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My in-laws each have a LTC Insurance Policy. Both meet the 2 of 6 ADLs. Doctor drafted a Plan of Care for my homebound FIL, age 88 (father-in-law) with cognitive impairment and mobility issues. My MIL, age 90, is visually impaired, glaucoma, cataracts, dry macular degeneration (legally blind left eye) and in need of respite care as she has been the primary caregiver since FIL 2017 diagnosis. She uses magnification to read printed material and needs with meals, housework and respite care. Are there resources to better understand what is need to initiate Medicare and LTC Insurance?

You’ve gotten really great answers from Freebrowser & Gracie.

if it’s looking like it will just be better for them to go into a NH, you might want to do a bit of research ahead of this. Some places will not take LTC insurance for payment. My moms NH did not. I asked billing why and what they said was that each of the LTC insurers have their own form and requirements. Some want very detailed info on staffing as they pay only if it’s an RN & it was taking staff loads of time to do this. That the reinbursement doesn’t cover all costs so still have to bill for the rest. And that it would tend to be a constant “more info needed” from the LTC insurance co. so payment took forever. That the NH could easily fill their beds with private pay residents or duals on Medicare and Medicaid. So not need for LTC insurance & it’s hassles.
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soupnsalad Dec 16, 2020
Thanks Igloo572. With the pandemic we plan to navigate the LTC process (thank you for sharing Freebrowser & Gracie). Hopefully we will not have to deal with NH's during Covid. Thank you for responding!
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Our experience was similar to Gracie61's.

Read the policy. Call the number to get the forms, etc. Take the forms to the doctor, complete and submit. Interview with insurer's RN. Approval for X number of days/hours in-home coverage.

Our 90 days ran consecutively, even if care wasn't used every day. Visiting Angels agency required a deposit and billed weekly to credit card during 90 day period, then submitted bills to insurer who direct deposited approved amounts, not including small amounts for extras like short shift fees.

Insurer sends statement stating how much remains of dollar amount of coverage. Ours is three years' worth of daily benefit amount (DBA). Home care daily max is half that of nursing home amount, so can be stretched for six years and more. Waiver of premium means they stop billing for monthly insurance payment after she was on claim.
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soupnsalad Dec 16, 2020
Thank you for taking time to share your insight. It is so helpful.
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I just called the LTC insurance to iniate a claim. Read the policy some have specific requirements for facility. Mom's insurance came out to evaluate her to confirm need. Didn't matter that the facility and doctor had already done so. They also required info from facility. My mom's policy had a 90 day exclusion,so she had to private pay for 3 months before they paid. You will get a ton of forms to fill out. The way it works for us,is that the facility auto debit her checking account and sends detailed invoice to LTC insurance, who then autodeposits what they will pay into her account. I am my mom's POA, so they required copies of POA. I get an EOB, which shows what they paid. She has a good policy, pays 232/day, which covers a lot of her costs. It would pay for AL or Memory Care or Skilled nursing. Or a smaller amount towards aides at home setting.
Meducate only covers medical stuff, so it may cover durable equipment or maybe an aide to help with something after a hospital visit, but it really doesn't pay for LTC. Also only use it when you need it, mom's policy has a dollar amount cap, it will payout for about 5 years, then its going to be private pay again.
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soupnsalad Dec 16, 2020
Thank you Gracie61 - this is so helpful.
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