Approximately eight million Americans own long-term care (nursing home) insurance, purchased to help cover the escalating costs of long-term nursing care – whether in-home care, assisted living, or nursing home care. These long-term types of nursing care usually are not covered by Medicare, and they are not covered by Medicaid unless a person qualifies based on a complex set of rules that include consideration of income and other resources.
According to a recent article in The Wall Street Journal (The Latest Long-Term Care Snafu), however, some families are encountering claims-denials that can prevent or delay the collection of benefits.
If you have purchased a long-term care insurance policy, there are steps you can take to help avoid this problem. Most importantly, be sure to re-read your policy’s fine print before hiring a caregiver or entering a facility. In some cases, it also may make sense to get an agent or geriatric-care manager to help in preparing your claims.
Be particularly vigilant if you purchased your policy before 1997. Older policies often include special requirements, such as a three-day hospital stay, before they will pay for nursing home care. These types of stipulations can exclude many people from receiving care, especially those who are physically healthy, but still require care (such as Alzheimer’s patients).
Federal law requires tax-qualified long-term care contracts issued since 1997 to pay benefits under two conditions: when policyholders are unable to perform two out of six basic “activities of daily living,” such as dressing or bathing, or when they have a cognitive impairment requiring “substantial supervision.” For virtually all policies sold today, a health-care professional, such as a doctor or nurse, must certify that the disability is expected to last at least 90 days.
To learn more, be sure to visit the Hawaii Elder Law center on our website. If you are currently evaluating a long-term care insurance policy and would like an objective evaluation of your policy terms, please call our office for a consultation. Or us the handy contact form on our website, and someone from our office will call you.