Long-Term Care Insurance: How To Guide

Choosing to move forward with enacting a long-term care insurance policy is a profoundly emotional transition.  Your loved one has been fine so far.  They have been independent.  They have been able to care for themselves.  But now they need help.

This also means a change for you.  You need to put aside work, free time or connecting with your children to care for another.  In the back of your mind is the deep fear of what this will mean for your loved one.  Will they suffer?  What do I do?

You are also beginning to see that with this next step comes great moments of joy and intense connection.  The world is smaller but also shines bright.  Exhaustion is interrupted by a kind smile from a lady at the checkout counter.  The pure presence of a loved one in the same room takes on a new and profound meaning.

In this emotional hurricane it can be near impossible to do anything.  The smallest task can feel insurmountable.

I want to provide you with the quick and easy guide to initiate a claim if you already have long-term care insurance.  My goal is to provide you with the exact steps to start the claims process.  I want to get someone in your home rapidly to support you and your family.

If you fear insurance companies or can’t stand calling people on the phone this is the post for you.  This post will save you hours of time.  I will show you how to start and how to get past speed bumps that stall families from getting the care they deserve.

The plan to initiate and secure long-term care insurance requires activity over four separate days with significant breaks in between.  The moment from when you first contact the insurance company to when you have a home health aid in the home can take 2 to 3 weeks.  (More rapid arrangements can be made if there is a need).

Below are the steps you need to take:

Day 1: Call The Insurance Company

Take a break

Day 2: Talk To The Nurse

Take a break

Day 3: Participate In The Assessment

Take a break

Day 4: Interview Home Health Aids

First, let’s recap what long-term care insurance does.


Overview of Long-Term Care Insurance

I first addressed long-term care insurance in a post about who should buy it titled “I Don’t Want My Kid’s Lives To Revolve Around Taking Care Of Me.”  In this post I will focus on the benefits of long-term care insurance as it applies to providing care services at home.

Long-term care insurance provides financial and logistical support for individuals that need assistance with activities of daily living as well as other activities associated with severe illness.

The primary services often covered include:

  • Home health care nurse (to assist with activities of daily living)
  • Custodial services (cooking, cleaning, etc.)
  • Visits from nurses
  • Physical and speech therapy sessions
  • Hospice services (end of life care)
  • Home remodelings

These services can be delivered to the insured:

  • At home
  • In an assisted living facility
  • In a nursing home
  • In adult day care

The anchor of long-term care insurance is home health aids and custodial services.  60% – 70% of the cost a family incurs is tied to these services.  More specialized services like a visit from a nurse or doctor are less frequent and less expensive.

Long-term care insurance does not cover:

  • Hospital visits
  • Tests or screens
  • Medications
  • High skilled medical services (e.g., visit from a doctor)

There are also a host of what are called “riders” in insurance products.  This simply means features.  These features often increase or decrease the above services.

For example, one feature may be that you can pay a family member to provide care.  Another feature may be that you get protection against inflation.  We’re not going to go into detail here but you can ask your insurance company when you speak to them.

Now let’s review the actions steps you can take to get someone into your home.


Day 1: Call The Insurance Company

Find your loved one’s insurance policy and determine from which company they have long-term care insurance.  Google the company’s phone number or find it on the policy information.

The person who sold your loved one the insurance policy may be different from the insurance company offering the coverage.  This is fine.  You want to call the insurance company that provides the coverage.

The next steps is to initiate a claim.   A claim is a formal request to an insurance company for reimbursement for specific expenses.  The purpose of this call is to let the insurance company know that you will need their help.

Ask for the claims department and tell them that you would like to start receiving services.  You will need your loved one’s name, date of birth, and zip code or social security number.  Explain the health situation of your loved one.

At this stage there are a few questions you should ask them:

  • Is the policy up to date on premium payments?
  • What riders (a.k.a. features) does the policy have?
  • Are there any major restrictions on coverage for this plan?
  • Are there any initial forms that you need us to complete?

They will inform you that a nurse will call your loved one or the appointed contact person within the family.  This often occurs within a few days.

At this stage take a step back and rest.  Do something generous for yourself.  Acknowledging that a loved one needs assistance at home can be an emotionally exhausting process.


Day 2: Talk To The Nurse

The nurse or an insurance company representative will call you back.  The purpose of this call is to go into more detail regarding the medical condition of your loved one and the potential support needs of the family.

The goal from the insurance company is to identify if an in home assessment and care plan is warranted.

During this call you can also ask more detailed questions about what type of care is on the table for you and your family.  Some questions you may want to ask include:

  • What is the coverage amount (amount per day or per month of expenses that the insurance company covers)?
  • How is payment provided?
  • What is the coverage limit (limit for overall reimbursement from the insurance company)?
  • Is respite care available (relief for the family who is providing care)?
  • Does the policy allow for paying family members?
  • What is the allowance for equipment and home modifications?
  • Does the policy cover hospice care?

This call will provide you and your family with some good momentum towards getting assistance into the home.  Step away from the process for some time and approach again later.


Day 3: Participate In The Assessment

The insurance company will send a nurse to your loved one’s home to conduct an in-home assessment.  They will sit down with the family and speak about your current needs.  They may also walk around the home and look at any mobility concerns (e.g., difficulty of getting into the shower).

This is your opportunity to advocate for your loved one.  Think in advance of the meeting what type of care and assistance you need in the home.  Nothing is too small.

Some good questions to consider include:

  • Is an at home caregiver needed to help with activities of daily living?
  • Is assistance needed for custodial home chores (e.g., cooking, cleaning)
  • Are any specialized medical services needed (e.g., weekly visits from a doctor)?
  • What type of help does the family need (e.g., at home care)
  • What are the top 3 home modifications you can think of?

The nurse will return in about a week with a care plan for your family.  This plan will outline the type of at-home care they recommend for your family.

The plan will also include the contact information for specific agencies and organizations that can provide your family with care.  It is the responsibility of the family to reach out to these companies.

The care plan is negotiable.  So if there are elements of the plan that you and your family don’t agree with contact the insurance company and make your case.  You can also request for a different nurse to come to your home to conduct another assessment.


Day 4: Interview Home Health Aids

If the care plan calls for in home care the nurse will connect you with agencies that coordinate home health aids to provide services.  The agency will set up a series of interviews with home health aids in your area.

In addition, reach out to family members for recommendations.  Ask if anyone has had good experiences with caregivers or knows of caregivers that have had great relationships with the families they have been working with.

Most long-term care insurance policies allow you to use any home health aid as long as they have the appropriate certifications in the field.  Checking with your friend network can be a great way to find a good person.

If you work with an agency ask them to coordinate 3 to 5 caregivers to visit your home on the same day for interviews.  Set a common set of 5 to 10 questions to ask each of them.  Include your loved one in as many interviews as they like.

Good questions to ask include:

  • What is important to you in being a home health aid?
  • What certifications do you have?
  • Whom have your worked with before? What types of challenges did they face?
  • Can you please provide references?
  • Are you looking for a long-term role or more short-term?
  • What parts of the job are you most / least comfortable with?

Once you find 1 or 2 good people ask them to come in for a final round interview.  This should be conducted with your loved one.  Provide your loved one with the opportunity to ask as many questions as she likes.

Once you find someone you like set up a 1 to 2 week trial period.  The best way to see if someone is a good fit is to try them out.

Congratulations!  You have taken great steps to help your loved one.

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Published: May 1, 2015
By: JP Adams

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