ADLs.
So, how do you know if your needs qualify under your policy? If you are employing an in-home care agency, they should come and do an in-depth assessment of your needs. This could take between 2 and 3 hours, and should be free. From there the agency should draw up a Care Plan based on the assessment, that stipulates exactly what is needed each time a caregiver visits. The Care Plan should be submitted to the insurance company with your claim - any reputable in-home care agency will do this for you, and liaise with the company, if you have long term care insurance.
Next time, we will talk about other things that you need to be aware of when considering if your long term care policy will cover in-home care services.
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