LONG TERM CARE 10
California Department of Insurance
Protecting California Consumers
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are accumulated either in a home care or institutional
care setting are combined to satisfy your overall elimination
period. Be sure to ask your qualified agent to explain this.
Period Of Care
A Period of Care usually begins on the first
day you are eligible for benefits, and ends after a treatment-free
interval during which you do not need any benefits. If you
need care later, you may have to meet another Elimination
Period.
Example
If your policy uses a 180-day treatment-free interval
to measure the end of the Period of Care, and you leave the
nursing home on June 1 and require no further care for 180
days, the Period of Care will end in 180 days on November
30. If you return to the nursing home before November 30,
you will be in the same Period of Care and there will be no
new Elimination Period. If you return to the nursing home
again after November 30, you will have to pay your own expenses
during a new Elimination Period.
Selecting The Elimination Period
Multiply the current cost of one day of care
by the number of elimination days you plan to use. (Example:
$141 X 30 = $4,230)². Then estimate the number of days you
could afford to pay for your own care without liquidating
any assets. That is the maximum number of days you should
select as an Elimination Period. Although choosing a short
Elimination Period increases your premium, the amount you
will pay for your own care during an Elimination Period is
likely to be much more expensive. Another factor to take into
account is that the daily cost of care doubles about every
14 years. Your out of pocket cost for the Elimination Period
you choose will increase as well. Remember that short nursing
home stays are more common than long stays and many people
may need long-term care services more than once during their
lifetime. ² The average daily cost in California in 2002.
Plan Of Care
This is a plan written by your doctor or a medical
team (such as a home health Agency’s health care team) that
establishes your need for care, and describes the kind of
care you need, and the frequency of the required services.
The Plan of Care is a familiar document to your doctor, hospital
discharge planners, home health agencies and other health
care providers who know about long-term care services. Many
policies also require that the Plan of care be updated periodically
to reflect any change in your need for care.
Care Management
Some policies include Care Management features.
A Care Manager may assess your condition, consult with your
doctor, establish a Plan of Care, follow your progress, and
recommend care providers.
How Much Do Insurance Policies Pay for Long-Term
Care?
The Daily Maximum
When you buy a policy you choose the amount
you want the company to pay for each day of your care. Most
companies allow you to select as little as $50 daily or as
much as $500 daily. When you need care, companies pay the
daily benefit you selected or the actual cost, whichever is
less. Some benefits may be paid as a percentage of another.
For instance, a policy may pay $100 a day for care in a nursing
home, 80 percent of that amount for assisted living in a Residential
Care Facility for the Elderly.
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