LTC Insurance


Do I Just Call LTC Insurance and Open a Claim?

LTC insurance is used to pay for private duty personal home care. As a Geriatric Care Manager for a Senior Services company in South Florida, I meet with many elder folks when they need assistance at home.  Either they sustained an injury- fall or hip fracture, recuperating from surgery or have a cognitive disease. In each case, they need an extra pair of hands to help with household chores, – laundry, cooking, driving/shopping and often personal care; bathing and dressing. Having LTC insurance can cover much of the costs of in-home care.

Clients who have Long Term Care (LTC) Insurance likely haven’t looked at their policy since they originally bought it — that is natural.  When they are returning home from either a hospital or Rehab stay or can no longer manage without any help but wish to remain home, it is time to review your LTC policy.  We recommend you speak directly with your insurance company as well as your broker, if he/she is still working.

Some extremely important things to ask are:

  1. Is there anElimination Period?  It can be 7 days or even 100 days in which you will have to pay out of pocket, before policy begins to cover.
  2. What is yourdaily coveragein dollar amount and does it pay 100% of that amount or less than one hundred percent? Is it a daily/weekly sum or from a pool of money?
  3. What are thetriggersfor coverage? These are usually two of the 5 Activities of Daily Living (ADLs) – assistance needed with: bathing, dressing, transferring/walking, feeding or toileting.  Dementia will usually be a trigger by itself, regardless of ADL needs.
  4. What is thelengthof the policy?  Is it a 2-3 year policy? Does it have a Restoration of Benefits? This is important as you’ll need to use your coverage time judiciously.
  5. Whatother thingsmay it cover? Care Management visits, safety features like grab bars or Emergency Response Systems.

Like any type of policy, you, the consumer bought an individual policy with features or add-ons you chose. Rarely are two policies exactly alike.  Review your policy before you go to use is so you can plan better and avoid unpleasant SHOCKS.