Qualifying for long term care insurance.

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Okie32 Asked November 2023

Qualifying for long term care insurance.

My mother is 96 and lives with us. She shuffles when walking and uses a cane. She is able to do the ADLs although not easily. I manage her business, appts and medication. She has early dementia but I think it’s advanced somewhat so we will see what the Dr says. Her insurance says to trigger she has to not be able to do 2 of the ADLs or have cognitive impairment. I know it will be different with different insurance companies but I was wondering what people have experienced with LTC insurance qualification? I feel like her age and dementia should qualify her. But there is a 90 day elimination period and I can’t apply for LTC until she moves into AL. But if she doesn’t qualify she can’t afford to stay. Thoughts?

Assisted Living Care Decisions Financial Planning Long Term Care Insurance Paying for Care

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score 0 · Answer 1

If your mother lived alone, would she be safe? Probably not due to the dementia. Make sure your doctor knows her limitations and her safety issues. What does the neurologist say?
She should qualify based on that.
And the fact that you’re handling her medication‘s and other items for her indicate that she can’t be on her own. Safety is usually the key to being approved for cognitive issues. That needs to be in the medical records.

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score 0 · Answer 2

For momma as soon as she entered assisted living I applied for Long Term Care. She did have a waiting period and we had to self pay a couple of months but after I filled out all of the paperwork she got qualified. They pay every bit of it every month. Now she does have a Dailey limit and when she goes over that we have to self pay the difference but we are not there yet eventhough her assisted living fee went up to $500.00 more a month. Last year it went up $200.00 more a month. Jacked up!!

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score 3 · Answer 3

I can't imagine that she wouldn't qualify. Without you help there would be very little in terms of ADLs that she could manage on her own; am I correct?

You might consider contacting an independent board certified patient advocate for help with this at www.NPAF.org. Or contact an aging professional at www.aginglife.org. I have never contacted either but have them "on my list" and think they may provide information or further guidance on what to explore?
Good on you for thinking ahead.
Hope you will update us and wishing you good luck.

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score 2 · Answer 4

Newbie here, first post.
My parents' LTC insurance policies had a option for in-home care that could be started immediately if unable to do 2 ADLs. Then, if they went into AL, the 90days was waived. Might you have that option?

The insurance company sent a nurse to my parents' home who evaluated my dad (first of the 2 to need help) for ADLs as well as cognitive decline (with the mini test). A doctor's assessment wasn't required.

Having difficulty with ADLs may be all you need. Both of my parents could, between the 2 of them, manage a lot, but slowly and not great results.

If I were you, I'd ask for an evaluation at home. Ask lots of questions of the insurance company, they won't necessarily tell you.

Good luck.

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My husband's LTC policy was similar. Because it covered in-home care, once he was getting in-home care the 90 day clock was started. In his case, he had Parkinson's, but that wasn't what necessitated the care initially, but rather an unusual case of shingles that went into his spine and damaged the nerve for one leg, rendering him unable to stand or walk for quite a while. Because this was an acute situation, Medicare covered in-home OT, PT, nursing, and a bath aide a few days a week. The LTC company got the notes from the agency providing the Medicare services, and that was enough to get him approved initially for home health aides shortly after the Medicare-covered services ended, once the 90-day mark had been hit. The following year, the LTC company sent a contracted nurse to the house to re-evaluate him, and she was very thorough. In subsequent years they didn't send anyone to the house because Covid had hit, but instead relied on notes and forms filled out by the company providing his aides. To tell the truth, if you ask the LTC company for an evaluation of eligibility, I think the 90 day clock could start even if no one is being paid for in-home care.

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score 0 · Answer 5

Did the insurance company tell you that she can't apply until she moves into AL?

Does the policy define ADLs (does it include IADLs?) and does it define cognitive impairment?

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It says ADLs and cognitive decline. They said to apply 30 days out from move in date. And they said it could take 30-45 days for approval. the places we’ve looked at require deposits 30 days out so we would have to commit to a place before knowing if she is approved.

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score 1 · Answer 6

Does the policy specifically say they will not pay out unless someone is in a facility? I asked the question because many many policies do not require that, only inability to perform 2 ADLs (in rare instances, 3).
Does she have a formal dementia diagnosis?

Take a look at the link below. Is she really able to perform these ADLs safely?

https://erisaattorneys.com/activities-of-daily-living-trigger-long-term-care-benefits/

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score 0 · Answer 7

Too late for LTC insurance, alas. Spend down and get her ito a place that accepts Medicaid.

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She HAS LTC insurance. The question, will the policy pay out.

(2)

Qualifying for long term care insurance.

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