When should I file an LTC claim?
When you can't perform two of the six ADLs without substantial assistance, or when you have severe cognitive impairment requiring substantial supervision — these are the standard policy triggers. Most policies have an elimination period (90 days is common) before benefits start. Notify the carrier early; they'll send a benefits coordinator or care manager to evaluate the claim, coordinate care assessments, and review provider invoices. The earlier you involve them, the smoother claims processing tends to go.
Section C — Group Benefits (Employer-Sponsored)
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Related FAQs
Are LTC premiums tax-deductible?
Federal: yes, as itemized medical expenses, subject to age-based limits that increase in steps every decade of age (current figures published annually by the IRS). The deduction phases in based on whether your total medical expenses exceed a percentage of AGI. NY allows a state income tax credit equal to a portion of LTC premiums paid (subject to caps). Self-employed individuals can deduct LTC premiums above-the-line up to the federal age-based limits. Confirm current dollar limits with a tax advisor…
Read answerAre NY plans different from plans elsewhere?
Yes, in two ways beyond community rating. (1) **NY mandated benefits** require coverage for things federal ACA doesn't mandate: infertility and IVF on most plans, autism spectrum disorder treatment including ABA therapy, broader contraception coverage, telehealth parity, and stricter mental health parity enforcement. (2) **Provider networks** in NY are heavily concentrated around the major hospital systems (NYC: NewYork-Presbyterian, Mount Sinai, NYU, Northwell, Montefiore; upstate: each region has 2–3 dominant systems) — picking a plan is functionally picking a hospital network.…
Read answerCan I see specific doctors / hospitals on the plan I'm considering?
This is the most important question and the most-overlooked one at enrollment. Marketplace plan summaries don't tell you network depth. The right move: get the list of every provider you currently see (PCP, specialists, dentist, mental health), call each one, ask "do you take [Plan Name from Carrier X for the current plan year]?" — and confirm the *specific plan*, not the carrier. Carriers offer many plans on different networks (e.g., HMO, EPO, PPO, narrow network) and a doctor accepting…
Read answerDo I need a medical exam?
For most term policies above $500K, yes — a paramedical exam (height, weight, blood pressure, blood draw, urine sample) at home or in an office. **No-exam (simplified or accelerated) underwriting** is increasingly available for healthy applicants under age 50–55 buying $500K–$2M of term, often with an answer in 1–7 days. **Guaranteed-issue** policies (no health questions, no exam) exist for older applicants but cap face value at $25K–$50K and are expensive per dollar of coverage. We pre-screen the underwriting category at…
Read answerDoesn't Medicare cover long-term care?
No, and this is the single most-misunderstood point in retirement planning. Medicare covers up to 100 days of **skilled nursing care** following a qualifying hospital stay (with cost-sharing after day 20). It does **not** cover custodial care — the day-in-day-out help with ADLs that constitutes the vast majority of long-term care needs. Medicaid covers long-term care, but only after you've spent down most of your assets. This is why people who want to control where and how they receive care,…
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