Using LTCi Benefits to Pay for Home Care

Using Long Term Care Insurance for In-Home Care in Salt Lake City, Provo, South Jordan, Orem, Sandy, Ogden, Bountiful and other Utah communities.

The difficulty in explaining exactly how long term care insurance works is because every policy is a little different. While they use common language, how that language is applied is based upon what your particular policy says. Some common LTCi terms are (click to expand):

Elimination Period is the period of time between when you initiate a claim and the insurance starts paying. This is like paying your deductible. Most policies have a 30 to 90 days elimination period. This means that you will have to pay for home care services out of pocket for that period before the insurance will pay for care. Some policies have a requirement that you pay for 30 to 90 days of actual home care services, some policies simply require you to wait for 30 to 90 days after your start the claim. Some policies waive the elimination period for cases of dementia.

At LTC@Home, we will work with you to create a care plan and financial plan to ensure that you get the maximum benefit out of your policy at the least expense to you.

Daily Benefit is the amount the long term care insurance will pay for care on a daily basis. In most policies, the daily benefit is a fixed amount that you can utilize as you see fit. Sometimes the benefit is based upon “reasonable and customary” charges for similar services in your area. We will help you figure out what your policy will pay and then devise a care plan to provide the care you need within the budget that you set.

Lifetime Benefit is the total amount the policy will pay out over the life of the policy. In most cases, the lifetime benefit is an amount that you will never have to worry about exceeding. Some policies don’t have a lifetime limit. We will always take into account the policy limits and make sure you understand them when creating the plan of care.

Many long term care insurance policies have a benefit that increase the benefits of the policy to account for inflation. This is a benefit we will identify up front so that we can adjust the level of care over time as the policy benefits increase.

Most policies stop requiring that you pay your insurance premium once the policy starts paying for care. Sometimes this waiver begins as soon as a claim is made and sometimes after the elimination period has passed. This is a good reason to start using your policy as soon as you will qualify. Not only will you receive needed care in your home, you monthly expenses will go down because you won’t be paying the long term care insurance premium any longer.

To use your long term care insurance, you have to need assistance with ADLs or have a diagnosis of dementia. LTC@Home will track and report on assisting you with ADLs. Insurance companies will be looking for us to assist you with some or all of the following:

  • Bathing
  • Toileting
  • Dressing
  • Ambulation (walking)
  • Feeding
  • Grooming

Most long term care insurance policies require the inability to do two to six ADLs as a criteria for benefit qualification.  However, if there is a diagnosis of dementia, such as Alzheimer’s disease, most policies waive the requirement of ADL assistance.

Assignment of Benefits is a document we will file on your behalf which allows us to bill your insurance directly and provide directly to the insurance company the daily charting that they require. Without the assignment of benefits, you would be required to pay for the home care, gather the paperwork that we will generate, then submit that to the insurance and wait for reimbursement. If you have ever dealt with insurance companies before, you will understand what a nightmare that can be. Let LTC@Home take the nightmare out of claims processing. We will submit all required paperwork and track all payments.

After you have called LTC@Home to find out about care, we will come to your home and review your LTCi policy with you. We know what to look for and how to initiate a claim. We will step you through the process to ensure that you get all of the benefit out of the policy you have spent so long paying for. We take the confusion out of the process. We will support you throughout the LTCi claims process by:

  • Reviewing the policy and providing a detailed explanation of policy benefits
  • Contact the insurance company with you to ensure you have the most current benefits
  • Initiate a claim for you, including completing all necessary paperwork
  • Work with you to schedule services in a way to get through the elimination period, if there is one, and get your full policy benefits paying
  • Complete all ongoing paperwork required by the insurance company, including sending the insurance weekly logs and claims documents
  • Accepting insurance payments directly from the insurance company through an Assignment of Benefits, eliminating the need for you to pay for care and get reimbursed by your insurance
  • Identify any home modification benefits and get the work scheduled and completed by a licensed contractor

These are just some of the benefits of working with LTC@Home when you have long term care insurance. Understanding the LTCi policies and how they will affect your individual needs is something we specialize in. One of our owners has years of experience dealing with long term care insurance companies and has personally helped hundreds of people with their long term care policies and getting the benefits and home care services they need. There’s a reason LTC@Home is a preferred provider with most insurance companies.

Complimentary In-Home Care Needs Evaluation

When you are faced with the challenge of finding an in home care provider to help care for the emotional and physical well being of someone you love, maybe your mom or dad, you will be faced with many questions.

Making the decision about in-home care for a loved one is never easy, but finding the right answers can help you feel more comfortable with the options available and confident in your final decision. That’s why LTC@Home provides prospective clients and their families with a complimentary, no obligation in home care needs assessment.

In our meeting, we will thoroughly discuss your care needs and work with you or your loved one to determine how best to meet your requirements. After evaluating your home care goals we will have a better understanding of your loved ones physical, emotional and cognitive needs and will work with you to create a personalized plan of care.