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  • Writer's pictureAlex Strein, MBA

Understanding Your Long-Term Care Policy


Understanding Your Long-Term Care Policy Graphic

According to Longtermcare.org, 60% of Americans will need assistance with care during their lifetime. Many older adults took out long-term care policies decades ago to help them prepare for the future. These policies help pay for care, while allowing the policy holder to preserve assets for their families. Making sense of your policy many years down the road can prove to be difficult. While each policy and each insurance company has its own regulations, there are a few things to look for when understanding your coverage.


• What Levels of Care are Covered?

Many people took out policies referred to as long-term care insurance, while some are specifically listed as “Nursing Home” insurance. If your policy mentions having options for alternative care, Assisted Living may be covered by your policy.


• How Much Will My Policy Pay Per Month?

Most policies layout a maximum payout per day. This amount multiplied by 31 is the total amount the policy could potentially pay out per month. This dollar amount can go towards any rent and care level costs.


• How Long Will My Policy Pay?

Some policies have a maximum payout. This can come in the form of a fixed dollar amount, or be indicated by a time frame (Ex. up to 36 months). Some policies do not have a maximum payout and will pay indefinitely.


• How Long Until the Policy Kicks In?

Most policies have some sort of exclusionary window or elimination period. This window typically ranges from 30-90 days, depending on your policy. That means that you will be required to pay out of pocket during that period before the policy will start paying out towards your care.


• Does My Policy Account for Inflation?

That is determined on a case-by-case basis. Some policies offer an inflationary increase, while others do not. You likely would have been mailed additional forms to inform you of such changes if your policy was eligible.


Once you’re ready to move into a community, you will need to contact the company to initiate a claim. You will need a letter from your physician stating that alternative care is in your best interest, as it is no longer safe for you to be at home alone due to your care needs. Most insurance companies want to see that you require assistance with at least two activities of daily living (ADLs) in order to approve your claim. Assisted Living can assist with ADLs such as bathing, toileting and dressing. Your community will be required to submit documentation on what ADLs they provide assistance with.


As an added bonus, The Paragon will help you file your claim and provide necessary documentation from month to month during your stay! Call to learn more about what else The Paragon can do for you. 270-824-9006.


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