What is the Least Expensive way to Satisfy my Long Term Care Insurance Deductible?

 

First, understand how to satisfy your deductible (called and elimination period on most long term care insurance policies). If your policy has a service day elimination period (EP), that means that you must pay for care covered by the policy in a given day to have that day count towards satisfying your EP.


For service day EP policies:
If you are in a nursing home or assisted living facility already, and your policy covers the type of facility in which you're living, usually your EP will be met simply by living in the facility for the number of days in your EP.


However, most long term care claims start at home. In a home-based claim, you can often manage the claim to minimize your out-of-pocket cost. For example, you may be able to hire a home care agency for the minimum number of hours they allow, and, during your EP, have family, friends and neighbors provide the rest of the care that's needed. Once your policy benefits kick in, you can then ramp up your professional care.


The philosophy is this: the least expensive way to satisfy a deductible is with the least-costly services that are covered under your policy. Examples may be a half-day in adult day health or a short visit by a non-medical home care service.


Remember, with a service-day EP policy, the amount that you pay for care usually doesn't matter in any given day. The policy usually just requires that you pay out-of-pocket for covered services. Check with your insurer to make sure that the services you are planning on using are covered by your policy, and that the provider meets the requirements of the policy. Finally, be aware that days on which you do not pay out-of-pocket for care may not count towards your deductible (EP).


For calendar-day EP policies:
The EP is satisfied with these policies simply by triggering benefits and watching the days in the EP pass, whether or not you pay for professional long term care. So, if you are in a nursing home or assisted living facility your EP will be met simply by living in the facility for the number of days in your EP.


For a home-based claim, the least expensive way to satisfy a calendar-day deductible is to have unpaid caregivers (friends, family, neighbors, etc.) provide your care. Once your EP has been satisfied, you will have coverage for paid professional care (subject to your policy provisions).

 

Go back to frequently asked questions - help with long term care insurance claims