Millions of Americans carry long-term care insurance policies — and many of them, or their families, are not aware of what those policies actually cover. For families paying for home care in South Carolina, a long-term care policy could represent a significant funding resource. Here is what you need to know.
What Long-Term Care Insurance Was Designed For
Long-term care insurance policies were specifically created to cover the types of services that health insurance and Medicare do not — including non-medical home care, assisted living, and nursing home care. The policies differ enormously in what they cover, how much they pay, and when benefits begin.
Understanding the Benefit Trigger
Most LTC policies activate when the insured cannot independently perform a certain number of Activities of Daily Living (ADLs) — typically two or three out of six standard ADLs including bathing, dressing, eating, transferring, toileting, and continence. If your loved one needs help with these, it is worth reviewing the policy carefully.
The Elimination Period
Most policies have an elimination period — a waiting period of 30, 60, or 90 days — before benefits begin. Understanding your policy's elimination period helps with planning. Private pay during the elimination period is common.
How to Activate Benefits
Contact the insurance company's claims department and ask specifically about home care benefits. They will initiate a claims process that typically involves an assessment of the insured's functional status. Once benefits are approved, they are paid according to the policy terms — sometimes directly to the provider, sometimes to the family.
What to Bring to the Conversation With Beyond Care
Once your policy benefits are confirmed, bring that information into your planning conversation with Beyond Care. We can help structure a care plan that works within your benefit parameters.
Frequently Asked Questions
Q: My parent bought a policy years ago and we are not sure what it covers. Where do we start?
A: Start by finding the policy documents. Call the insurance company's customer service line and ask specifically: does this policy cover home care? What are the ADL triggers? What is the elimination period? What is the daily or monthly benefit amount?
Q: What if the daily benefit does not cover the full cost?
A: Many families supplement insurance benefits with private pay for the difference. We can help structure a care plan accordingly.