Items to Pay Attention to
ELIMINATION PERIOD
The elimination period is sometimes referred to as the waiting period. Basically, this is the period
of time that must pass from the time a person is certified as needing long term care until the benefits will begin, and you
would pay your own expenses out-of-pocket. The shorter the period, the higher the premium. Virtually all of the
major companies' current plans only require you satisfy this period once in your life. So, a second episode years
later would not require another elimination period, if you already satisfied it previously.
There are several ways that a policy can spell out how this period may be satisfied. They are
as follows:
Calendar Days- This is the most favorable method, and is either included in the plan,
or it is an inexpensive option. The days are counted on the calendar, as long as the person is qualified as needing care.
No receipts for actual care are required.
1 Day = 7 days- The next best thing. This is very common and often included as a
standard feature. It simply means that if you pay for care at least one day during a week, you will still satisfy the seven
days of that week towards your elimination period. That single day could even be for just one hour. Hospital
stays are not counted. It must be a qualified long term care service, whereas the calendar method above doesn't require
actual proof of care, just proof that you need care.
Days of Service- This means that you actually have to pay for service for the number
of days called for. If you only get care for 3 days a week, you will satisfy 3 days towards your eliminatiuon period.
Newer Option-Zero Wait for Home Care- This is an option in many plans, but it does come
built-in with one company. This option simply means that there is no elimination period for home care, only for facility
care. However, if you are home for several months, with immediate coverage, those days will still count towards the
facility wait. So, there may never be an out-of-pocket expense to you, unless you exceed the daily amount in benefits.
This option usually adds 10% or more to the premiums, so it doesn't get chosen all the time.
Other Notes- Some older policies required you to satisfy the elimination period over a
certain amount of time, or you had to start over. None of the major companies have current plans requiring this.
HOME HEALTH CARE SERVICE PROVIDERS
For home health care, some policies require you to use someone from a certified home health care agency,
but most let you use an individual who is certified. This gives you more flexibility. Some companies even allow you to
use informal caregivers, such as neighbors, friends, or relatives to provide services and still be paid. Usually, the
only exclusion is that the caregiver can't be someone who lives with you, although there are features that can allow
this.
HOME HEALTH CARE BENEFIT LIMITS
When you specify the amount of coverage, either as a daily benefit or a monthly benefit, pay close attention
to see if the home health care coverage is equal to the amount of facility coverage you are choosing. Many plans
automatically keep the home care amount the same as a facility. Some plans let you choose a percentage of
the facility amount. For example, if you choose $200 per day coverage, the policy may let you choose 50% for home
health care. So, you would only have $100 per day for home care. The plan may cost less, but since most people prefer
to have the option to get home care first, it is not common to see a lower home care option chosen. I always recommend
100%, because trying to stay home with services can approach the cost of a facility if your needs become greater. Because
people want to remain home, some newer policies are starting to allow the choice of purchasing more home care benefit than
the facility amount, such as 150% home care. This allows people to afford increasing care at home to avoid a nursing
home.
