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How Do I Qualify for Long-Term Care Benefits?

Long-Term Care Insurance
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Most people usually enroll for long-term benefits during their working years as part of their financial planning. But when the time comes to collect your benefits, you might encounter problems if you fail to satisfy the set requirements.

So how do you ensure you are eligible to receive care and reimbursements?

You qualify for long-term benefits when you are unable to perform a minimum of two daily living activities without help, have dementia, or other cognitive impairment. Your insurer might need to see your medical records too. Before making your claim, the insurer will need to approve your care plan.

When planning for your future, it's essential to have the correct information, so you don't make a costly mistake. In this article, you will find in-depth information on what you need to qualify for long-term benefits, making it super easy for you when it's time to file a claim. 

What is Long-Term Care Insurance?

It's always good to plan for your healthcare. This is especially important for your later years when you might need extra help caring for yourself. Furthermore, according to the U.S. Department of Health and Human Services, 65-year-olds have up to 70% likelihood of needing long-term care support.

That's where long-term care insurance comes in. 

This insurance provides you with medical care when you're unable to take care of yourself adequately because of a chronic illness, physical condition, or disorder like Alzheimer's.

The benefit typically includes home health care, nursing care, hospice care, adult daycare, and assisted-living facility care. It offers services not usually available under standard health insurance, which does not typically cover custodial care or help when performing routine activities. 

Such services include offering assistance with:

  • Bathing, dressing, and feeding
  • Transferring from bed or seat to another location
  • Using the bathroom
  • Feeding and taking medication

The long-term care insurance policy assists you by covering payments for the extra care required due to the chronic medical condition or disability. When you lodge a claim, you receive reimbursements to help take care of ongoing expenses. 

However, to qualify for the benefits, you need to meet some basic qualifications. Let's find out what this entails next.

Long-Term Insurance Care Qualification Criteria

Unfortunately, you do not have the luxury of waiting until you need extra care to purchase long-term care insurance. This is not even an option. The thing is, you are not eligible to buy long-term care insurance if you already have an existing debilitating condition. 

As such, you need to start planning for your long-term care costs early, preferably in your 50s or early 60s. Besides, long-term care is pretty expensive, and you might not be able to afford it with a low income or minimal savings.

Therefore, you need ample time to plan for this necessary expenditure.

Once you have shopped around and purchased your long-term care insurance, below are the requirements you need to fulfill to become eligible for long-term benefits:

  • You cannot perform activities of daily living. You only qualify to receive benefits when you are unable to perform a minimum of two activities of daily living (ADLs) out of the total six. You are also eligible if you have Alzheimer's, dementia, or any other similar cognitive disability.
  • You need to have a doctor's referral. Your insurer will need a record from a doctor confirming that you need care services. In turn, the long-term insurer sends a nurse to evaluate whether you really need the care requested. 
  • Get a licensed caregiver. The insurance company will only reimburse your costs if you use the services of a licensed caregiver. The best thing to do is to get one who has insurance from their employer, preferably an agency.  
  • Confirm the minimum work hours per day. These could be anything between four and six hours. The caregiver will use this time to offer essential services like cleaning, shopping, meal prepping, and dispensing medication. Also, they might need to assist their charge with bathing, dressing, using the bathroom, or even entertaining.
  • Have the insured's name on the claim form. If your wife is the one needing extra help, she is still eligible to claim long-term care reimbursement from a caregiver, even if you usually assist her. But only your name (the insured person) should be on the insurance claim documents such as invoices.

How It Works

For starters, to get your life-term care insurance cover approved, your insurer might need to have a look at your medical records and ask you questions related to your health.

Depending on your health situation or preferences, you then proceed to select the amount of coverage. You can begin paying the premiums as soon as you receive your policy.

Before you file a claim for reimbursements, you need to have your long-term care insurance in place. For starters, you could enroll for a half-day each week, then increase the number of days according to your needs once the insurance company approves your care. 

Also, it's important to bear in mind that you might need to make some out-of-pocket payments for one to three months before your insurer reimburses you for any care undertaken. After this elimination period, your policy starts paying. 

At this point, you will have qualified to receive benefits and paid care for the period. In most cases, the insurer pays you a daily limit until you attain the lifetime maximum.

For couples who happen to have individual policies, your insurer could provide the option of sharing the total coverage amount. This means that you can access your spouse's benefits if you exhaust yours upon reaching the policy limit.

Read your policy document carefully so that you can understand your benefits and also note the exceptions. For instance, most insurers do not cover independent living in facilities offering assisted living as they limit the cover to essential services.

Final Thoughts

Long-term benefits become applicable when you need them most; when you cannot take proper care of yourself without outside assistance. Therefore, it's prudent to plan for your future health during your younger years.

This is also when you have the financial ability and the eligibility to enroll for long-term insurance care. Besides, the more money you have, the higher the quality of care you can buy for yourself.

Use the valuable information available here to buy the most suitable life-term insurance care for your needs. Your future self will thank you.


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