Long Term Care Insurance 101

Long Term Care Insurance (LTCI) can be very daunting and intimidating for just about anyone outside of an insurance agent or financial planner. There are so many nuances and requirements that it’s very important to read your policy in full and follow the exact procedures the policy outlines in order to qualify for coverage. Every policy is different and ultimately it is up to you, the policyholder to submit the correct information. This article is intended as a very basic guide to LTCI, it is not legal or financial advice.

What is an Elimination Period?

The best way to describe an elimination period is simple. It’s the basically the same thing as a deductible or cash out of pocket the policy holder must pay before the benefits begin to be paid. Typically the elimination period is 0-100 days. But there are several important questions to ask. How does the policy qualify these days? Do they require service days? Calendar days? What counts as “one service day”? These are very important questions to ask when you call to review your policy. Knowing what to ask may save you money and headache.

Where does my LTCI cover services?

  • Skilled Nursing?
  • Assisted Living?
  • Non-Medical Home healthcare workers?

How do I qualify for my LTCI? When is the best time to use it? Should I wait or should I proceed with a claim? What is the maximum daily limit? What is the maximum lifetime benefit? How do I get reimbursed? To whom does the claim get paid? All of these are very important questions.

To be eligible for any type of benefit under most policies, your Physician may be required show that you meet one of the three following benefit qualifiers:

  • Medical Necessity: (Acute or chronic illness)
  • Loss of Functional Capacity: (Assistance with ADL’s: Activities of Daily Living)
  • Cognitive Impairment: Dementia or other cognitive impairment requiring daily monitoring.

All too often we attempt to understand and activate our LTCI due to family crisis. When it comes to LTCI it can save you both time and money if you understand your policy ahead time. Even if you don’t currently need care we recommend contacting either your insurance agent or a home care company for a free assessment.  This will help you understand your coverage and plan for future needs.


Editor’s Note: This article was written and submitted by Amy Culler with Amada Senior Care – Northwest Denver. She may be reached at 720-239-1337 or by email at:Amy.c@amadaseniorcare.com