Somewhere in a filing cabinet or a desk drawer, there may be an answer to some of your biggest questions. If your loved one bought a long-term care insurance policy years ago, this whole season may be easier for you. But we always hear questions about those policies.
We want to help provide clarity behind some of those details.
What Long-Term Care Insurance Is
Long-term care insurance is a policy people buy, often in their 50s or 60s as they begin to look at life in their later stages, to help cover the cost of care they may incur. This insurance is not the same as health insurance. It is designed to provide help for assisted living, memory care, and in-home services as needed.
Not every family has one of these policies. But if your parent or loved one does, it is worth understanding fully before you make any decisions.
Who Typically Has a Policy
People who planned ahead, worked with a financial advisor, or watched a parent or loved one go through a care transition themselves often purchased these policies.
If your parent was cautious about the future, there is a good chance a policy exists somewhere.
Check old paperwork. Call their financial advisor if they had one. The search and discovery is worth your wait.
How Long-Term Care Policies Actually Work
These policies come with their own language. Below are some of the basic details to understand.
Elimination Periods
Most policies have what is called an elimination period. This is a set number of days, often 30 to 90, where your parent or loved one must be paying for care out of pocket before the insurance benefit kicks in. It is similar to a deductible but is based on initial days rather than an amount of dollars.
Daily Benefit Amounts
Policies usually pay a set dollar amount per day, not an unlimited amount. This is called the daily benefit. It is important to know this number early, since it affects how much of the assisted living cost the policy will actually cover.
How Long-Term Care Claims Are Triggered
Most policies require that your parent or loved one need help with a certain number of daily activities. These are called ADLs, or activities of daily living. Things like bathing, dressing, and eating usually count. A doctor or care assessment often has to confirm this need before the policy will pay out.
How to File a Claim for Assisted Living
Filing a claim can feel intimidating. It does not have to be. Below is a simple outline of steps to make it less stressful for you, your loved ones and those trying to help coordinate with you.
- Locate the policy. Find the actual documents, not just a summary. You need the full contract.
- Call the insurance company. Ask them directly what they need to start a claim.
- Get a care assessment. Most companies will require documentation from a doctor or care provider showing your parent needs help with ADLs.
- Submit the paperwork. Keep copies of everything you send.
- Track the elimination period. Mark the calendar so you know exactly when benefits should begin.
- Follow up. Insurance claims move faster when someone is checking in regularly.
Common Mistakes Families Make
At DaySpring, we see the same few mistakes take place frequently. Knowing them now can save you real time and money.
Missing the Elimination Period Window
Some families do not realize the clock is running until it is too late. Start tracking this the moment care begins, even before the official claim is filed.
Sending Incomplete Documentation
Insurance companies are strict about paperwork. A missing signature or an incomplete assessment can delay a claim by weeks. Double check everything before you send it.
Waiting Too Long to Start the Process
Some families wait until they are fully settled into assisted living before even looking at the policy. Start the process as early as you can. It runs in parallel with everything else you are doing.
What If Your Parent Doesn’t Have a Policy
If there is no policy, that is okay. Most families do not have one. It simply means other funding paths will carry more weight, things like personal savings, home equity, or programs like Medicaid or VA benefits.
We can help you look at the full picture and figure out what fits.
We Can Help With Long-Term Care Paperwork
Our team at DaySpring has helped many families work through long-term care claims during move-in. We know what these companies typically ask for, and we can help you gather the right documents from the start. Your focus should be on your parent or loved one, not every detail of what can feel like an overwhelming amount of paperwork.
If you think they may have a policy, or you are not sure where to even begin, reach out to us. We will help you sort through it, one step at a time.