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“We don’t want to use her Long Term Care Coverage…yet.”

Written By: David Emery, Owner – Senior Helpers

Private pay care is always a mystery for the family when the time comes to review care options with an aging family member. While there are always questions about the care process, how we can afford care services is always at the top of any list. It is common to hear “will my mother’s Medicare pay for it or will insurance cover the cost?”

Regretfully the answer is generally no, but there is a short-list of common sources for financial assistance. For example, if the senior was a veteran or is a surviving spouse of a veteran some veteran benefits may apply. My mother was the beneficiary of Aid & Attendance Veteran benefits. It was great in her case. Beyond this brief list, however, the options become limited. It doesn’t matter if the family is wealthy or of modest means, how to pay for care is always an important topic; but what I have found most interesting is the conversation with families holding Long Term Care (LTC) coverage purchased years ago with the idea some form of care may be needed later in life seem puzzled as to what it does and when to use it. This is a subject we have worked on for a few years and seem to be making some progress.

Back in the late 1980’s several major insurance carriers brought out a line of coverages to assist the “aging baby boomers” with care later in life. Roll forward and one would think this was a tremendous success, but insurance companies poorly accounted for the cost of care and the availability of coverage became limited and very costly. Regardless, several million policies were sold but only about 10% of private pay revenue comes from LTC. What do we see?

When we ask family members if LTC coverage is available for the senior needing care, it is surprising sometime to find out how often the answer is “yes!” What is amazing is the family too often doesn’t want to use it. LTC is often seen as something that will be needed later when needs are greater or if they must go into a nursing home or Assisted Living Facility; and sadly, that is often when it is used. Rather than use the coverage to remain at home where most seniors prefer, the LTC coverage is identified in a spend down process at a nursing home and taken until private funds and benefits are used while qualifying for Medicaid.

Even worse, LTC coverage is often not used at all, and the senior expires before using the benefits. Too often LTC is seen like an asset rather than a benefit purchased like any other insurance product intended to protect assets. This is a subject worth more discussion in the next blog.  

What is LTC? When should LTC be used? Why should it be used? What happens if I qualify to make a LTC claim under the policy but delay its use? Can I use it at home? Will LTC pay for services in an ALF? What is a spend down? Does LTC get used in a spend down? My guess is anyone reading this blog may have their own list of questions. The goal of Senior Helpers of North Coast Florida is to educate our clients on the use of LTC when it is available and help them age at home where most prefer. We have been able to identify thousands of seniors holding LTC in this market.  Next time, we will answer some of these questions listed above. If anyone has questions about approach and details to assist clients or family with LTC send an email to demery@seniorhelpers.com. I will respond to all inquiries.