If your parent has a long-term care insurance policy, it very likely covers in-home care. But many families either delay using benefits or leave significant money on the table by not understanding the process.
Key terms to understand
Benefit trigger. Benefits activate when the insured person can no longer perform a certain number of Activities of Daily Living (typically 2 out of 6) without assistance, or has a cognitive impairment requiring supervision.
Elimination period. Most policies have a waiting period of 30, 60, or 90 days before benefits begin. The insured pays for care out of pocket during this period.
Daily or monthly benefit amount. The policy pays up to a set amount per day or month toward covered care.
Benefit period. The total length of time or total dollar amount the policy will pay. Common periods: 2, 3, or 5 years.
Home care coverage. Not all policies cover home care at the same rate as facility care. Check whether in-home care is covered at 100% of the daily benefit or at a reduced percentage.
The claims process
1. Locate the policy — check with financial advisor or insurance agent if needed. 2. Review the benefit triggers and confirm your parent’s condition meets them. 3. Get physician certification of care needs. 4. Submit the claim following the insurance company’s specific process. 5. Keep records of all care provided, invoices, and communications.
Working with a care agency on LTC claims
A good home care agency has experience working with LTC insurance and can provide the documentation insurers require.
Contact us — we’ll help you understand your policy’s home care benefits and structure care accordingly.