When you think of long-term care (LTC) insurance, you might think it’s just a part of your health insurance policy—or at least pretty similar. But these are actually two completely different insurance products. And even though both health insurance and LTC insurance can help you financially prepare to deal with health problems, there are some very important distinctions.
Let’s take a look at five of the biggest ways LTC insurance is different than health insurance.
While health insurance is designed to provide coverage for basic health care necessities—regular doctors’ visits, inpatient and outpatient care, prescription drugs, etc.—long-term care insurance is intended only for just that: long-term care, which is when you need care for more than 90 days.
LTC insurance typically covers assisted living facilities, nursing home facilities, adult day care services, and home health care needed for basic daily functions (or activities of daily living, also known as ADLs, including bathing, dressing, toileting, transferring, and continence).
Like health insurance, premiums for LTC insurance can vary widely. Your age, your state of health, your state, your benefits, and your chosen insurance carrier can all have a significant impact on what you’ll pay for your LTC policy.
But unlike health insurance, you can purchase LTC coverage earlier in life to lock in a better rate, look for policies that may offer a discount for your spouse, or choose a hybrid policy that includes both health and long-term care benefits.
Often one of the first signs insurance carriers look for if you’re seeking to qualify for your LTC benefits is trouble with the ADLs (those activities of daily living), which include bathing, dressing, toileting, transferring, and continence. Difficulty performing these tasks on your own, either due to physical limitations or because of cognitive trouble, can trigger the benefits of your policy.
This can be a grayer area to navigate than some of the qualification requirements needed for health insurance benefits and can be difficult to maintain qualification for since these are ongoing conditions.
While most health insurance claims are for a single occurrence and don’t require anything from the insured after it’s filed and paid out, LTC claims are quite a bit more complicated. For starters, LTC claims require you to demonstrate the need for care every single month. If you or a family member requires LTC services for a period of years, that doesn’t change the monthly requirements—you can easily imagine the burden it puts on the family just through managing the insurance component of long-term care.
LTC claims can also face higher scrutiny than a typical health insurance claim, making it more difficult to get them approved and paid in a timely manner.
Because of the wide range of services that can be required for LTC support, including home health, assisted living facilities, and more, there are a lot of loopholes and gray areas for what is and is not covered. Some LTC policies require certain licensures or certifications for service providers, for instance, and it can be trickier to navigate those requirements than just knowing whether the provider is “in-network” or “out-of-network,” as is the case with most health insurance policies.
And due to the confusing nature of the LTC policies, it can be very difficult to determine what qualifies as a benefit.
LTC insurance policies and claims just aren’t as straight-forward as health insurance. And since health insurance isn’t known for being very clear-cut itself, that’s saying a lot!
If you’re having trouble navigating your LTC policy, your LTC benefits, or your LTC claims, contact Family Solutions for Care. Our claims team is experienced in understanding these policies and getting you and your family the benefits you deserve! We can’t wait to talk to you: contact us today!