LTC Insurance—Everything You Need to Know

family caregiver helping senior loved one with ltc insurance
Let our team help you successfully file and handle LTC insurance claims.

Long-term care  (LTC) insurance can offer great peace of mind, but obtaining those benefits can wind up being a complex experience for older adults and their family members. To help guide families through this process, Live Well at Home provides the following useful overview.

Which services are covered?

Prior to filing a claim, it is crucial to carefully read a copy of the LTC insurance policy in order to gain an understanding of the types of services the policy covers. If you don’t have a copy of the policy, reach out to the provider to ask for one.

Although all policies vary in what they cover, LTC insurance commonly covers non-medical services in the home, provided help is necessary with at least two or more activities of daily living, or the policyholder has been diagnosed with some type of cognitive problem, such as dementia. Examples of the kind of care that long-term care policies may cover are:

  • Personal hygiene needs, such as bathing, showering and getting dressed
  • Transfers and ambulation
  • Using the toilet and incontinence care
  • Preparing meals and feeding
  • Housework
  • And others

If you or a senior loved one needs help understanding the details of the policy, an insurance agent, elder care attorney or financial planner can help.

Does coverage include all of the costs for care?

Though individual plans differ, every plan describes the permitted monthly coverage, which is identified as the “present daily allowance,” and typically includes a lifetime maximum ceiling. Policies also usually identify a particular length of time during which the benefits are available, such as five years, or if the insurance coverage is effective for the remainder of the policyholder’s lifetime.

It is also essential to verify the long-term care plan’s elimination period. The elimination period is the time during which the cost of care needs to be paid out-of-pocket initially, until a certain amount of time has gone by. Although some plans identify a zero-day elimination, which means cost of care and coverage start immediately, other policies could require up to 120 days of care first.

Pick your care provider carefully.

If you are planning on filing a claim for long-term care insurance, it’s critical to work together with a home care  company which has experience in billing long-term care insurance providers; otherwise, there is the possibility that the claim might not be fully reimbursed. Live Well at Home has experience with helping families obtain their LTC insurance benefits and can provide the documentation necessary to help clients file claims properly.

What is the process for filing claims?

To file a long-term care insurance claim, the documents below are typically required:

  • A claimant’s statement (or policyholder statement) outlining the reasons for the claim
  • A physician statement provided by the doctor, confirming that care is necessary
  • A prescribed care plan and nursing assessment
  • A provider statement, completed by the home care agency
  • An authorization form

Once completed and submitted, a telephone interview is scheduled with the insurance company’s claims department, and then the claim is either approved or declined.

If you are seeking to obtain home care services  through a long-term care policy, reach out to Live Well at Home today at 800-478-1209. You can rest assured in knowing that we have years of experience in not just supplying superior care in the comfort of home, but also in helping families with long-term care insurance claims and getting the most out of their plan. To learn more about our top-rated elder care in Sacramento  and the other communities we serve, please visit our Service Area page.

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