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Long Term Care (LTC) Insurance

LTC policies are used to pay for many types of senior care. Most of the early LTC policies were written to pay for nursing home expenses, but now policies have expanded to cover in-home care, assisted living, adult day care, and even some skilled nursing or care management costs. These policies are available for pur­chase by those who are healthy. If you have a loved one who has health issues or who already needs senior care, it is probably too late to consider taking out a policy. However they may already have one in place that can be of great value to you at this time.

IMPORTANT – Ask your family members who need care whether they already have a long-term care policy in place:

  • Many family members looking for senior care for a loved one are surprised to find out that person has a LTC policy in place. It is not uncom­mon to find out a client has a LTC insurance policy that nobody else knew about.
  • Check bank records to see if any insurance payments have been made over the last year. Find out exactly what is in that policy before making any claims.
  • If you find a policy and need help understanding it, feel free to call Amada at 877.442.6232 and we can do a complimentary LTC assessment by phone to help you understand what the policy covers.
  • Most LTC policies have a similar structure, but each individual policy has different small print. Below is a list of sections that we use as part of Amada’s LTC planning guide to help families understand how best to use their policies. We recommend you call us before putting in a claim and we will walk you through the planning guide. If your first call is to your insurance company, you may unknowingly be giving them information that may slow or invalidate a claim. It is vital to understand what is in your policy before making a claim.

1. What is the elimination period on your policy?

The elimination period is like a deductible where you are responsible for paying the full portion until your coverage begins and can be a zero-, 30-, 60-, 90- or 100-day period.

2. What is the maximum daily benefit?

The benefit is usually $80-$300 a day. Maximum daily benefit is the maximum amount your policy will reimburse for each day.

3. What is the maximum lifetime benefit?

Most policies state the maximum lifetime benefits in terms of days or dollars. Find out which your plan uses.

4. What does my policy cover?

Assisted living care? In-home caregivers? Skilled nursing facilities?

5. What do I have to do to activate my LTC policy?

  • Call in and request a claim packet
  • Fill out the claim form and send it in
  • Make sure to list the information of the company providing care and their tax ID
  • Check to see if the policy requires a doctor to fill out a form documenting your need for care
  • Check to see if you need an assessment from a Registered Nurse (RN)

6. Once my claim is approved how do I get reimbursed?

To be reimbursed, you need to ensure that each invoice you receive from your provider is submitted with notes documenting that assistance with ADLs is provided each day. After determining your plan’s elimination period and maximum daily/lifetime benefits, put together a plan to optimize your policy’s benefits based on your expected length of care. Activate your claim as soon as possible to minimize your out-of-pocket expenses during the elimination period.