What to Do If You Have LTC Insurance and How Alliance Can Help

According to AARP, roughly 80% of adults 50 and older would like to keep living in their current homes as long as possible. Whether it’s in-home nursing, home health aide services, or palliative end-of-life care, custodial support can allow them this freedom. Of course, the expenses can add up, especially when care is required for an extended period, which is where long-term care insurance comes in.

Long-term care (LTC) insurance covers some or all of the costs of a senior’s ongoing medical needs. Sometimes called nursing home insurance, individuals usually pay a monthly premium for this type of healthcare policy. For a deeper dive into the basics of LTC insurance, check out our blog, What Is Long-Term Care Insurance?

Do you have LTC insurance and wondering if, when, and how to use it? You’ve come to the right place. Our team at Alliance Homecare is here to help you navigate your long-term care policy. Read on for insight into activating your insurance, benefit eligibility and verification, filing a claim, and a rundown of your care choices.

When Should I Start Using My LTC Insurance?

Now that you have a policy in place and are making monthly payments toward the premium, you might be wondering when to start using it. There’s no one-size-fits-all age or time to activate LTC insurance, but the stats can provide some insight.

Some people require ongoing care at age 70, while others may be self-sufficient until they’re 90 years old. Upwards of 95% of long-term care insurance claims are filed by individuals over 70, and 70% of all claims are filed by people 81 years and older.

It’s not just about age-related mental and physical decline, either. An injury, chronic illness, or a change in their living situation could mean someone needs care sooner than later.

How to Activate Your LTC Insurance

If you’ve determined that you or a loved one need long-term care, the next step is to activate the insurance policy. As one of the leading licensed home care services agencies (LHCSA) in the New York metro area, Alliance is proud to offer in-house expertise and support for those looking to verify and activate their insurance policies. Find details about the process below.

Benefit Eligibility

LTC insurance policyholders have to meet specific criteria (also called benefit triggers) to receive their benefits. While eligibility requirements vary among policies, benefits are typically available when the individual needs assistance with two or more ADLs (activities of daily living). 

These basic self-care tasks include bathing, grooming, grocery shopping, and health maintenance. Learn more about activities of daily living care in our blog, What Is ADL Care?

Some insurance providers accept the need for standby assistance as a benefit trigger. This means the policyholder needs someone else present for transfers and to help prevent falls.

To determine eligibility, an LTC insurance company may:

  • Review the policyholder’s medical history
  • Interview the policyholder or a close family member
  • Conduct a face-to-face assessment
  • Conduct a physical or a cognitive test
  • Contact the policyholder’s healthcare provider
  • Review notes or referrals from physicians

Some insurers are more meticulous, requiring several steps to determine eligibility, while others may go off a single doctor’s note. If you’re unsure about the criteria or need help presenting proof of eligibility, Alliance Homecare is here to assist.


Submitting a Claim

Once you’re approved, you can begin receiving long-term care services and have peace of mind knowing the costs are at least partially covered, if not fully covered. As with the eligibility requirements, the process of submitting a claim varies among insurance providers. However, you can expect to provide certain information and documents.

To file an LTC insurance claim, you’ll need:

  • The insurance company’s name and contact information
  • The insurance policy number
  • An invoice for medical services received
  • Proof of payment for medical services
  • A form authorizing the release of the policyholder’s information
  • A statement from the LTC provider detailing the care plan
  • A signed policyholder statement (also called a claimant’s statement or insured’s statement)
  • An attending physician statement verifying LTC is necessary

Some insurance companies may also request a detailed care summary with each claim, but for others, an invoice might suffice once the initial paperwork is in. Claims can usually be submitted by mail, email, fax, or through an online form. 

Seniors with dementia or physical impairments (as well as those who may not be tech-savvy) may struggle to file a claim. A trusted loved one can assist with the process, but working with an LHCSA like Alliance Homecare can help the process go much more smoothly.

How Alliance Can Help with Benefit Verification

Typically, a policyholder submits a claim after receiving and paying for long-term medical services. Once the insurance company processes the claim, they’ll receive reimbursement via a mailed check or direct deposit.

This works for some people, but it’s not always easy to front the money, especially for intensive, ongoing care. Additionally, the filing process alone can be tricky to navigate and create an unnecessary burden for individuals and their families. 

To help our patients get the care they need without having to worry about filing a claim, Alliance handles the benefit verification process. Our seasoned team will review your policy to help you figure out your benefits, whether in-home services are included, and what portion of care will be covered.

With your signed permission to speak on your behalf, we’ll then work with your insurance company on reimbursing our agency for claims, so you don’t have to front the costs. If your policy covers 100% of your LTC, you won’t have to pay anything. If it covers a portion, you’ll pay the difference once Alliance is reimbursed.

Knowing Your Care Choices

Though LTC insurance policies vary, you can generally expect your benefits to include care received at nursing homes and adult day care centers. What many don’t realize is that most also cover at-home services, such as support from a home health aide, nursing care, or palliative end-of-life care. Plans often include expenses for chronic medical conditions and disabilities too.

This is crucial for many seniors, as a majority of aging adults would prefer to continue living in their homes while getting the medical support and ADL care they need. Knowing your LTC options can empower you to make the best choice for your unique situation.

Compassionate Long-Term Home Care in New York

At Alliance Homecare in New York, we offer a range of care options, including home health aide services, ADL care, in-home nursing care, post-surgical care, chronic care management, respite care for the elderly, and palliative end-of-life care.

Alliance support services include everything from educational resources for families and physician house calls to transition management and emergency response. We’re committed not only to providing high-quality, compassionate care services but also to helping our patients get the most out of their LTC policies.

If you have questions about your benefits, are unsure of your eligibility, need support arranging for care, or want help filing a claim, we’d love to hear from you. Contact us at Alliance Homecare today.

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