How Does Long-Term Care Insurance Work?

Even if you do not need it now, many end up requiring long-term care as they age. So what can you do to prepare for when the time comes?

One of the things you can do to prepare is purchase long-term care insurance. Buying long-term care insurance allows you to be reimbursed for various aspects of your care that are not otherwise covered by standard health insurance.

What Exactly is Long-Term Care Insurance?

Long-term care insurance refers to policies that assist the policyholder by reimbursing them for care received if the individual is living with a chronic illness that prevents them from doing routine activities in their life – such as eating, bathing or dressing.

Who is Eligible for Long-Term Care Insurance?

To be eligible for benefits of long-term care insurance, most insurers require that you not be able to successfully execute at least two of six activities of daily living. These six activities include the following:

  • Transferring into and out of bed (or into and out of a chair)
  • Eating
  • Dressing
  • Bathing
  • Getting onto or off of the toilet
  • Caring for incontinence

How Exactly Does Long-Term Care Insurance Work?

The majority of policyholders will purchase long-term care insurance well in advance of when they will actually require the benefits. The process begins with an individual filling out an application and answering questions regarding their health. The insurance company will often request proof of medical records.

You can choose how much long-term care insurance you would like to purchase. There is typically a limit on the amount paid out per day and also paid out for the remainder of your life.

What Do You Need to Do to Activate Your Long-Term Care Insurance?

Prior to activating your long-term care insurance plan, there are a few steps that you will need to take:

  • Understand the details of your policy
  • Have your medical records prepared
  • Speak with your doctor
  • Create a care plan

Understand the Details of Your Policy

It is imperative that you understand the details of your long-term care insurance policy. You will need to know details such as what your policy covers and what documentation will be necessary for you to have. Once you understand this information, you can move on to the following steps.

Have Your Medical Records Prepared

You will need to have all of your medical records in order. As referenced above, the insurer will typically request to see these records.

Speak with Your Doctor

Speaking with your doctor is a key part of the process. You should review your medical records with your doctor to determine if there is a need for assistance with any of the previously mentioned activities of daily life.

Create a Care Plan

Creating a care plan will allow you to determine what you believe is the best path for you to take in regard to your care. A significant part of this step will be determining whether you want to receive home care or go to an assisted living facility.

What Happens When You File a Claim?

When you need to file a claim, the first step you will take is to contact your insurer. If you are the policyholder, you can request a claim form. If you are not the policyholder, you must provide the insurance company with a copy of the power of attorney documents, in addition to information about the policyholder and the policy number.

Upon sending your claim forms to the insurance company, they will reach out to the assisted living facility or home care agency to verify the information you have provided.

Lastly, the insurance company will make their final determination as to whether your claim meets your policy requirements.

For assistance with long-term care insurance matters, or various other estate planning and elder law matters, contact us today. To find out more information about estate planning and elder law, visit our resources page, where you will find previous blog posts, newsletters and our webinar series.

Image by Alterio Felines from Pixabay

About the Author

Alyssa Marie Monteleon, Esq.

Alyssa Marie Monteleon is an elder law and estate planning attorney at the Monteleon Law Group, PLLC with offices in New York and Virginia. For more information, please visit or call (914) 840-2529.

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