Long-term care insurance waiting periods can surprise families

When a policy uses a service-day elimination period, only days with qualifying paid care count toward the 90-day requirement. If a caregiver receives assistance only three days a week, it can take nearly 30 weeks – approximately seven months – to fulfill the waiting period. This means the daughter in this case has been providing unpaid care for months while the insurance clock ticks slowly.

Elimination periods, ranging from zero to 180 days, impact insurance premiums. Calendar-day periods begin counting from the first day of care, while service-day periods only count days with paid care. A qualifying day under Mom’s policy requires a paid provider’s presence, meaning the daughter’s efforts, however extensive, don’t contribute to the waiting period.

Calculating the time to meet the 90-day requirement involves understanding how many service days are accrued weekly. With three visits per week, it takes 30 weeks to reach the threshold. Families are responsible for paying the aide during this elimination period, and increasing the frequency of visits to five days a week would shorten the waiting period to 18 weeks, but at a higher cost.

According to KFF, the direct care workforce faces shortages and high turnover, making it challenging to secure consistent paid assistance. Families may find it difficult to book the desired number of visits, leaving unpaid family members to fill the gaps.

Before initiating care, families should carefully review the policy’s definition of the “elimination period,” “qualified provider,” and “home health care.” Contacting the insurance company to clarify qualifying agencies and whether other care settings, like hospitals or rehabilitation facilities, contribute to the waiting period is also recommended. Maintaining a log of dates, provider names, and services delivered can help ensure accurate claim processing.

By the time benefits begin, the daughter may have provided months of unpaid care, effectively subsidizing the insurance policy while it only recognizes days when a paid aide is present. This highlights the importance of understanding the nuances of long-term care insurance policies.