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I’m afraid to use her benefit for minor help, like getting ready in the morning. Should I save it for major things?

My experience has been that most long-term care insurance policies were purchased 10 to 15 years ago with benefits of $100/day with no inflation rider. Most are limited in duration by either the bucket of money approach or by a stipulated benefit period.

What most don't know or recognize is that it is possible to receive public benefits (Medicaid and/or VA) while simultaneously making claim on an LTC insurance policy (depending on expenses and assets).

For instance, I presently have a Florida client living with her spouse in Independent Living. She has a policy that pays $150/day for Home Health Care; not enough to cover the 24 hour cares she requires. The family does NOT want to place her in Assisted Living or a Nursing Home. The policy and the couple's income are not enough to provide the needed care and cover room and board.

She has less than $2,000 and her spouse has less than $123,600 in countable assets. Her income is under the $2,250 per month Medicaid eligibility limit (her spouse's income is higher but in Florida there is no income limit for the Community Spouse).

We applied for and she is receiving Medicaid Home and Community based services which is providing 40 hours of personal home care per week.

The husband is a wartime veteran who does not require care. Still, because of the couple's high unreimbursed medical expenses, He will qualify for a VA Improved Pension Basic award of $1,097 per month.

This combination of all three benefits, plus the couple's income and a small amount from savings is supporting the couple's needs.
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Reply to Ralph Robbins
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Baradee Dec 18, 2018
Ralph. Thank you for this info. Extremely helpful. Tx
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I am going through the same decision process right now for my dad. I am leaning heavily toward using the funds from the LTC now, as there is no cash value should my dad pass away before using up those funds.

However, before you can make that decision, you really do need to have a clear understanding of the details of your mom’s policy. For example, my dad’s policy states it pays for two years, but, when closely asked, they told me that the 2-year period assumes maximum payout per day and actually pays until the full dollar amount of his benefit is exhausted. In most cases, in order to activate a claim, the beneficiary must be diagnosed as requiring at least 2 of the 6 ADLs (Activities of Daily Living) AND the policy issuer will send their own HHC rep to assess. (Warning: They don’t always agree on the stated level of need and can deny the claim.) Also, and I’ve heard this from just about everyone with regard to LTC plans, the plans have specific requirements as to who can provide the HHC services; they may or may not have a list of “in network” agencies, and/or they may allow non-agency aides, but most require those aides to be licensed, whether working through an HHC agency or independently.

I hope this helps. Please keep us posted! :>)
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Reply to DaddysgirlinTX
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AT1234 Dec 16, 2018
Some like my moms have a “elimination period” that is like 180 days private pay, only THEN does a claim begin any payment. So 6 months of private pay can wipe parent out before insurance pays an 80$ a day. Many AL are much higher than that.
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Honestly, it depends on the policy and how it is written. Does it cover both home care and residential placement? What is the waiting period? Is the coverage length limited by time (will cover for two years) or by total money to be paid?

We found when activating a long term care policy that there were many aspects of it that the person who bought it was unaware of. You need someone to review the policy with you to decide how best to use it.

We also found that in the county our elders lived, the Council on Aging offered a certain number of home care hours without fee. Contact your local Aging department and see what resources are available to you.
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mlface Dec 19, 2018
This is true in our case as we bought so board & care homes could be used & any person we hired (no relatives) could be hired at our home for his care. Also it states can’t do 2 things OR cognitive impairment. He as Alzheimer so cognitive impairment qualified him but had elimination period then good to go no more premiums. Ours says 6 yrs at $120 day which doesn’t mean only 6 yrs but total Amy. If we use $60 day we’d have 12 yrs. I hired caregiver for 4 hrs & 2 hrs times what I paid them, filled out the hourly form & days required by LTC then they reimbursed me & subtracted that amount from the contract total. I say use it so you the caregiver arn’t one of the 70% of caregiver that die or get sick before one caring for. I’ve seen it happen. Stress we don’t think we have but our kids notice it so listen &get in a support group.
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Question 1. You may check if the benefit kicks in but it is usually meant for LTC.
Question 2 is never pay out of pocket. Check with social services first. If she is still paying for the insurance you have now discovered the loophole that makes these plans expensive and sometimes worthless. Can she sell the house and move to smaller quarters so that she can afford help?
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Reply to MACinCT
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Please read policy repeatedly and then talk to their case worker more than once. We thought we had a good plan but discovered we were still mistaken on couple things. Those policies are complicated. On ours, Mother had to live in the facility and pay herself for 6 months before policy paid.
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AT1234 Dec 16, 2018
Same with ours my mom is panicked over running out of money, before 6 months. Even at that afterwards it pays $80/day but that’s for life. She doesn’t want to be in facility so we’re researching home health options.
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I agree with MACinCT (clicked on helpful) - never pay until and unless there is no other option.

