Long-Term Care Insurance: How to Use a Policy and File a Claim

The prospect of needing help with daily activities or needing supervision due to memory loss increases with age. Our health, body, and mind will decline. Often you will need long-term health care. It is costly. LTC Insurance pays for quality care.

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Long-Term Care Insurance: How to Use a Policy and File a Claim
4 Min Read December 9th, 2022

Long-Term Care Insurance has become a popular type of insurance that provides coverage for people who need help with everyday living activities or supervision due to dementia. The benefits are often used to pay for at-home assistance, adult day care centers, assisted living, memory care, and nursing homes.

These policies are helping people nationwide. In 2021 alone, over 12.3 Billion in benefits have been paid to policyholders, much of those benefits helping them stay in their homes.

LTC Insurance policies have been around since the 1970s and have become increasingly popular among Americans over 50. In fact, the American Association for Long-Term Care Insurance reports that 88.2% of people purchasing Long-Term Care Insurance were aged 45 to 65. While some surveys report that 80% of respondents say they should get coverage before age 70, 44% of applicants ages 70 to 74 get declined for coverage. For ages 65 to 69, 32.5% see their applications rejected. 

What is Long-Term Care Insurance?

Long-term care insurance covers the cost of long-term health care, which can include anything from in-home caregivers to a nursing home and everything in between. The goal of long-term health care is to help you maintain your independence and quality of life as you age and need assistance with daily activities such as eating, dressing, or bathing or supervision due to dementia.

Long-Term Care Insurance provides a benefit account from which you receive a monthly or daily benefit to pay for care. Premiums are based on the initial amount of money within the policy. Long-Term Care Insurance policies vary significantly in price and coverage, so it's essential to understand what each policy offers before deciding on one that's right for you. 

Why Buy Long-Term Care Insurance?

Long-term health care is expensive. In fact, the average base cost of a stay in an assisted living facility is around $49,000 per year - LTC NEWS Cost of Care Calculator. Depending on the amount of in-home care you need, it can be even more expensive. Although the least used type of care, nursing homes are the costliest. These costs vary depending on where you live.

But with Long-Term Care Insurance, you can pay for these services without taking out a loan or draining your savings account. You can also avoid going into debt and having to sell your home to pay for long-term health care costs. For most people, they want to avoid Medicaid. Medicaid will pay for long-term care services, but you must have little or no income and assets. Health insurance and Medicare pay a limited number of days of skilled services. 

The other thing to consider is the consequences placed on your family. Often, without an advance plan, adult children must become caregivers. Trying to juggle a career, family, and caregiving is challenging, if not impossible. Many people don't want to place this burden on their loved ones.

Most people obtain coverage in their 50s. Several top-rated insurance companies offer coverage. Premiums can be affordable but vary dramatically between insurance companies. Generally, a Long-Term Care Insurance specialist will help you navigate the available options and provide you with accurate quotes from all the top companies.

How to File a Claim for Long-Term Care Insurance Benefits

If you're eligible for Long-Term Care Insurance benefits, the process of filing a claim is pretty straightforward.

First, make sure that you actually qualify for coverage. Your policy may have specific terms and conditions that could exclude certain types of care. Read up on these details, so you know what's covered before filing a claim.

Federal regulations have standardized the benefit triggers if your policy is a tax-qualified Long-Term Care Insurance policy - Is Making a Claim for Long-Term Care Insurance Benefits Difficult?

Next, get a copy of your policy if it's necessary to reference it during any communication with the insurer or while waiting for them to review your claim. The policy will include a "schedule of benefits" outlining the initial benefits and any "riders" attached, like inflation protection or shared spousal benefits. You will also find the elimination period, which is a deductible based on days, not dollars. 

Sometimes health insurance or Medicare may pay some of the first 100 days if skilled care is required. Any days paid for by health insurance, or Medicare will go against your elimination period. 

You Have Control

You can use any providers or facilities you want, as long as they are operating legally (meaning licensed properly). Some LTC Insurance policies pay you a cash benefit. With those plans, the insurance company will pay you the full cash amount, no matter the bill. Since the payment is going directly to you, you have the freedom to use anyone you want to care for you.

Otherwise, the insurance company will pay bills they receive from providers based on the benefits within your policy. In this case, you are assigning the benefits directly to the provider. 

If the actual cost of your care is more than your Long-Term Care Insurance benefit, you will pay the difference. Keep in mind that you will have income from social security or retirement accounts that you can supplement any difference in the cost and your LTC Insurance benefit. This is much better than paying 100% of the cost and adversely impacting your lifestyle and legacy.

You can find the phone numbers for all the major insurance companies and get help with processing a claim here - Filing a Long-Term Care Insurance Claim.

As you can see, Long-Term Care Insurance is a good way to plan for the future. It can help you cover costs that Medicare doesn't and give you peace of mind while keeping your wealth intact. However, it's not right for everyone—and even if it is right for you, it may not be the only tool in your retirement planning arsenal.

