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Helping Families Understand Long-Term Care Insurance

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When talking with families about how they will pay for their loved one’s long-term care services, you may want to ask about a Long-Term Care Insurance (LTCI) policy. From time to time a family does know about their loved one’s policy, but more often than not, families are unsure and have to do a bit of detective work.

In the event that their loved one does have a policy, they are often confused by the terminology and have no idea exactly what the policy covers. As professionals in the aging industry, families often look to you as a resource for them to find where to get answers and explanations. This American Society on Aging webinar hosted by Lakelyn Hogan focuses on LTCI and how senior care professionals can help assist the family as they discern the policy.

While sales in traditional LTCI policies are on the decline, the number of claims is increasing. The latest data from the American Association for Long Term Care Insurance reveals that $9.32 billion were paid out in LTCI claims in 2017. Data also shows that 52% of those claims started in the client’s home.

Before a claim can even be initiated, there is important information the family should know about LTCI. You can help communicate some of this information to them by referring to the below. In addition, this webinar provides full details if you want to learn more.

  • Each policy is unique to the person, no two policies are alike. This means that the family needs to uncover what their loved one’s unique policy does and does not cover in terms of long-term care services.
  • LTCI is more flexible than it once was. Many of the older policies limit covered services because newer offerings were not around when the policy was created. For example, if the policy does not have a home care benefit and the individual wants to remain in their own home, there may be an opportunity to propose an alternate plan of care.
  • Regardless of the type of care needed, the individual needs to meet the eligibility criteria before initiating a claim. That is why it is important to gain a clear understanding of the benefit eligibility criteria. Commonly, the insurance carrier will require that the individual needs assistance with at least two of the six Activities of Daily Living (ADL) or require that they need supervision because of cognitive impairment such as Alzheimer’s disease or a related dementia.

Providing the family with a set of questions to ask the insurance provider is not only helpful for the family, but can also help professionals assist them in arranging their long-term care provider. Suggested questions are listed below:

  • What services are covered?
  • How much does the policy pay per day, week or month for each type of service?
  • How long will the benefit last?
  • Does the policy ever expire? Is there a maximum lifetime benefit?
  • Does the policy have a maximum length of coverage period for each service?
  • What are the terms of the elimination period? In other words, how many days must I wait before benefits begin for the different types of services? Do I pay for the services out of pocket during the elimination period? Is there a buyout fee for the elimination period?
  • How is cognitive impairment such as Alzheimer’s disease or dementia covered?
  • Does the policy require an assessment, physician referral, prior hospital stay or other prerequisites for benefits to kick in?
  • Does the policy have an alternate plan of care provision or exchange benefit?

You can equip yourself with the knowledge and information necessary to confidently discuss LTCI with clients’ families. To learn more about LTCI, watch this webinar and earn a free Continuing Education (CE) credit*.

You can also download a free guide: Navigating Long-Term Care Insurance, which can be passed along to older adults and their families.

*CE credits are only available for 60 days following the live webinar event.

Last revised: March 8, 2019

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