The 3 Most Important Things to Clarify with your Long Term Care Insurance:

  • Do you have an Elimination Period? If so what is needed to satisfy it?
  • What is your daily or monthly benefit? Does it pay 100% of the benefit for care in the home?
  • Do you need to use a licensed agency to use your benefit?

Getting through the “red-tape” of Long Term Care insurance can be daunting. This is why it is so important to understand your policy before you initiate a claim.

Eligibility Criteria

All LTC policies have eligibility criteria that you must meet, before you can use your insurance. There are two ways to access your long term care policy. The first is to qualify by needing help with at least two of the six activities of daily living. These activities of daily living usually include bathing, dressing, feeding, ambulating, transferring and continence. Help with daily activities does not necessarily mean that you need “hands on” assistance. A patient can need “stand by” assistance. Stand by assistance is having an aide present at arm’s length to provide assistance and ensure safety.

The second qualification is cognitive impairment, which needs to be diagnosed  for eligibility to use their long term care insurance.

Once you decide to use your LTC insurance you will need to contact your carrier by phone and initiate a claim. It is a good idea to have your policy available during this process. The representative can explain your policy specifics and their meanings.  They can also answer any and all of your questions. A quality agency should be able to assist you and participate in this process.

It is common for your insurance carrier to arrange for you to be evaluated by a local independent registered nurse assessor. He or she will be sent to your home by the insurance company to evaluate your functional status. They will conduct a short test called a Mini Mental Folstein exam. This is a 30 question interactive exam where the insured is scored based on their answers. A comprehensive score below a 23 usually makes the insured eligible to use their policy.

Help with Claim Forms

Most insurance companies will send you claim forms to complete as well as forms for your doctor and agency to complete. You MUST complete your forms and send back to the carrier so they can review your claim for approval. Remember,  your claim needs to be APPROVAL before it will pay out the benefit to you or your agency. This process can take anywhere from 14-60 days depending on the carrier.

When looking into licensed agencies, you will want to inquire about their ability to help process your claims. Confirm that they can submit and track your claim for the entire time you are receiving services from the agency.  Always ask how frequently they process and submit to the carrier. If your agency does not submit on a weekly basis chances are you will have issues with the insurance payments being timely. Look for any agency that has a significant amount of LTC clients and has a dedicated insurance person or personnel. This way you can rest assured that your insurance is working for you!

Elimination Period

Many Long Term Care policies have an elimination period. This is a period of time that the policy will take to go into effect. For example, if a policy has a zero day elimination period, the policy will go into effect on the first day the patient requests help. Some policies have a 30 day elimination period.  The policy holder will have to pay-out of pocket for the first 30 days of care, before the insurance pays on day 31. Elimination periods can be as long as 90 days.

It is to your advantage that you understand your policy, so you can use it to your full advantage. There are policies that will even pay you a benefit for medical equipment. These include hospital beds, commodes, grab bars, monitoring systems, ramps and handicapped renovations. Many policies even cover homemaker services, such as meal preparation or housekeeping.


When you are shopping for the Long Term Care Insurance, make sure that you check to see what exclusions apply. It can be pricey, so you want to understand what will and will not be excluded.

Platinum Select Care has a dedicated insurance department with many years of experience dealing with Long Term Care Insurance companies. We will on your behalf, verify your insurance and assist with initiating the claim. We will also contact and communicate with your LTC carrier to see if there is any way to waive or reduce the elimination period.

Knowing that your Golden Years will be golden, is the smartest decision you can make. In conclusion, l LTC insurance ensures that you have care  when you need it. Furthermore, it provides peace of mind for you and your family. If you have any questions regarding the Long Term Care insurance process or home health care, please feel free to contact us at Platinum Select Care  561-998-3211