It can be challenging to seek support for your loved ones as they age, especially if they suffer from Alzheimer’s or dementia. The cost of care and memory services is extremely high, and many fail to qualify for the care they need from state and federally funded programs due to strict income requirements.
This leaves their estate and their family responsible for shouldering the financial and emotional burden of care. Thankfully, there may be another way – long-term care insurance.
Long-term care insurance policies can help cover the gap, providing financial peace of mind that your loved ones will have access to the care they need, when they need it. LTC insurance policies start where traditional insurance policies stop. They reduce out-of-pocket costs of medical services without compromising on the quality of care, which is especially important for those who need memory care services.
What Cognitive Conditions LTC Insurance Commonly Covers
Long-term care insurance covers the care associated with various health conditions, including cognitive impairments like Alzheimer’s and dementia.
These conditions often qualify for long-term care benefits because they require specialized care that’s often not covered under traditional medical policies. Additionally, individuals who suffer from Alzheimer’s and dementia often need help with their daily routines. They benefit from constant supervision as they can forget what they are doing, have cognitive delays, or simply live in the past.
Alzheimer’s and dementia get progressively worse, and this decline impacts their care over time. Those who are taking care of their loved ones at home may need additional assistance to keep up with their constant care, and long-term care insurance can help.
How LTC Insurance Defines and Triggers Cognitive Benefits
Long-term care insurance policies only kick in once an individual meets the qualifying requirements. While the benefit triggers will vary from policy to policy, they typically include:
- No longer able to perform at least 2 activities of daily living (ADLs), such as bathing, eating, dressing, moving, using the restroom, etc.
- Official Alzheimer’s or dementia medical diagnosis, including cognitive and mental health test results.
You must meet minimum health criteria to qualify for a long-term care insurance policy. You will not be able to obtain a policy if you have already received a medical diagnosis for Alzheimer’s, dementia, or other significant pre-existing conditions.
During the underwriting process, insurers will evaluate an individual’s risk for needing long-term care, including assessing their current health, health history, age, and ability to perform ADLs. Additionally, they will take into account safety risks, supervision needs, and other criteria to determine if you qualify for a policy, when benefits will be triggered, your monthly premium, etc.
Once you meet the qualifying circumstances in your LTC policy, cognitive benefits will be triggered.
Documentation Needed to Approve Cognitive Care Claims
Cognitive care claims require specific documentation, so you must have all your paperwork before filing a claim.
You should have:
- Physician evaluations and cognitive assessments are used to confirm an official diagnosis and to determine the extent of cognitive decline. These can include physician statements, doctors’ notes, mini-mental status exams, neuropsychological evaluations, and diagnostic reports like MRIs or CT scans.
- Provider information, including their licenses and certifications. All caregivers and facilities must be licensed to qualify.
- Licensed provider care plans, including an outline of what the individual needs help with and the plan to address these needs moving forward.
- Invoices for care, including itemized bills to show the date of service, types of care, costs, etc.
Check with your long-term care insurance provider to understand if your loved one’s policy requires additional documentation. This will help the care claim and reimbursement process be smoother and more efficient.
Types of Care Settings Typically Covered
Long-term care insurance policies give you and your loved ones a choice in the type of care you would like to receive.
- In-home care and supervision may be available for memory-related conditions.
- Assisted living and memory care communities that support individuals with cognitive decline.
- Skilled nursing facilities that specialize in dementia and Alzheimer’s support provide the best care for your loved ones.
The choice of care is one of the most significant benefits of long-term care insurance policies, allowing you and your loved ones to control where and what type of care to receive as you continue to age.
Common Misconceptions About LTC Insurance and Dementia
According to a recent survey, nearly 60 percent of Americans wrongly believe that Medicare will cover long-term care needs. While Medicare may cover some of the doctor’s and prescription needs related to Alzheimer’s and dementia, it will not cover long-term custodial care.
What does that mean?
Medical insurance will cover medical treatment, including diagnostic testing, medical equipment, physical therapy, prescription medication, and select inpatient treatment.