DaddysgirlinTX's answer is also very good advice. You can always call the provider of her Long Term Care policy and ask questions.
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Reply to RayLinStephens
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You have been given some spot-on advice from others.

The only things I’d like to add is that should the day come that your mom needs to go into a LTC facility - like a NH or MC - you do need to clearly ask IF the place will accept your mom’s LTC insurance policy as payor on her bill. Like Shady Acres NH does NOT have to accept your mom’s Genworth policy she’s been paying on last 20 years. My mom’s NH did not take any LTC insurance and had a large sign as to that in the lobby, admissions and billing offices. The NH ( small chain) was private pay, MediCARE or Medicaid only.
My mom was a “dual” (on MediCARE & Medicaid) and one day I was in billing office adding $ to my mom’s personal needs account I ask why the no LTC insurance. The billing guy told me that it wasn’t worth their time to deal with the myriad of requirements from the various LTC policies..... every insurer had their own forms and requirements as to data needed (like how many hours of RN, CNA, LPN, etc) in order for a bill to get paid and there just was always, always, always something to delay payment. That the older policies from last millennium tended to require actual RN doing 1-on-1 care, so they wouldn’t meet the staffing requirements for the policy, yada yada. That it was more efficient & financially better to take a M&M resident as payment was assured and payed timely and he knew to the penny what my mom’s account was getting paid.

Yeah read that again, it was better financial decision to take Medicaid resident rather than one private pay with a LTC insurance policy. I have no idea if this is a trend but if so, a lot of folks will find that their LTC policy means it can only work IF they stay in their home and get assistance with Home Health companies that take their specific insurer.

As others posted be sure to carefully read what the required self pay period is BEFORE the policy activated. Especially look to see IF a post hospitalization rehab period (Medicare paid) does or does NOT count in the selfpay period.
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mlface Dec 19, 2018
In our case w LTC yes they fill a plan of care w license #. But. I am given the bill as well as them faxing to LTC & I pay the bill & our LTC reimburses me which is no more per day than contract w LTC & each pmt to me is deducted from contract total.
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I agree with everyone's advice so far. The LTC policy can be a godsend depending on the policy and care level needed. I do feel you should call the insurance company and have them explain exactly what the policy covers and under what circumstances. For instance: Does it cover home health care or would your mom have to live in a facility? Can you just get a CNA to come in to help out a few hours per wk or does the policy require some sort of medical person like a nurse or therapist to see her once a week? For how long do you have to pay out-of-pocket before it kicks in? What would cause the insurer to discontinue payments? What do you need to do to activate the policy, and then what?

Please note that due to privacy laws they may not be willing to divulge any info to you unless you have POA for your mom &/or you submit a document (which they can provide to you) on which your mother gives them formal permission to release info to you. You should submit a separate one of these for each person who might need to act on her behalf. Send in these forms NOW while she is hopefully still able to sign them even if you don't activate her policy just yet. It will make things easier for you later on.

Good luck to to you and your mom.

Also, some policies are like a clock, once a claim is triggered they continue until the time's up. So if she has a 2-yr policy but she only needs to use it for a short time it might be best to wait until she needs it for a longer period.
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Reply to karenjoy
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I just thought I would give you and others, an example of how long my mom's LTC with Genworth lasted. (and how much was paid out of pocket)

It was a $150,000 policy with max of $100 per day.
Dad paid all of the first 90days of home care. ($16,000)
Genworth paid the next 3 yrs of home care at $80/day ($2400 of a $7400/mo fee)
Genworth paid the next 3 yrs of Memory Care at $60/day ($1800/mo of a $5000/mo fee)

These policies are not for the poor! It definitely helped, but had she not had a good retirement plan, she would have been better to use up all of her funds & end up on Medicaid. (which is what will probably happen now)

Mom has Vascular Dementia and has not declined or had any further strokes/TIAs, in the last 4 years. At 83yrs, with a history of 3 strokes and many TIAs, she is amazing us all.
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AT1234 Dec 16, 2018
Thank you for specifics, that really helps.
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Thank you. Very helpful info.
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