How CareWorks Helps You Navigate and Maximize Your Long-Term Care Insurance Benefits
Thinking about the cost of long-term care in Orange County, CA can be overwhelming. Many people assume Medicare will cover services like in-home care, assisted living, or board and care homes—but it doesn’t. Yes, Medi-Cal may help, but qualifying means navigating the IHSS caregiver list or finding your own personal care aide. On top of that, long-term care insurance (LTCi) policies are filled with confusing jargon and fine print, making it easy to feel lost. At CareWorks Health Services, we help families in Fountain Valley, Laguna Beach, Seal Beach, and throughout Orange County understand their options and get the care they need—without the stress.
Understanding Long-Term Care Insurance: ADLs and When Benefits Start
When it comes to long-term care insurance, what is an ADL? ADL stands for “Activities of Daily Living,” which include essential tasks like bathing, dressing, eating, transferring, using the bathroom, and maintaining continence. These activities are often used as a benchmark by insurance providers to determine eligibility for benefits. Most policies require an individual to need help with at least two ADLs before coverage begins.
This brings us to the next important question:
When does long-term care insurance kick in? Typically, long-term care insurance benefits start after the policyholder meets specific requirements, such as a waiting or “elimination period” (usually 30–90 days) and demonstrating a need for care due to ADL limitations or cognitive impairments. Depending on the senior care insurance policy, they may have additional requirements, such as a recent stay and discharge from a skilled nursing facility with doctor’s orders for home health. In addition, the LTCi company will send an RN to conduct a physical and cognitive assessment, to determine how many hours are truly needed.
What Does Long-Term Care Insurance Not Cover?
While long-term care insurance benefits can pay for services like in-home care, assisted living, adult day care, and nursing homes, it’s important to know what long-term care insurance does not cover. Generally, these policies do not pay for assistance with Instrumental Activities of Daily Living (IADLs)—such as housekeeping, meal preparation, or transportation—unless combined with the need for help with at least two Activities of Daily Living (ADLs) like bathing or dressing.
Coverage also typically doesn’t extend to home safety modifications (e.g., wheelchair ramps or grab bars) or medical supplies such as diapers, gloves, or hospital beds. Additionally, policies may have restrictions on combining certain services, like assisted living alongside a private caregiver. Since coverage varies widely, reviewing the specifics of your policy is essential to avoid unexpected gaps in care.
Why Is Getting Benefits So Complicated?
Long-term care insurance companies are not in a rush to pay out, and that means lots of paperwork, rules, conflicting statements and hoops to jump through. I’ve made five separate calls to the same LTC insurance carrier to verify benefits, and each time I got a different, often vague response—ranging from “I can’t tell you” to conflicting answers—forcing me to rephrase the same question repeatedly just to get a clear and accurate answer.
Don’t Let LTC Insurance Confuse You—We’ve Got You
If you’ve been paying premiums for a long-term care insurance policy, the last thing you want is to struggle to access the benefits you’re entitled to. Without help, families often face frustrating delays, denied claims, and missed benefits—leading to unnecessary out-of-pocket expenses and stress. You’ve been investing in peace of mind, but if you don’t navigate the system correctly, you might not see the payoff when you need it most.
The experts at CareWorks and our SimpliClaim Services are here to take the confusion out of long-term care insurance. We’ll set up a conference call with you and your insurance company to verify your LTCi benefits and make sure everything is crystal clear. From there, our senior care advisors will guide you step by step—reviewing your policy, helping you file claims, and ensuring you start receiving your benefits as soon as possible.
Don’t let your hard-earned premiums go to waste. Call us today for a free LTCi assessment, and let’s get the ball rolling. Here’s what we’ll do for you:
- Verify your benefits and clarify policy details.
- Guide you through the claim-filing process.
- Manage the paperwork and follow-ups to avoid delays.
We’re here to make sure you get the most out of your LTCi coverage—stress-free and without the hassle.