My grandmother has long term insurance. We need an aide. When looking for a home health agency, can it be a private agency or Medicare?

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Does is have to a medicare regulated agency to accept long term care?

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Look on you LTC contract & see if it has premium waiver written anywhere. I would call & ask how do I get my Premiums waived. I did & luckily had asked before starting 90 1hr days & got them waved BUT must comply w their rules to continue so keep phoning & ask several times a year to make sure. Ours was $3000 yr so lots of savings.
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Every long term care insurance policy is indeed different. However, when I was helping a client call her LTC insurance company to help her ask questions about her coverage, I found that the LTC company rep used confusing language. Remember that home health agencies are licensed to provide home health services through Medicare (or private pay, or LTC insurance)-- no matter who is paying, home health provides ONLY skilled nursing, physical therapy, occupational therapy, or speech therapy in the person's home. A bath aide may be provided while the person is receiving one of the other services. Home health must be ordered by a physician and is going to be short-term therapy or skilled nursing provided in the person's home. The person must be considered "homebound," meaning they have difficulty or need assistance in leaving the home to go to appointments. Home health agencies do not provide "custodial care," meaning cooking, cleaning, laundry, transportation, personal care.
Home Care Agencies, on the other hand, can provide personal care, meals, housekeeping, laundry, and transportation. They do not provide any medical services such as skilled nursing or physical, occupational or speech therapies.
Make sure you and the LTC insurance rep you're speaking with understand the difference between home health and home care. This is important because home health is a benefit already included Medicare Part A at no additional cost- so why use up your LTC insurance benefits for something you get free? Medicare does not cover "custodial care" (cooking, cleaning, personal care, laundry, transportation)- so you want to make sure to save using those LTC insurance benefits for home care, not home health.
You also want to see what the waiting period is for your grandmother's policy. For example, the lady I was helping had a policy that would begin paying after she had already paid for 90 days privately. Make sure you ask what the company considers a "day." In this lady's case, I made sure that they considered a "day" as at least one hour per day in which she paid for her care. The company rep said what this lady had to do was to go ahead and hire a licensed home care agency, then call the company and give them the home care agency's name and contact information. The insurance company would then contact the home care agency and send them some paperwork. (while this is happening, the insurance company would also conduct an assessment through an independent assessor the insurance company works through). The home care agency will then submit monthly invoices to the insurance company, who will track the countdown to 90 days that the lady is paying for herself. The rep said that once the 90 days are met, then the home care agency can begin bill the insurance company, which would pay for up to 5 hours of home care per day. This lady was smart and paid extra money in her premium to cover inflation- so her benefits will keep up with the rising costs of care. Typically, when you start using your benefits you do not have to keep paying your premium. However, this lady chose a plan that had a lower premium amount- but- she will have to keep paying her premium even when she is using her benefits.
I hope that helped! Of course, that was an example of a particular lady and her policy. I would recommend calling and asking lots of questions. Don't be afraid to ask the insurance company rep the same question more than once in maybe a different way--that way you make sure they're giving you correct info. Also, make sure to check in with them that you're understanding, and state back to them in your own words what they've told you. For example, you could say, "So what I'm hearing is that my grandmother would have to pay privately to a licensed home care agency for 90 days before her benefits will start. Do I have that right?" Write down the rep's name, date and time of the telephone call. Take lots of notes, and see if you can get a rep's e-mail address and communicate with them via e-mail so you can have it in writing.
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Every Long term care is different I found. We have one & I have read it 10 times but still don't understand it all. I just keep calling the company LTC as they explain to me my questions. I prefer it in writing but not always getting. Don't be afraid to keep calling them tell them give the answer in kindergarten language so you can understand. Every call is usually recorded. Also ck on when premium can be waived. If it is written so you can use unlicened caregivers as some are not written that way so only reimburse licensed.
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That's a question for the insurance company.
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