Long Term Care Insurance
Many people buy a long-term care insurance policy or plan because they want to stay independent of government aid and/or imposing on family. Long-term care insurance is a low cost tool which helps our clients protect assets from costly long term care while still receiving quality long term care home care services in their time of need. Key terms relating to long term care insurance are defined below.
Long -Term Care Insurance Policies may cover the following services which are available at Abcor Home Health, Inc.:
- Caregiver (Come & Go)
- Live-In Caregiver
- Certified Nursing Assistant (CNA)
- Skilled Nursing (RN/LPN)
- Physical Therapy (PT)
- Occupational Therapy (OT)
- Medical Social Worker (MSW)
Long-term care insurance considers these triggers for the start of benefits. If the client is chronically ill or suffers from cognitive impairment, AND they are unable to do at least two activities of daily living (ADLs) without assistance from another person for at least 90 days.
Another way the client may be considered to be chronically ill is if the client requires substantial supervision to protect his/her health and safety due to cognitive impairment. All long-term care insurance policies issued to the client before January 1st, 1997, do not have to define chronically ill as mentioned above.
Activities of Daily Living
A client’s ability or lack thereof to perform various activities of daily living (ADLs) is the most common criteria used by insurance companies to decide whether a client is eligible for benefits. ADLs most commonly used are bathing, dressing, eating, using the bathroom, and transferring. Typically, a long-term care policy pays benefits based on the clients ability to do a certain number of the ADLs, such as two out of six or three out of six. The six activities of daily living (ADLs) have been determined through years of careful scientific research. Interestingly, this and other research has shown that bathing is usually the first ADL that a person becomes unable to perform without assistance. While most long-term care home care policies use all six ADLs as benefit triggers, qualifying for benefits from a policy that uses five ADLs may be more difficult if bathing is the omitted ADL. Therefore, always make sure to ask your insurance company what the ADLs are under your policy.
Chronic illness is defined as an illness with one or more of the following characteristics: permanency, residual disability, the requirement of rehabilitation training or a long period of home care supervision, home care observation, and in-home care. Chronically ill is a term which describes a person who needs long-term home care either because of an inability to perform activities of daily living (ADLs) without help or because of a severe cognitive impairment.
Some long-term care insurance policies will pay benefits if the client’s doctor orders or certifies that home care is medically necessary. Long-term care insurance policies sold in the past required a hospital stay of at least three days before paying home care benefits. Most insurance companies no longer sell long-term care insurance policies that require a hospital stay.
Elimination Period/Waiting Period
Elimination, or waiting, period is a type of deductible. It is defined as the length of time the long-term home care plan holder must pay for covered home care services before the insurance company will begin to make payment. The longer the elimination period the lower the premium will be, so check with your long-term care insurance company regarding your plan’s elimination period.
Cognitive impairment is a term used to describe deficiency in a person’s short or long term memory, orientation as to person, place, and time, deductive or abstract reasoning, or judgment as it relates to safety awareness. Most long-term care insurance plans also pay benefits for “cognitive impairment.” The policy usually pays benefits if a client cannot pass certain tests of cognitive function. Coverage of cognitive impairment is especially important if you develop Alzheimer’s Disease or Dementia.