Long-term care planning is an essential part of protecting your family and finances, making now an ideal time to review your long-term care insurance (LTCI) policy or explore your options if you're considering purchasing one. M Financial Planning Services is here to help guide you through this process and find the right fit for your needs.
Whether you’ve had a policy for years or are new to the concept, understanding the specifics of your LTCI policy is critical. Key details to review include:
What determines if you're entitled to benefits?
LTCI policies vary, so it's essential to review yours. Common triggers for benefits include:
- Inability to perform a certain number of activities of daily living (ADLs) without assistance (e.g., eating, bathing, dressing). Policies differ in how they define "unable to perform" and which ADLs are covered.
- Specific care ordered by your doctor.
- Medically necessary care or mental/cognitive impairment.
- (Rarely) a prior hospitalization of at least three days.
Who decides if you've triggered benefits?
The "gatekeepers" of LTCI benefits determine if you meet the criteria for coverage. Some policies allow your doctor to qualify you, while others require evaluation by an insurance company physician. Make sure you know who has the final say in your policy.
When will benefits start?
Most LTCI policies have a waiting (elimination) period before benefits kick in. These vary by policy and can be cumulative, consecutive, or applied once per claim or for the life of the policy.
Filing a Claim
Understanding how to file a claim in advance is critical. Policies often require:
- Written notice within a specific timeframe.
- Proof of loss and supporting medical records.
- Periodic verification of your condition.
Missing key steps could delay or deny your claim. M Financial Planning Services can help ensure you’re prepared to navigate these steps and make informed decisions about long-term care. Reach out to us this Long-Term Care Planning Month to start the conversation!