Long term care, assisted living, budget

[Nice Guy Eddie 13735]

My dad has long term care insurance with Genworth via Texas Retirement System for teachers.  He's about to move into assisted living but I was hoping for advice here about long term care (LTC) insurance.

A few people have told me to move my dad into the assisted living and then make the LTC claim.  While I could do that but the LTC benefit could be a significant portion of his budget and his selection of a facility is strongly correlated to the level of LTC benefit that he would receive. 

I know insurances never want to pay but I don't believe that Genworth never pays or make it next to impossible to receive benefits. Any one have experience with LTC and assisted living benefits, particularly with Genworth.

[mdmost 44063]

Different situation but we dealt with Genworth for my mom both at an assisted living facility and then with in-home health aides. They paid fully for her time at the facility and are currently paying out for her in-home care. We've used it for the past 2 years now. I've heard of Genworth screwing over people if they missed a premium payment but thankfully, my deceased father paid it off a long time ago. He never used the benefits for himself.

Genworth typically has a set per day amount they pay out. I believe my mom's is around $250 a day but it is unlimited. We do have to cover the overage as her in-home aides cost more than that per day. The amount they pay out increases with cost of living each year. You should be able to see that if you log into his account. We checked with Genworth in advance on both the facility and the in-home aides to make sure they would pay for them. They have a free service called CareScout that helps with placement services. There is a period of time, I believe it's 60 days, that you have to pay yourself and then the benefits will kick in. You make the claim as soon as the service starts at the facility since Genworth will need to verify your father is qualified to receive the benefits. Usually the qualifications are him not being able to do one of the functions of life on his own from the following: bathing, eating, cooking, sleeping, going to the restroom. They will either send out a nurse to do an examination of your father or it will be done via Zoom. My mom has had to do it a few times now. 

If your dad has Medicare, it should pay for the first 60 days, possibly. Our situation was my mom going to a rehab facility after a fall at her home so Medicare picked it up for a time and then Genworth kicked in after that. She then stayed in facility until she was strong enough to go back home. Genworth shifted from paying for the facility to paying for in-home aides. After you get the paperwork set up, the facility should be able to either email you the invoices that you can submit to Genworth or they can send the invoices to Genworth directly. Everything is automatic now for us so we only check with Genworth if a reimbursement doesn't happen. I'd imagine most facilities deal with Genworth so they should be able to help you out. The rehab place was nice and met the daily rate with exactly what Genworth paid out per day so there was no additional cost.

Good luck man. It's a bit of a grind to get it all dealt with. 

tldr- start the claim ASAP. 

Edited March 18, 2022 by mdmost

[Reagan1k 3042]

Most disability or LTC policies have an "elimination period".  That's the time between the start of the claim and the start of the benefit payments.

Your policy will spell it out but in most cases you have to float the first 60 or 90 days - could be 180 days.

Your father may have to enter the facility, and self pay for the duration of the elimination period before Genworth kicks in.  You'll need to ask the agent or their customer service support staff how the claims process will work with regard to timing.

The shorter the elimination period the higher the premium and vice versa because of the exposure for the insurance company.

[mdmost 44063]

Thank you. Elimination period was what I was thinking of. It was 60 days for my mom's policy and I believe Medicare covered the initial 40 days since it was a rehab facility and not a true assisted living facility. The place had that but my mom isn't able to live on her own any longer due to a neck brace she has to wear the rest of her life. 

[mdmost 44063]

Word to the wise based on what I'm currently dealing with regarding Genworth and my mom's payments, stay on top of these bastards. They are looking for any reason not to pay. Either it's they "aren't getting care notes from the aides" or "we need the 6 month assessment to be done again before we'll pay". They're currently 98 days past due on paying her for charges that occured back in April. Just total bullshit. They claim they will pay by the end of the week. I'm about to go up the ass of that organization. Everyone on our end of the situation has done what they've needed to. These bastards just aren't paying. It was a pretty regular thing to get them to pay in under a month. Then it started going longer and longer. Thankfully, my mom is good on money but if she was on a fixed income, she'd be underwater right now because of course the amount isn't keeping up with cost of living increases or cost of care increases. They owe her around $24,000 right now. 

Edited July 26, 2022 by mdmost

[Nice Guy Eddie 13735]

On 7/26/2022 at 10:16 AM, mdmost said:

Word to the wise based on what I'm currently dealing with regarding Genworth and my mom's payments, stay on top of these bastards. They are looking for any reason not to pay. Either it's they "aren't getting care notes from the aides" or "we need the 6 month assessment to be done again before we'll pay". They're currently 98 days past due on paying her for charges that occured back in April. Just total bullshit. They claim they will pay by the end of the week. I'm about to go up the ass of that organization. Everyone on our end of the situation has done what they've needed to. These bastards just aren't paying. It was a pretty regular thing to get them to pay in under a month. Then it started going longer and longer. Thankfully, my mom is good on money but if she was on a fixed income, she'd be underwater right now because of course the amount isn't keeping up with cost of living increases or cost of care increases. They owe her around $24,000 right now. 

Thanks for the heads since I’m dealing with them in almost the same situation. We just recently got past the elimination period and the first full payment should be sent within a week.

genworth has been good about sending letters with info but I wish they had a portal page where I could ensure they’ve received and processed the invoice. Going through the mail seems like the 80s. Thankfully they accept scanned invoices or other documents on their website.

[mdmost 44063]

They do have a portal page. You'll need to register an account with them. I check all my mom's invoices and payments on there. That's how I knew they were full of shit about dragging their feet.  Your provider should have a way to send the invoices to them directly to speed up the process. That's what the home health aide service does. You can also set up so they don't send stuff through the mail. I read all the correspondence minus the one off issues on there. 

https://www.genworth.com/ Go to Login in the top right and register the account. You'll need the policy number, last 4 of the social, and date of birth. I believe they will then send a code to the cell phone on file. 

[Nice Guy Eddie 13735]

6 hours ago, mdmost said:

They do have a portal page. You'll need to register an account with them. I check all my mom's invoices and payments on there. That's how I knew they were full of shit about dragging their feet.  Your provider should have a way to send the invoices to them directly to speed up the process. That's what the home health aide service does. You can also set up so they don't send stuff through the mail. I read all the correspondence minus the one off issues on there. 

https://www.genworth.com/ Go to Login in the top right and register the account. You'll need the policy number, last 4 of the social, and date of birth. I believe they will then send a code to the cell phone on file. 

Thanks for the info.