Insurance Agent Forum

[Slade]

A client asked me a question during a sales presentation which I had never considered and didn't know the answer.

Question: Say you have a LTC policy with a 90 day elimination period and it includes a bed reservation benefit. After a short hospital stay you enter a nursing home under skilled care. You are there for 45 days when you are readmitted to the hospital, later returning back to skilled care in the nursing home. Medicare and your supplement cover 100% of the nursing home costs but none of a $300 bed reservation charge. Once you have met your 90 day elimination period, will the LTC policy go back and cover the bed reservation charge?

I called the carrier to ask this question. They told me there is no exact answer, that a situation like this would be handled on a case by case basis during a claim for benefits.

This seems like a relatively simple question that the carrier should be able to answer, don't you think?

[Graham]

If the bed reservation expense occured during the 90 day elimination period then no the carrier would not go back and pay the $300. LTC expenses incurred during the elimination period are 100% out of pocket and would not be covered at all.

[annuityseller]

I agree totally!!!!!!!

[Slade]

Thank you both for your response. That makes sense to me. Sometimes I equate LTC to major medical insurance where the carrier will go back and cover earlier expenses once the deductible is met.

I guess that is why they call it an elimination period and not a deductible.

[Graham]

No problem glad to help!

[GonnaFlyNow]

Originally Posted by Slade

A client asked me a question during a sales presentation which I had never considered and didn't know the answer.

Question: Say you have a LTC policy with a 90 day elimination period and it includes a bed reservation benefit. After a short hospital stay you enter a nursing home under skilled care. You are there for 45 days when you are readmitted to the hospital, later returning back to skilled care in the nursing home. Medicare and your supplement cover 100% of the nursing home costs but none of a $300 bed reservation charge. Once you have met your 90 day elimination period, will the LTC policy go back and cover the bed reservation charge?

I called the carrier to ask this question. They told me there is no exact answer, that a situation like this would be handled on a case by case basis during a claim for benefits.

This seems like a relatively simple question that the carrier should be able to answer, don't you think?

A) in a situation like this, the medical insurance is probably paying for the nursing home anyway.

B) also, in a situation like this, it is not very likely for the nursing home to continue to assess charges while you're in the hospital.