Long-Term Care Insurance Claim Articles
Long-Term Care Insurance Claims, ALF vs. Nursing Home

By Jeffrey L. Greyber, Esq.

There is much to be assessed when exploring long-term care insurance options, particularly the decision of choosing an assisted living facility or a nursing home. The fundamental differences between an assisted living facility and a nursing home are the level of care that a resident receives as well as the amount of freedom allotted to a resident. Assisted living facilities provide more independence to the resident than a nursing home does, but also, less complex medical services. Each individual insurance policyholder has varying needs as well as every right to be fully covered in their requisites.

So how does either decision affect your long-term care insurance policy? Particular to the insurance policy of your choosing, insurance companies may or may not clearly delegate which facility will in fact be covered under your long-term care policy. While there are generally no extreme, practical differences between an assisted living facility and a nursing home, insurance companies will absolutely deny coverage over a technicality. For all intents and purposes, an assisted living facility and a nursing home have the same goals, to provide quality, long-term care.

I have seen many policyholders, be approved for coverage in a nursing home, check their loved one into an assisted living facility, (or vice-versa) thinking they are the same thing, and then the policyholder is no longer covered. I have worked on these kinds of denials and been able to sort out a number of these types of denials, so I am more than willing to help in a situation such as this.

Conclusively, it is paramount to stay cognizant of what type of facility or home your long-term care insurance policy affords you coverage for, to avoid finding yourself in a predicament. The varying distinction of coverage in a long-term care insurance policy is common in older policies. This is a real issue for people who are looking to enter assisted living facilities or nursing homes now, considering they have the older insurance policies.

As for future policyholders looking into long-term care insurance policies now, make sure that your policy is entirely comprehensive. Recognize if you are specifically covered for an assisted living facility or a nursing home, and be able to differentiate between the two.


Long-Term Care Insurance Claim Articles
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