If you need long-term care based on your cognitive decline, medical insurance will not cover nursing homes, memory care facilities, or in-home care. If you want to receive those services, you will need to pay for them out of pocket or use an existing long-term care insurance policy to cover the cost.
Keep in mind that you will not trigger your long-term care simply because you or your loved ones were diagnosed with dementia. It must impact your ADLs or require constant supervision to prevent harm.
You will need to provide medical documentation to support the need due to cognitive decline. Still, as long as you had the policy before diagnosis, your care needs due to Alzheimer’s and dementia should be covered.
Costs, Care Needs, and Family Impact
Cognitive decline in you or your loved ones significantly increases the need for supervision and support. Often, they can harm themselves if left to their own devices, and many families take on the role of unpaid caregiver during this time.
This can cause significant financial and emotional strain as they navigate situations in which they are not qualified. They are trying to provide the best care they can and often put their lives on hold to do so, which is one of the most considerable unseen family caregiving costs.
Long-term care insurance can help support your loved ones during this time. It can relieve the financial burden and provide additional support to help you get the care you need for your Alzheimer’s.
Understanding Coverage Within Washington State Facilities
Washington recently established the WA Cares Fund to help support long-term care needs. However, the benefits are limited, and the need for care will likely outpace what is available in the fund. You can opt out of the fund by purchasing a private LTC insurance policy in Washington.
For your Washington facility to qualify for LTC reimbursement, it must meet specific requirements under SB 5337. This includes:
- Specialized dementia-specific training for staff
- Individualized care plans
- Established program and safety plans
Washington also requires its staff to be continuously trained in dementia-specific programming and to provide person-centered care plans for its residents. All residents must receive at least 3.5 hours of daily nursing care; facility assessments determine the amount of staff needed on-site, and registered nurses must be available on-site 24 hours a day.
Similar care frameworks may apply in nearby states as federal regulations continue to strengthen long-term care facilities in the United States.
How Families Can Prepare for a Dementia-Related LTC Claim
If you suspect your loved one may be suffering from Alzheimer’s and dementia, there are steps you can take to help you prepare.
- Receive an official diagnosis. Get a doctor to confirm your suspicions and run the necessary tests.
- Gather your documentation. You often need official records, medical tests, and more to support your claim.
- Determine a care plan. Identify the type of care you want to receive (in-home, skilled nursing facility, memory care) and work with them to outline a care plan.
Early planning can help avoid delays in the care your loved ones need and prevent claim denials.
When LTC Insurance Isn’t Enough
Long-term care insurance can cover the gap, but sometimes, it may not be enough. As you consider your loved one’s care needs, be aware of the options available to you. You can purchase supplemental support options, including Medicaid or respite care. These may cover some costs and free up LTC funds for other needs.
Additionally, you may still need to pay out-of-pocket costs, even with a strong LTC policy. Most policies have an exclusion period that you have to meet before your coverage will kick in, or you could exhaust the benefits of your policy.
It’s best to connect with a financial planner and long-term insurance provider to help you understand what is best for you and your family. The more you plan, the better you’ll be able to preserve your financial security, safety, and quality of life as you age.
Final Thoughts: Choosing LTC Insurance With Cognitive Care in Mind
As you consider whether LTC insurance is best for you, it’s essential to review the cognitive impairment benefits before you purchase it. This will help you understand what you need to qualify, which types of care are covered, and how you can prepare for future care needs.
The sooner you select your policy, the better outcomes you will receive. You could be denied coverage for pre-existing conditions or face higher premiums if you attempt to purchase a policy later in life – both of which will increase the financial burden on you and your loved ones.
Long-term care insurance coverage protects families from overwhelming care costs and gives you control over the type of care you’d like to receive.
When you’re ready to purchase an LTC policy, Lavine LTC Benefits is here to help. Our team of skilled professionals works with you to determine your care needs and recommend a policy that meets them while fitting in your budget.
Contact us today for a free consultation.