The value and application of Long Term Care Insurance is growing. As healthcare costs increase, Medicare covers fewer services and reduces benefit allowances for care at home and for inpatient services.  Healthcare Pathfinder’s clients who are fortunate enough to have Long Term Care Insurance are accessing benefits sooner to cover services once paid by Medicare.  Knowing how and when to initiate a claim is complex, and understanding the nuances is essential to accessing the highest allowable level of care and reimbursement.

The level of benefits that Medicare covers for services has changed significantly over the past 20 years.  Medicare’s skilled nursing facility (SNF) benefit of 100 days is very closely managed now.  The average approved stay for rehabilitation services is restricted to two weeks vs multiple weeks.  Similarly, home health care benefits are limited to 1½ to 2 hours per day, 2 days per week;  reduced from 2-8 hours per day, 5 days a week.  Medicare has transferred most of the financial responsibility of these services to the beneficiary.  

The cost of these services has increased significantly as well.  24/7 home care services in Fairfield County costs approximately $700/day, and $600/day in a skilled nursing facility.  Assisted Living Facilities rarely offer 24/7 hands on care, and costs vary depending on levels of care. Most LTC insurance policies will reimburse for some or all of these services after a 100 day elimination period (similar to a deductible) has been met.  

Timing and accuracy in the claim filing process are critical, and will ensure that benefits are paid at the earliest possible point.  Initiating a claim early, as soon as a loved one’s level of care needs change, is essential. For this reason, it is important to have a family member, professional, or advocate support the patient through the claims process and be present during any insurance assessments. Unfortunately, insurance companies and medical providers can make costly mistakes that impact benefit calculations, so processed claims and reimbursements should be tracked closely.

Healthcare Pathfinder provides informed reviews of Long Term Care coverage and provides professional support during changing health circumstances.  We take on the burden of understanding how and when the insurance you have purchased will add the most value.   We can help you make the most of your LTC coverage and get the maximum reimbursement from your policy.