You’ve paid premiums all these years hoping you would never need care, but it’s getting so hard to get around that you need to cry uncle and arrange for some help. Now you hope the LTC insurance policy will do what you expect.
Lets review what the triggers are for most LTC insurance policies, either needing assistance with 2 of 6 ADL’s (activities of daily living) or a cognitive impairment. Generally, these ADL’s are eating, bathing, dressing, transferring, toileting , and continence.
Years ago congress added a requirement that your LTC needs are expected to last more than 90 days. Nobody, not even your doctor can predict the future, but the need must be expected to last more than 90 days before the insurer can consider the claim. Congress wanted this to be LTC insurance, not cold or flu insurance. Thus, be sure to ask your medical providers if the care you need is simply expected to last for 90 days or more.
Next, your care provider(s) will probably be the ones working out a plan of care, outlining how much and what type of care is required. Sometimes documentation is left out in this step. For example, if you need care with bathing only, that is just one ADL, not two. However, if you do not get undressed first, and redressed after bathing, you will be soggy all day. Be sure that the second ADL is specified in the claim paperwork, and not assumed.
Every insurance has a choice of deductibles. The most common deductible in LTC insurance is 90 days. The fact that this number is the same as the number of days your care is expected to last to be considered LTC is simply a coincidence. It is possible to significantly lower your out of pocket costs here.
The insurance company does not specify how expensive, or cheap, those 90 days are, they simply want proof that you have had (and paid for, most likely) 90 days of care. Often the need for care starts small, and may be met by family helping out. Many clients tell me they plan to file a claim when they get into an assisted living facility.
I suggest that it is less expensive to meet that 90 days of care deductible (or elimination period) at the lowest out of pocket cost to you. If family is providing your care, but you qualify by needing help with two ADL’s or have a cognitive impairment, why not bring in some home care for the shortest (think least expensive) visit possible?
Even though family might be perfectly capable to do it all, by paying for 90 days of very short visits each day, visits that cost much less than the first 90 days in a facility, you can get through your deductible (elimination period) at a much lower out of pocket cost. Why wait until the more expensive care is needed to start your 90 days of required deductible payments?
Talking to an expert in the financing of LTC can be very helpful, and can save you money. For more information visit www.TheLongTermCareGuy.com We’re here to help.