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LTCI Claims Require A Process

Question: My spouse and I have Long Term Care Insurance (LTCI), but we are not sure how to use it?

Answer: This is the third and final answer to this question — filing a LTCI claim.

LTCI insurance works by reimbursing you for care costs you have already paid. If you have help in the home, and you don’t pay the help money (maybe they are family) the LTCI will not pay any benefit.

When you hire help in the home, the LTCI could potentially reimburse you for homecare costs. The caregiver completes LTCI paperwork explaining her qualifications and experience to become an approved provider of services by your company. When approved, the caregiver will complete a timesheet each day indicating what she did, when she did it, how long she was there, and what she was paid for her service. This timesheet is usually submitted on a weekly or monthly basis to the company. Before you are reimbursed for services, you must fulfill your elimination period, (90 or 100 day elimination periods are common). The elimination period means you must pay for care for 100 service days before the insurance policy will begin to reimburse you. When you have help 4 days a week, it would take 25 weeks to get through the elimination period. If you pay for help in the home every day or reside in an assisted living or skilled nursing facility, it will take 100 days or just over 3 months to receive reimbursement for those expenses.

The 100-day elimination period may sound reasonable, but when you are paying out of pocket it can seem like a long time before the money begins to roll back.

After the elimination period is completed, the insurance company will reimburse you for the approved care provided. You will continually submit timesheets on a weekly or monthly basis as long as you require care. This will continue until your situation improves so that you longer need the care, the policy is used up, or the person passes away.

If you no longer need care and have benefits still left in your policy, this benefit stay available to you to use when you need care again.

As a geriatric care manager (GCM), I often work with people and their families to assist with the LTCI process. Many LTCI policies will reimburse you for a GCM’s services. The reimbursement usually has an annual allowance limit. The GCM benefit does not come out of the daily reimbursement limit for care. It comes out of a separate benefit within the policy. So using a GCM does not lessen your reimbursement for other services.

LTCI is meant to pay for your care when you need. A GCM can offer you insight into concerns and problems you have, as well as experience with the LTCI process.

If you get to the stage where you have used up the policy, congratulations. That means you received back more than the cost of your premiums. Some people worry about using up the policy, and what happens after. If your LTCI policy benefits are used up, you may evaluate eligibility for Medicaid. If you don’t qualify for Medicaid, you may continue to pay for caregivers out of your own pocket, and there is no reimbursement.

Most individuals and families wait too long to begin using their LTCI policies. They don’t begin to make a claim for coverage until their situation is overwhelming. I often hear from people, “I don’t want the policy to run out.” I say “yes you do.” It means you got your money’s worth out of the policy.

Senior Life Matters is a community based program sponsored by Lutheran Jamestown. For questions and concerns or to reach Janell Sluga, GCMC, call 720-9797 or e-mail SLM@lutheran-jamestown.org.

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