Long-term care insurance
Using Long-Term Care Insurance for Home Care in Orange County & the Inland Empire
If your parent bought a long-term care policy years ago, it may pay for much of their care at home. Premium Care provides that care with Certified Nursing Assistants, and we help your family with the claim paperwork so the benefits actually get used.
- Every caregiver a CDPH-certified CNA
- Licensed California Home Care Organization
- Help with claim paperwork
- Complimentary consultation
Does long-term care insurance pay for home care?
Usually, yes. Most traditional long-term care policies, and many hybrid life insurance policies with a long-term care rider, cover in-home care from a licensed agency. What your family receives depends on four parts of the policy:
Benefit trigger
Most policies start paying when a licensed health care practitioner certifies that your loved one needs help with at least two activities of daily living (bathing, dressing, eating, toileting, transferring, continence) or has a severe cognitive impairment such as dementia.
Elimination period
A waiting period, often 30, 60 or 90 days, before benefits begin. Care during that window is usually paid privately. Policies differ on whether they count calendar days or only days care was received.
Daily or monthly benefit
The most the policy pays per day or month. Together with our hourly rate, it decides how many hours of care are covered.
Benefit period
How long benefits last, or the total pool of money available. Knowing this early helps you plan care that the policy can sustain.
How Premium Care helps with the claim
Families tell us the claim is harder than finding care. Here is what we do alongside you:
1. Review the benefits
We go through the policy with you: the daily benefit, the elimination period, and which kinds of care it covers.
2. Start the claim
We help you gather what the insurance company asks for, including the plan of care and the practitioner’s assessment.
3. Keep records the insurer accepts
Caregiver timesheets, visit notes and itemized invoices, prepared the way your insurance company needs them.
4. Keep benefits flowing
Documentation every billing period and help with any recertification, so payments continue without gaps.
What to have ready
- The policy number and the insurance company’s claims phone number
- The claim forms the insurer sends after your first call
- A physician or other licensed practitioner’s certification of need
- A written plan of care (we prepare this during your consultation)
- Our agency information, license details and invoices, which we provide
Not sure where the policy is, or whether one exists? Check old files, bank statements for premium payments, and ask the financial advisor or insurance agent your parent used. Hybrid life insurance policies with a long-term care rider are easy to overlook.
Group, federal and hybrid policies
Many retirees in Orange County and the Inland Empire hold coverage through a group program rather than a private policy, including the CalPERS Long-Term Care Program for California public employees and the Federal Long Term Care Insurance Program for federal employees, retirees and military families. We also work with hybrid life/long-term care policies and California Partnership policies. Each has its own claim process, and we will help you follow it.
Why the caregiver’s credentials matter
Some policies pay only for care from a licensed agency, and some ask about the caregiver’s training. Premium Care is a licensed California Home Care Organization, and every caregiver we send is a Certified Nursing Assistant certified by the California Department of Public Health.
Pricing is personalized to each care plan; after a complimentary in-home consultation, you’ll receive a clear written proposal. Your policy’s daily benefit determines how many of those hours it covers, and we will show you the math before care starts.
For insurance agents, financial advisors and elder law attorneys
When a client with a long-term care policy needs help at home, the claim is often what stalls them. We would like to be one of the names you give them. We handle the care with CNA-level caregivers, help the family through the claim, and keep you informed with the family’s permission.
To refer a client or request our one-page overview, call Aaron Sanders, Director of Operations & Marketing, at (909) 284-8657 or email info@premiumcareca.com.
Frequently asked questions
Does long-term care insurance cover in-home care?
Most traditional long-term care policies and many hybrid life/long-term care policies cover care at home from a licensed agency, once the benefit trigger is met and the elimination period has passed. Check your policy’s home care benefit, or ask us to review it with you, without obligation.
What is the elimination period?
It is a waiting period, commonly 30 to 90 days, before the policy starts paying. Care during that time is usually paid privately. Some policies count every calendar day and others count only days care was received, so ask the insurer which applies.
Will the insurance company pay Premium Care directly?
It depends on the policy. Many reimburse the policyholder after they pay the invoice; some allow benefits to be assigned to the agency. We will help you find out which yours does and prepare invoices either way.
How many hours of care will the policy cover?
Divide the daily benefit by the hourly rate. Pricing is personalized to each care plan; after a complimentary in-home consultation, you’ll receive a clear written proposal. We will work this out with you before care begins.
Can I use long-term care insurance for dementia care at home?
Yes, in most policies a severe cognitive impairment such as Alzheimer’s disease meets the benefit trigger on its own. See our dementia and Alzheimer’s care page for how we support clients at home.
What if we don’t know whether Mom or Dad has a policy?
Look for premium payments on bank or credit card statements, check files for a policy document, and contact the financial advisor or insurance agent they used. If you find a policy, call us and we will help from there.
Find out what your policy covers
A complimentary benefits review and consultation in your home, without obligation.