I get frequent calls from people asking how the claim process on a loved one’s LTC insurance works. The most common question is on what is called the elimination period, which I call the deductible.
The most common “deductible” on LTC insurance policies is 90 days. Most policies require one to actually pay and show receipts for 90 days of care to prove you have met your deductible. Some policies do have features that will credit 2 days per week as a week of your deductible, but these are not the norm.
Thus, to get through the deductible, you must have had, been billed for, and paid for 90 days of care. If hospice care is provided from a hospice organization, and Medicare paid for their services, you received no bill, nor did you pay for that care, then those days may not count towards your deductible.
If children help out, on weekends perhaps, so that no professional care is received, billed, or paid for – those days may not count towards your deductible either.
Thus, the fastest, and often the least expensive way to satisfy the deductible of a LTC insurance policy is to have paid care every day, and at the smallest bill possible. Let me interject a short story here to make this easier to understand.
An adult son of a client of mine called one day to tell me that mom had moved in with he and his wife and was being cared for by them in their home. He indicated that in the near future she will need to move into an assisted living facility (costing about $4500 per month, or $150 per day). He wanted to know what he should do to prepare for filing a claim on her LTC insurance policy.
I explained that the 90 day deductible was measured in days of care, whether they are expensive days or inexpensive days. Assuming he wanted his mother to satisfy the deductible at the lowest possible cost, I suggested they hire home care to come in and help out for the shortest (least expensive) visit available, even though they could manage on their own. As long as mom needed help with 2 activities of daily living or was cognitively impaired, she qualified for care and coverage on the policy.
I explained that this would help satisfy her deductible at a cost of perhaps $35/day for 90 days, versus $150/day for 90 days in the assisted living facility. Once he understood how this would save his mother significant money, even though he and his wife could provide the care themselves, he readily agreed to bring in help each day for the shortest, least expensive bill possible.
Remember that most LTC insurance deductibles are for so many days, not so many dollars. Thus planning the paid caregiving for the least expensive 90 visits, one per day, can help you satisfy the deductible at the lowest out of pocket cost to the insured person.
More information is available at www.TheLongTermCareGuy.com or call 920 884-3030 to schedule a time to investigate LTC insurance for yourself. Call or email if you have questions about your LTC insurance coverage.