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Time for a Review on Long-Term Care Policies

By Sheree Ellingson, Owner of Senior Helpers of West Jacksonville

Do your parents have a long-term care policy? Let us talk about that. I am finding more and more seniors who have long-term care policies where the senior has not filed a claim because they are “waiting” till a time when they really need it. Does this describe your parent?

Now that we are on social distancing restrictions, this is a great time to pull out the long-term care policies to review them and see if now may be a good time to activate a claim.

Here are some things that are quite common in most long-term care policies I have read over the past 12 years. First, there is usually an elimination period. An elimination period is just like an annual deduction on health insurance or your deductible on homeowners or car insurance. The elimination period must be met in totality prior to the long-term care insurance paying any money for care. Most long-term care insurance policies have a set amount of days to be paid by the policyholder; this set number of days can range from 14 days to 90 days. More times than not, when your parent purchased this policy, they threw it in a drawer, continuing to pay the premium and have forgotten about this elimination period. Then, low and behold, they do not have the money to pay out of pocket for the elimination period. That is when it is hard to get the help they need when they cannot come up with the money to pay for care until they reach their elimination period. If you parent needs to start using their long-term care insurance but cannot afford the elimination period, call me. I can help get them through this 904-779-5515.

The second part of the long-term care policy is understanding what is required to qualify to put in a claim. All policies have the requirement of needing help with two ADLs (Activities of Daily Living). Under the guidelines of ADLs, this is the requirement for assistance with bathing or dressing or transfers or walking. If your parent needs help getting their socks and shoes on, that is one ADL. If they also need help walking without risk of falling, that is a second ADL. Now your parent would qualify to file a claim on their long-term care insurance. Cooking, cleaning, doing laundry, going to the grocery store or the doctors, picking up prescriptions are considered IADLs (Independent Activities of Daily Living) and are not considered a necessity under any long-term care policy.

If your parent has cognitive impairment, such as dementia or Alzheimer’s, they automatically qualify to file a claim and have it approved. In my experience, however, some of the long-term care companies will make the family and supporting physicians jump through a lot of hoops prior to accepting this diagnosis and approving a claim. Just be aware!

Once a claim has been filed and accepted by the long-term care insurance, your parent generally does not need to pay any more money into the policy for the life of the claim. However, you must wait on the letter from the long-term care company letting them know prior to stop paying premiums.

Most policies cover home health care, nursing home care or assisted living but I have also seen policies that do not cover home health care (home health care is a relatively new breed, only been around since the 1970s). Be sure to know what is or is not covered prior to making plans. There is a daily benefit amount listed for each plan of care. Most have riders on the policy which may have kept up with the cost-of-living increases but not everyone purchased the riders. You may need to call the long-term company to find out what the daily allowance is based on the policy number.

Lastly, look for the total amount to be paid out or the life-time limit on the policy. Some have unlimited time but have maximum amounts to be paid or I have seen where it is only limited by the daily benefit amount for the entire lifetime of the policy holder.

It is better to act now over later. I have had, unfortunately families call me for help, they get the claim started and then the parent passes away prior to ever getting the help they need. This is unfortunate because all the money paid into the long-term care insurance cannot be recouped by the family. If you have questions, please give me a call. If you want to set up a plan of action to make sure your parent uses this benefit at the correct time in their life, call me at 904-779-5515.