Long Term care insurance- How complicated?

Glenn1963

Hello I am brand new to this forum and am seeking advice. My mom has Alzheimer’s but is still functioning enough to live alone.  However she is easily confused and would be lost in any unfamiliar surroundings.  Like everyone she has good days and bad days.  Been told it’s not going to get better…. Luckily she has long term care insurance that will cover much of her care.  We’d like to move her into some kind of nice facility where we won’t have to worry about her as much. We understand she has to dish out for the first 3 months before coverage starts.  Does anyone know how daunting or complicated the claim forms are?   The ins company is John Hancock and is supposed to be quite good.  Thanks for listening.

Cynbar

John Hancock will have a representative who will assist you through this process, and they are generally quite friendly and helpful. Policies and companies vary widely, so it's hard to give advice specific to you and your mom. Reading the policy carefully is a good first step. There will be paperwork to fill out, usually by her PCP, in order to activate the policy. It's not as simple as telling them you are ready to start using it --- your mom will have to meet the criteria, which usually involves needing help with a certain number of ADLs such as bathing, dressing, etc. I've occasionally known people who went into AL but weren't able to start using their LTC insurance immediately (including the 3 month elimination period.) Often the doctor's nurse will fill out the paperwork and either call or have your mom come in for an appointment. Make sure she gets "credit" for any help she does need, many people try to put their best foot forward and say they need less help than they really do. Once the initial qualifying is over, it goes pretty smoothly, you submit copies of bills and get reimbursed up to the amount allowed. Some facilities and home care companies will send the bills to the company, but I think most of the time families are expected to do this.

Stuck in the middle

My wife's LTC policy covers care if she needs constant supervision or help with ADLs like eating or bathing.  If your mother can live alone, she would not qualify for insurance benefits under that standard.  I suggest you read the policy carefully before you commit to any expense.

Iris L.

You need to spend the weekend with your mom.  Look into her refrigerator.  You can't go by her attestation that she's doing okay and doesn't need any help.  

Iris L.

towhee

Hello Glenn, welcome to the forum. 

Complicated claim forms are not the issue. You really only need to qualify once, although they often reevaluate yearly and what they cover and don't is usually pretty straightforward. 

It is getting her qualified and how and what they cover that is important. You want that policy to benefit you as much as possible.

First step is to read that policy. Three times cover to cover. When you are rested and have time and your brain is working at maximum. I kid you not. Make notes of anything that is not completely clear. Contact the company for explanations of anything you do not understand. Get explanations in writing if possible, e-mails are good. You might want to go over the policy with an elder law attorney.

Look for  the type of policy it is.

 If it is a daily benefit policy--  how much per day? Does it have a maximum lifetime benefit? Does it have an inflation rider? Does it cover in home care as well as facility? Does it cover assisted living as well as nursing home? If it covers in home care do you have flexibility to use the benefit by the week and not the day? If she goes to long term care do you still have to pay the premium? Is there an equipment benefit?

 If it is a lump sum policy--How much? Do they just give you a lump sum and you have flexibility how you spend it or must you spend and then get reimbursed like a daily benefit policy?

Most policies sold today and for the last few years are lump sum policies and when you use the money up it is gone. Even with long term care insurance you have to take a good hard look at your mothers financial resources. Do you have enough for maybe 2-3 years of AL, 2-3 years at MC, 2-3 years at a nursing home. Do you need to think about qualifying her for Medicaid at some point and how will that affect your choice of facility?

towhee

Part two-Qualifying- Like Cynbar said your mom has to qualify and the criteria will be in the policy. With dementia it is usually that a person needs 24 hour supervision to prevent harm to themselves or others, although not being able to do physical activities of daily living also helps. The persons' PCP is asked to fill out paperwork, and also the LTC insurance company often sends out a nurse to do a home visit, interview the applicant and do some testing, usually a longer form of the MMSE that the PCP or neurologist does at each visit. It is important that someone be at this interview other than the person with dementia, as the person with dementia will often say they can do everything fine. They will ask safety awareness questions such as "what would you do if a pan caught fire on the stove?" Any help the person gets needs to be mentioned, even if the help is only verbal cueing or supervision.

Like Iris suggested, if you have not done so, it is a very good idea to spend a few days living with your Mom to get an accurate picture of her abilities. Spending a few hours with her will not give you a valid assessment. Check out her bill paying and whether she is donating money excessively, or any strange investments, as well as her fridge. Check her medications and how she takes them, you might want to check with her pharmacist.

If you are her POA and HCPOA and are already on top of all this, please just ignore unneeded advice.

Wish you well-

Glenn1963

Thanks everyone for all the advice.  It’s not going to be easy going but will do our best. Great advice and suggestions.

mommyandme (m&m)

We’ve used John Hancocks LTC insurance for almost three years. They’ve updated their website which has helped. As soon as she was officially diagnosed mid-moderate AD she qualified.  And yes she had to pay out completely the first 90 days. We started with 6 hours per day, three hour split shifts. Then increased to two 4 hour shifts in a day to 24/7. 

She has to pay out personally for her care after her monthly limit of LTC coverage is used.  We are still keeping her at home and hope to do so for the rest of her life.  

When her neurologist told us she needed 24/7 care we continued her split shifts for a bit but installed cameras to supervise her when no one was there.  The neurologist said that could be used as 24/7 supervision for a bit. That worked and the cameras were invaluable but we did have to get caregivers to be with her consistently not long after.  

We moved her right next door to me a year ago... I still use the cameras even though I’m her primary care giver.  We are using her LTC insurance for my respite, which covers about 32 hrs a week.  She pays the Home Care company we use then I submit the invoices to John Hancock so they can then reimburse her. 

There’s always room for improvement with any company but we are so fortunate that she invested in this.  They also refunded her premium that she had already paid when she started making claims. 

So sorry you’re having to navigate through all this.  I find this forum so helpful! I read it most every day.