We have written several articles recently about significant changes in long-term care. Due to the high costs of providing long-term care, many companies have raised premiums substantially, in some case by as much as 40 percent. Others, such as Met-Life have stopped issuing new policies. For details see our past blogs titled: “Another Blow for Long-Term Care Insurance” (November 13, 2010) and “More News on Long-Term Care” (February 15, 2011).

A recent article in the Wall Street Journal, titled “The Latest Long-Term Care Snafu”, by Anne Tergesen, January 22, 2011 pointed out some additional issues you need to be aware of.

Many older, long-term care policies have provisions that can make it difficult to successfully make claims. The article points out that by taking care to read the policies in detail so that you understand the terms of the contract, you can, in many cases, avoid having a claim denied. Today’s policies generally are more liberal in their coverage than the policies written twenty years ago, according to the article.

Some of the rules to be aware of that the author pointed out in the article are:

(1) Some policies require a three-day hospital stay before benefits kick in. Therefore, patients with Alzheimer’s, who are physically in good shape, may not be able to receive benefits after satisfying the a 90 to 100 day waiting period. Family members may move Mom to a nursing home, pay for the first 100 days and then find out that mom can’t receive benefits because she didn’t spend three days in the hospital first.

(2) Make sure a health-care professional certifies that the disability will last 90 days or longer. Make sure the claim is documented adequately, as well. It may pay to seek help in preparing a claim from a geriatric care manager.

(3) Some insurers send assessors to verify disabilities. Some seniors, embarrassed by their disabilities, downplay their problems, only to have their claims denied.

(4) Some insurers have a 90 calendar-day waiting period before benefits can start. Others have a “service-day” waiting period where only days where care was paid to a licensed provider counts. In those cases, families can’t satisfy the waiting period requirements by taking care of Mom or Dad themselves.

(5) Some policies require that caregivers have specific licenses in order to be covered. Others require a certain number of beds in a facility (ruling out places like adult family homes).

As you can see, it’s very important to carefully understand the fine print in any long-term care policy you or your parents have or on any policy you are considering. Clearly, with the cost pressures on insurers, the recent increases in premiums and the companies getting out of the business, you can be sure that insurers will only honor future claims that meet all contract requirements.