How does LTC Insurance reimbursement work?

Curious about how LTC Insurance reimbursement works? Whether you currently have a plan with reimbursement or are interested in buying one, there are a few things you should know.

Some LTCI policies are reimbursement only, while others may allow the insurance carrier to be billed by the caregiver or facility directly. In this scenario, the insurance company pays the facility for your care without you needing to get involved.

LTC Insurance Reimbursement policies require a little more effort on your part. Here’s how LTCI reimbursement policies work.

1. Become Eligible for LTC Insurance

When your doctor confirms you can no longer do two out of six activities of daily living (eating, bathing, dressing, transferring, toileting, and continence), or have a cognitive impairment (dementia or Alzheimer’s), your eligibility for LTC coverage is triggered.

2. Complete Your Waiting Period

Once you’re deemed eligible for coverage, your waiting period (or elimination period) will begin. Typical waiting periods are 90 days though they may be as low as 30 days or as high as 180 days depending on your policy.

You may pay for care out-of-pocket during your waiting period. This care is not covered under your policy and reimbursement will not begin until your waiting period is complete.

3. Receive Eligible LTC Services

After your waiting period, you may be reimbursed for eligible LTC services. Review your policy to understand which services are eligible. Most policies include coverage for home care, assisted living, and nursing home facility care.

4. Pay for LTC Services and Submit Forms to Carrier for Reimbursement

You must first pay the bill for services received and submit receipts and carrier forms for reimbursement. Some care providers will bill the insurance company directly. Keep in mind, you are only reimbursed for eligible LTC services. If a home care invoice lists “washing windows,” and the service is not covered by your insurance, you will only receive reimbursement for eligible expenses.

Reimbursement policies may require insureds to track billing and invoicing each month. In cases of cognitive impairments, individuals will need family members or a power of attorney to assist with reimbursement or make sure they are in a facility that will bill the carrier directly.

Review your policy to know the specifics on how you’re reimbursed, or if other options are available for facilities to bill the insurance company directly.

Interested in LTC coverage? Check out current rates and browse our resources library to learn more about the options available to you.