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HOW DOES LONG TERM CARE (LTC) INSURANCE WORK?

Updated: Nov 23, 2020

Q: I have a Long Term Care Policy. Can I use it now?

A: Under most long-term care policies, you're eligible for benefits when you need assistance with at least two out of six "activities of daily living," called ADL's or you suffer from dementia or other cognitive impairment.

The activities of daily living are: bathing, caring for incontinence, dressing, eating, toileting and transferring in or out of a bed or chair.


Q: How many hours of care can I get each day?

A: Most policies have either a daily or a weekly dollar limit that they will pay for any services. The daily amount will be divided by the hourly cost of the care to determine the number of hours of care. For example: $100 daily limit divided by $20 cost per hour equals 5 hours per day of service.


Q: How do I start a claim?

A: The claim process starts with calling your insurance company to ask them to start the claim. They will send you a claim packet of forms that need to be filled out by you, your doctor and the company that is going to provide the care services. After you complete the packet, the insurance company will review medical documents from your doctor and may send a nurse to do an evaluation. **WE CAN HELP GUIDE YOU THROUGH THIS PROCESS AS WELL AS COORDINATE THE FILING OF ALL THE NECESSARY FORMS AND DOCUMENTATION WITH THE INSURANCE COMPANY**


Q: What is an elimination period?

A: This is the period of time that you are responsible for paying for services before the benefits are paid. 90 day and 120 days are the most common. That means you will have to pay for the first 90 or 120 days of service.


Q: What is an assignment of benefit?

A: Assignment of benefit allows the insurance company to pay the provider directly. The provider submits all the paperwork and follows up with the insurance company for all payments. You do not need to get involved in all the time sheets, billing and receivable paperwork.


Q: What is a waiver of premium?

A: Most policies contain this clause. Once a claim is filed and approved, premiums are waived and no longer have to be paid. Premiums typically increase every year and can be very expensive, so be sure to check if this applies.


Q: Will the Government help pay for my personal care services?

A: Unfortunately, no. There is lots of confusion about government coverage of long-term care. Medicare may pay for limited nursing assistance after you have been hospitalized. But neither traditional Medicare nor Medicare Advantage managed care nor Medicare Supplemental (Medigap) will pay for long-term care services for someone with chronic disease.


**COMFORCARE HAS BEEN PROVIDING SERVICES TO CLIENTS WITH LONG TERM CARE INSURANCE FOR OVER 20 YEARS. COMFORCARE IS AN APPROVED PROVIDER BY VIRTUALLY ALL THE LONG TERM CARE INSURANCE COMPANIES**


WE CAN HELP YOU WITH UNDERSTANDING YOUR SPECIFIC POLICY, STARTING CLAIM PROCESS, PROVIDING THE NEEDED CARE SERVICES AND TAKE CARE OF ALL THE PAPERWORK AND BILLING.


FOR MORE INFORMATION PLEASE CONTACT COMFORCARE - MIAMI (305) 860-8200 OR BROWARD (954) 946-1960.



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