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About the Author

Jeff Peters is a lifestyle and health writer at SolidEssay and ConfidentWriters, where his main focus is on senior health and senior living experience.

LTC News Contributor Jeff Peters

Jeff Peters

Contributor since December 9th, 2022

Editor's Note

Aging brings challenges that must be met by you and your family. One of the biggest challenges is future declining health and the consequences of long-term health care. Being prepared for these challenges will make getting older easier for everyone.

Long-term care costs are climbing quickly. Health insurance, including Medicare, pay little or nothing toward long-term care costs. The financial impact can change your lifestyle and legacy.

While the cost of long-term health care is a financial issue, it is not the only problem. The impact on your family is something that should be considered.

Family caregivers are neither trained nor prepared for the role, which interferes with their careers and other responsibilities. You probably don't want to place this burden on your adult children and their families.

You also deserve quality care. Quality care requires professional caregivers trained to provide unique personal services helping you with daily living activities or providing the proper supervision due to memory problems.

That takes money! Most people have only a limited amount of money to meet all their needs.

People require long-term health care as a result of chronic health problems, dementia, and frailty due to aging. The chance of needing care at some point is pretty high. Are you and your family prepared for the impact of long-term care in the decades ahead?

The solution is Long-Term Care Insurance.

You want guarantees in life, and an LTC policy offers guarantees. When you own a policy you will have guaranteed tax-free resources to pay for quality care options - including care in your home. With quality care taking care of your needs, your family will have time to be family, not caregivers.

Planning for future long-term care is about family. Take action now to maintain your control and independence and ensure you have quality care when you need it. The time to plan is sooner than later. Most people get coverage in their 50s when they enjoy good health.

Locate a Reliable and Experienced LTC Expert

Make sure to get the proper kind of professional assistance. A knowledgeable Long-Term Care Insurance specialist can assist you in navigating the many options from all the top insurance companies. Premiums vary over 100% between insurance companies, and each company has its own underwriting rules. 

A general insurance agent or financial advisor lacks this expertise.

Seek help from a qualified Long-Term Care Insurance specialist and get accurate quotes and professional recommendations from all the top companies - Find a Long-Tern Care Specialist.

Have Questions About Long-Term Care Planning?

You probably have questions about long-term health care planning, and LTC NEWS provides the answers for many of the most asked questions here - Frequently Asked Questions. Find all the tools and resources that are available on LTC NEWS - Resources for Long-Term Care Planning.

The cost of long-term health care is exploding. This calculator is an outstanding tool whether you are helping someone find care today or you are planning for yourself for the decades ahead.

Find the current and future cost of long-term health care where you live - LTC NEWS Cost of Care Calculator.

Loved Ones Need Help Now?

Get help finding quality caregivers or long-term care facilities and get recommendations for a proper care plan, whether a person has a policy. - Filing a Long-Term Care Insurance Claim.

If your loved one is lucky enough to own a Long-Term Care Insurance policy, be sure they use it. Sometimes families wait, thinking they can save the benefits for a rainy day. Waiting on using available Long-Term Care Insurance benefits is not a wise idea. 

If your parent or parents need help, be sure to get them quality care. LTC NEWS can help. We have put together several comprehensive guides to help you in your process.

Start by reading our four guides -  

The Benefits of Today's Reverse Mortgages

Some people have a large portion of their savings in their homes. With the help of reverse mortgages, you can find ways to pay for quality in-home care, pay for LTC Insurance, and even assist with cash flow during retirement.

Yes, today's reverse mortgages may be the perfect way to pay for a Long-Term Care Insurance policy or even cover the cost of in-home care if you or a loved one is currently in need.

Asking an expert with your questions will help you learn more. Mike Banner, a columnist for LTC NEWS and the host of the television program "62 Who Knew," will respond to your inquiries about long-term care, reverse mortgages, aging, and health.

- Just "Ask Mike." - Reverse Mortgages | LTC News.

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Email your story idea or article: newsroom@ltcnews.com - LTC News Contributors | LTC News

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Use LTC NEWS to drive traffic to your website and help you attract people interested in your products and services. Plus, you can improve your website's SEO so more consumers can find you when they search for your products and services.

There are various marketing options available with LTC NEWS. Traditional advertising, sponsored content articles, strategic alliances, and more are available. 

Learn more about how LTC NEWS can help market your business, drive traffic, and improve SEO - Advertise With Us | LTC News.

Shared Links

LTC NEWS offers a 'helpful links' page so readers looking for additional information can find them easily. You can get a dofollow link to your website on LTC NEWS in exchange for a dofollow link on your site.

Let's work together and help consumers who search for us on the web - Site Request | LTC News.

You can also affordably purchase a dofollow link to your website or blog on LTC NEWS. Just contact the advertising department.

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Include LTC NEWS in your press release distribution. If your group, organization, business, political committee, etc., have news to share, send it to LTC NEWS. Email - newsroom@ltcnews.com  

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