FAQs

The following list of Frequently Asked Questions is designed to give you some general information about long-term care insurance.

For more specific information, please contact our long-term care insurance attorneys at 954-523-2020.  Because we serve clients throughout Broward County, Fort Lauderdale, and South Florida, as well as Miami-Dade, Palm Beach, and Monroe counties, we can help you with all types of long-term care insurance claims.

What is a waiver of premium?

Some policy’s provide that once you have been receiving benefits under your insurance policy for a certain amount of time you are no longer required to pay the premiums for you insurance policy. If your insurance policy contains a waiver of premium provision and you have met the requirements you may be entitled to a return some o r all of your premiums if your long term insurer has over charged or mischarged you.

What is an activity of daily living?

Most long term health policies require that you are no longer able to perform one or activities of daily living. When discussing activities of daily living, (“ADL’s”) insurance companies are generally referring to activities such as bathing, dressing, eating, the ability to use the toilet without the help of another individual, and the ability to move from one room to another without the assistance of another individual. The precise definition of and ADL varies from policy to policy. Likewise, the number of activities required to trigger insurance coverage also varies from policy to policy and company to company. At Leader & Leader we can help you understand the complex and often consuming definitions and requirements contained in your long term health care policy.

Do you provide free consultations?

Yes. At Leader & Leader, our Fort Lauderdale insurance attorneys will sit down with you to discuss all aspects of your case, no matter what point you’re at in your claim., we’d start early in the process, before your application has been filed. However, we have successfully handled many long-term insurance cases for those whose claims have been denied.

How much does long-term care insurance cost?

The cost of a long-term care insurance policy depends on the type of coverage you choose, and the age at which you are applying for the policy. A 2007 study by the National Clearinghouse for Long-Term Care revealed that the average annual premium for long-term health care insurance was $2,207. According to this same source, a nursing home can cost an average person about $81,777 a year; assisted living facilities approximately $42,345 a year; and in-home care about $33,223 a year. Therefore, long-term care insurance can be a small price to pay considering the skyrocketing costs of health care.

Is nursing home insurance the same as long-term care insurance?

No. Nursing home insurance generally covers the policyholder if he or she is in a nursing home.  Long-term care insurance often covers policyholders for in-home care or assisted living care as well.

What type of care is covered for long-term care?

It depends on your policy. Most policies cover care in nursing facilities, assisted living facilities, adult day care centers, or at home. Less comprehensive policies restrict the benefits to services that are provided in nursing facilities. Long-term care is for people unable to care for themselves because of disability, chronic illness, loss of functional capacity or cognitive impairment. Most commonly, long-term care is required by the elderly, although a younger person could suffer from a disabling injury. Long-term care insurance covers expenses normally not covered by your health insurance plan.

Can my insurance company deny my long-term care claim?

Yes, particularly if your claim is outside the scope of your long-term care insurance policy, or if the insurance company deems your claim to be fraudulent. Since most insurance companies are for-profit organizations, they will look for technicalities or loopholes with which to deny your claim.

Does Medicare cover long-term care?

Medicare benefits are very limited when it comes to skilled care. The program was not designed to cover activities of daily living. Rather, it was designed to cover acute care or skilled care during a short hospital stay.

Does Medicaid pay for long-term care?

es, but coverage is very limited. Medicaid is designed for those with low incomes and few assets. Even then, there are many limitations for what benefits are available. For example, you may be restricted as to the physician you can choose, or the facility where you receive your care.

How long is “long-term”?

In 1996, the federal government effectively defined a “long-term” need for assistance as one that lasts at least 90 days. Some long-term care policies provide coverage on the first day that the insured person meets the criteria for benefits. Others require 30, 60, 90 or 120 days of assistance before benefits become payable. The definition of “long-term” varies by policy.

 

For specific questions about filing, appealing or understanding your long-term care benefits, trust the Fort Lauderdale insurance attorneys at Leader & Leader to help maximize the benefits you’ll receive and provide the knowledgeable answers you need.  Call 954-523-2020 today to talk to one our knowledgeable Florida attorneys.  We can help prevent any problems and expedite your long-term care benefits.

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Do not delay! Call Leader & Leader, P.A. at (954)-523-2020 for advice about the denial of your long-term care benefits or long-term care insurance claim right away!