Insurance Law

Long-Term Care Insurance

Most people only carry the insurance they have to have, like car insurance or homeowners insurance. If you have family members to think about, you may have a life insurance policy. Unfortunately, most people don’t think about one of the most useful and overlooked options — long-term care insurance.

Long-term care insurance can help pay for your care when you get older or are no longer able to care for yourself. To find out more about long-term care insurance coverage and disputes, contact a long-term care insurance attorney for legal advice.

What Is Long-Term Care Insurance?

Long-term care insurance (LTC) is a type of insurance that covers the costs associated with long-term care. This is different from medical care for illness, medical conditions, or disease. This type of care is for people who are no longer able to provide for all their daily needs without help. This could include people with a physical disability, chronic condition, cognitive impairment, or simply after getting older.

If you need long-term care, you can pay out of pocket, get government benefits if you qualify, or buy LTC insurance. With a long-term care insurance policy, you can choose your level of coverage to offset the costs of long-term care. Costs of coverage can depend on:

  • Age
  • Maximum coverage amounts/maximum days
  • Lifetime maximum benefit amount
  • Other benefits
  • Individual care plan

Who Needs Long-Term Care Insurance?

Chances are, everyone needs long-term care. According to the U.S. government’s Administration for Community Living, 70% of people aged 65 or older will need long-term care at some point in their lives. Women in the U.S. generally live longer than men and need long-term care for more time. About 20% of older Americans will need long-term care support for more than five years.

Even for people who feel healthy now or are looking forward to aging gracefully, a simple accident or illness can change everything. Before you know it, you may realize you have problems walking, difficulty remembering basic things, or taking care of your basic needs. Long-term care insurance policies are a way to make sure your needs will be taken care of when the time comes.

What Does Long-Term Care Cover?

Long-term care coverage depends on the individual insurance policy. Types of long-term care benefits can include medical and non-medical care. Long-term care provides services to allow for independence and quality of life. One of the most basic needs is for people who need help with activities of daily living (ADL), like:

  • Personal hygiene (washing, dental health, grooming)
  • Mobility and walking independently
  • Eating and drinking
  • Dressing
  • Bathroom functions (toileting)

Community living, adult day care, assisted living facilities, nursing home care, Alzheimer’s disease facilities, or in-home health care can provide these services. Some facilities, like skilled nursing homes, also have medical staff that can provide limited medical services to residents. Some long-term care policies will also cover temporary care or short-term hospice care for the terminally ill.

Long-term care may not cover certain preexisting conditions. Eligibility for benefits may require a waiting period of several months or longer. If a family member caregiver gives you in-home care, the policy may exclude coverage.

Do You Need Long-Term Coverage If You Have Medicare and Health Insurance?

Health insurance and Medicare coverage are great for reducing your costs of health care, but they don’t cover everything. Medicare specifically advises people that it does not cover long-term care or custodial care. Medicare only pays for long-term care if you need skilled medical services or rehabilitation.

Some Medicaid programs cover medical long-term care services. Medicaid is for people with limited income or those with certain disabilities. Medicaid coverage varies greatly by state. Find out about your state Medicaid coverage, if you qualify, and what it covers.

What Can You Do When the Insurance Company Doesn’t Want to Pay?

Dealing with insurance companies is never pleasant. It can be hard enough to get a human on the phone. When a doctor or nursing home provides services, they bill the insurance company using billing codes. The insurance company may decline your services if the provider code doesn’t match up with the insurance code. Some insurance coverage disputes are just a mix-up between the provider and the long-term care insurance company. Unfortunately, you are the one who pays the price.

If the insurance company doesn’t pay for covered care, the policyholder can dispute the bill with the insurance company. This can be complicated and require you to do some research. If you have an attorney on your side, they can handle the billing dispute to make sure your insurance pays for what they owe. Your attorney can also review past bills to identify other charges the insurance company should refund.

How Can a Lawyer Help With Care Insurance Disputes?

Insurance company disputes can be complicated, and the insurance company has an interest in keeping as much money as they can. It may take an experienced insurance law attorney to help you get coverage for your long-term care.

Your attorney can handle any claims disputes to make sure you get the long-term care your loved one needs. This can also help avoid any further disputes down the road. Find an insurance attorney to answer your questions about long-term care insurance claims.

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