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What most don't know or recognize is that it is possible to receive public benefits (Medicaid and/or VA) while simultaneously making claim on an LTC insurance policy (depending on expenses and assets).
For instance, I presently have a Florida client living with her spouse in Independent Living. She has a policy that pays $150/day for Home Health Care; not enough to cover the 24 hour cares she requires. The family does NOT want to place her in Assisted Living or a Nursing Home. The policy and the couple's income are not enough to provide the needed care and cover room and board.
She has less than $2,000 and her spouse has less than $123,600 in countable assets. Her income is under the $2,250 per month Medicaid eligibility limit (her spouse's income is higher but in Florida there is no income limit for the Community Spouse).
We applied for and she is receiving Medicaid Home and Community based services which is providing 40 hours of personal home care per week.
The husband is a wartime veteran who does not require care. Still, because of the couple's high unreimbursed medical expenses, He will qualify for a VA Improved Pension Basic award of $1,097 per month.
This combination of all three benefits, plus the couple's income and a small amount from savings is supporting the couple's needs.
However, before you can make that decision, you really do need to have a clear understanding of the details of your mom’s policy. For example, my dad’s policy states it pays for two years, but, when closely asked, they told me that the 2-year period assumes maximum payout per day and actually pays until the full dollar amount of his benefit is exhausted. In most cases, in order to activate a claim, the beneficiary must be diagnosed as requiring at least 2 of the 6 ADLs (Activities of Daily Living) AND the policy issuer will send their own HHC rep to assess. (Warning: They don’t always agree on the stated level of need and can deny the claim.) Also, and I’ve heard this from just about everyone with regard to LTC plans, the plans have specific requirements as to who can provide the HHC services; they may or may not have a list of “in network” agencies, and/or they may allow non-agency aides, but most require those aides to be licensed, whether working through an HHC agency or independently.
I hope this helps. Please keep us posted! :>)
We found when activating a long term care policy that there were many aspects of it that the person who bought it was unaware of. You need someone to review the policy with you to decide how best to use it.
We also found that in the county our elders lived, the Council on Aging offered a certain number of home care hours without fee. Contact your local Aging department and see what resources are available to you.
DaddysgirlinTX's answer is also very good advice. You can always call the provider of her Long Term Care policy and ask questions.
The only things I’d like to add is that should the day come that your mom needs to go into a LTC facility - like a NH or MC - you do need to clearly ask IF the place will accept your mom’s LTC insurance policy as payor on her bill. Like Shady Acres NH does NOT have to accept your mom’s Genworth policy she’s been paying on last 20 years. My mom’s NH did not take any LTC insurance and had a large sign as to that in the lobby, admissions and billing offices. The NH ( small chain) was private pay, MediCARE or Medicaid only.
My mom was a “dual” (on MediCARE & Medicaid) and one day I was in billing office adding $ to my mom’s personal needs account I ask why the no LTC insurance. The billing guy told me that it wasn’t worth their time to deal with the myriad of requirements from the various LTC policies..... every insurer had their own forms and requirements as to data needed (like how many hours of RN, CNA, LPN, etc) in order for a bill to get paid and there just was always, always, always something to delay payment. That the older policies from last millennium tended to require actual RN doing 1-on-1 care, so they wouldn’t meet the staffing requirements for the policy, yada yada. That it was more efficient & financially better to take a M&M resident as payment was assured and payed timely and he knew to the penny what my mom’s account was getting paid.
Yeah read that again, it was better financial decision to take Medicaid resident rather than one private pay with a LTC insurance policy. I have no idea if this is a trend but if so, a lot of folks will find that their LTC policy means it can only work IF they stay in their home and get assistance with Home Health companies that take their specific insurer.
As others posted be sure to carefully read what the required self pay period is BEFORE the policy activated. Especially look to see IF a post hospitalization rehab period (Medicare paid) does or does NOT count in the selfpay period.
Please note that due to privacy laws they may not be willing to divulge any info to you unless you have POA for your mom &/or you submit a document (which they can provide to you) on which your mother gives them formal permission to release info to you. You should submit a separate one of these for each person who might need to act on her behalf. Send in these forms NOW while she is hopefully still able to sign them even if you don't activate her policy just yet. It will make things easier for you later on.
Good luck to to you and your mom.
Also, some policies are like a clock, once a claim is triggered they continue until the time's up. So if she has a 2-yr policy but she only needs to use it for a short time it might be best to wait until she needs it for a longer period.
It was a $150,000 policy with max of $100 per day.
Dad paid all of the first 90days of home care. ($16,000)
Genworth paid the next 3 yrs of home care at $80/day ($2400 of a $7400/mo fee)
Genworth paid the next 3 yrs of Memory Care at $60/day ($1800/mo of a $5000/mo fee)
These policies are not for the poor! It definitely helped, but had she not had a good retirement plan, she would have been better to use up all of her funds & end up on Medicaid. (which is what will probably happen now)
Mom has Vascular Dementia and has not declined or had any further strokes/TIAs, in the last 4 years. At 83yrs, with a history of 3 strokes and many TIAs, she is amazing us all.