Most long-term care insurance policies pay for in-home care once a doctor or the insurer confirms the person needs help with daily activities or has a cognitive impairment such as Alzheimer's disease, and after a waiting period called the elimination period.
Many families find a policy in a file drawer only when they need it. If that is you, you are not behind. Here is how these policies usually work.
What usually triggers benefits
Most policies start paying when the person needs help with at least two activities of daily living, such as bathing, dressing, eating, toileting, moving from a bed to a chair, or continence. A diagnosis of a cognitive impairment, like Alzheimer's disease, often qualifies on its own. Your policy spells out its exact rule.
The elimination period
Most policies have a waiting period, commonly 30, 60 or 90 days, before benefits begin. Some count calendar days and some count only days of paid care. It is worth knowing which, because it changes when payments start.
Daily or monthly benefit
Each policy pays up to a set amount per day or per month, sometimes with a lifetime maximum. Some reimburse you for invoices you submit. Others pay a set amount regardless of what the care costs.
How to start a claim
Call the insurance company first, before any home care assessment. Starting care before you talk to them can change how, or whether, the policy pays.
- Find the policy number and the insurer's claims phone number.
- Call the insurer to open a claim, and tell them you are starting home care. They will send forms and may schedule their own assessment.
- Ask your loved one's doctor for any records the insurer requests.
- Choose a home care provider and keep every invoice.
Aging Well Care works with many long-term care insurers. We send invoices by email, keep a care log for every visit and keep thorough records, and we are glad to help you read your policy. See how paying for care works or call (480) 582-9898.
