You have LTC insurance. Here's how to use it for home care — and we handle the billing
If you have LTC insurance, it may cover significant portions of home care costs. Here's what you typically need to know:
Most LTC policies cover assistance with activities of daily living (ADLs): bathing, dressing, grooming, toileting, mobility.
Home care, companion care, medication reminders, light housekeeping, and meal preparation often covered depending on policy.
Your policy specifies daily maximum ($100–$500+ typical). We bill insurance; you pay difference if hours exceed daily max.
Many policies have elimination periods (30–90 days) before benefits start. Confirm whether this applies to your policy.
Your policy specifies how long benefits last (3 years, 5 years, lifetime). Total pool of available benefits.
Some policies restrict coverage to in-network providers. We can confirm your policy details and coverage.
Dig out your LTC policy document and call the insurer's customer service line. They can tell you: daily benefit amount, remaining benefit period, elimination period status, and whether home care is covered. We can help interpret and coordinate once you have this info.
You pay us directly. Seek reimbursement from insurance yourself (often tedious).
We bill your LTC insurance directly. You receive benefits, we coordinate everything.
Invoice management, insurance paperwork, waiting for reimbursement
We handle claims, documentation, insurance coordination, benefit tracking
Pay upfront, wait for reimbursement
Insurance covers services; you cover any gap (if hours exceed daily max)
Example comparison (Orange County):
Scenario: 20 hrs/week home care
Cost: ~$360/week ($18/hr × 20)
Your insurance daily max: $200/day
Insurance covers: ~$1,000–$1,400/month
Your cost: You pay the gap or nothing if within daily max
Same scenario: 20 hrs/week
Cost to you: $1,440/month
Insurance benefit: $0
Your total cost: Full amount out-of-pocket
Impact: Many families reduce hours or forgo care
You provide your LTC policy info (or insurer contact). We verify coverage, daily max, elimination period, and remaining benefits.
We perform caregiver assessment confirming need for home care. LTC policies require functional assessment (ADL limitations).
We create detailed care plan specifying hours, services, and need rationale. Insurance requirement for claims.
We submit verification and care plan to insurance. Receive authorization confirming coverage before services start.
We provide agreed-upon care hours. We bill insurance for covered services. You receive EOB and any billing summary.
We track benefits, report on care received, adjust if needed, and manage any authorization renewals.
Check email, filing cabinets, or insurance agent files. If lost, call your insurance company with your name and SSN — they have records.
Most policies do cover home care — but confirmation is critical. Your insurance company's customer service can answer definitively.
Call your insurer. They have records of when coverage started and when elimination period expired (or if already satisfied).
Your insurance company can report remaining available benefits (total pool remaining of policy maximum).
Most require ADL limitation (needing help with 2+ of: bathing, dressing, toileting, eating, transfers, continence). Your functional assessment documents this.
Yes. We coordinate with your insurance, handle verification, manage claims, and answer questions about coverage.
With her $200/day benefit, Mrs. Chen's LTC insurance covered most of her 24-hour live-in caregiver costs. Her son paid only the difference, making affordable care possible. Without insurance, they'd have had to move her to a facility.
Post-hip replacement, 4 weeks of 8-hour daily home care was fully covered by LTC insurance. Family saved $8,000+ in out-of-pocket costs and Mr. Martinez recovered at home with loved ones present.
We handle everything: verification, authorization, billing, claims. You get the care you need, the way insurance intended.
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