One of the most common calls we get at our senior home care agency is “will my insurance pay for this?” The answer is, “it depends.”
One of my clients, Marjorie, was living alone with her disabled adult daughter when I met her. She had been a widower for nearly 20 years, and told me the Long-Term Care Insurance her husband had purchased over 40 years ago, was one of the most difficult and painful checks to write month after month, year after year. But yet here she was in her 80’s, barely able to walk after two strokes, and no longer able to care for her daughter who needed to be watched and care for around the clock. Now Marjorie needed in-home care at least 8 hours a day. Since home care companies, personal and companion care, are not covered by medical insurance, that came to a cost of almost $200 a day for Marjorie. She told me that paying that check to her provider every month was the best thing she ever did, as they were picking up the entire tab.
Long-Term Care Insurance policies vary greatly from carrier to carrier, and from policy to policy. Most have an “elimination period” or deductible period, in which you must contract and pay for in-home care yourself through usually the first 90 days. But this is not always the case. Some “Cadillac” plans have not elimination period and start reimbursement from the first day of in-home care.
Caps on Coverage
All plans have a lifetime, monthly, and sometimes a daily limit. Do not go buy what it says on your policy. You have to call the company to find out what those limits are for you today. Many policies adjust their limits over the years to adjust for inflation and age. Your agent will be able to quickly find this out for you when you call.
A good agency will do all the paperwork and phone calls for you to get you reimbursed as quickly as possible. Generally, as soon as you pay your bill to your caregiver agency, they will submit the paper work to the provider for you, and you should receive a reimbursement check within 30 days.
Opening Your Claim
Your home care agency will meet with you and get all the policy information from you. They will probably have to call the Long-Term Care Insurance company with you the first time so you can give them permission to share your personal information. They will gather all the needed forms, some of which they can have you fill out and submit for you, and others that you will have to take to your doctor to get his authorization that your really do need the care you are seeking. The requirements are usually that you need help with 2-3 ADL’s (activities of daily living). These include bathing, dressing, grooming, transferring, toileting, or supervision because of cognitive impairment.
Choosing a Provider
There are over 20 strong providers to choose from, but choose wisely. Go online and look at their reviews:
- Do they pay promptly?
- Do they come up with a lot of trivial excuses before paying a claim?
- Are they easy to reach?
- Are their agents friendly and eager to help?
Some of the better providers we have worked with are Genworth, Banker’s Life, and Allianz. Try to avoid the big Government sponsored providers unless you have no choice. They tend to be the bulkiest and hardest to deal with.