Long Term Care Insurance Tips

Paradise Home Health Care accepts “Assignment of Benefits” for clients who have a Long Term Care insurance policy. We will contact your insurer and verify benefits with you to learn some of the details about your policy; i.e. the “triggers”, any other coverage such as home safety equipment and whether they require a Nursing assessment.

Things you should know about your policy BEFORE you need to use it.

  1. Is there an Elimination (out of pocket expense) Period?
  2. If yes, for how long?
  3. Is it a onetime Elimination Period?
  4. What is your daily dollar amount and is it paid at 100% or 80%?
  5. Are premiums waived once on service?

Usually help with 2 or 3 Activities of Daily Living (ADLs) are needed to trigger coverage. This includes some assistance with bathing, dressing, feeding, toileting, walking, and transferring.

In many policies, Dementia is also an overriding trigger.

It is important to remember that “needing help with” does not mean all out help because the policy holder is totally incapacitated. Very often it is “standby assistance” for safety. This is true for bathing, dressing, transferring, walking and toileting.  This is particularly true for anyone who has balance/gait issues and weakness. This causes them to be a fall risk and safety is a key feature of in-home assistance.

With many policies, the insurer will send out a Registered Nurse (usually from a third party entity) who will evaluate the situation. Be honest, but don’t be a hero. Our natural inclination when asked, “How are you?” is to answer “fine” — whether we are or aren’t. When someone is considering home care, it is a response to some need so “fine” is not truly reflective of the situation.

Remember, all policies are different, depending on what was purchased. You must start care first and OPEN a CLAIM.