How to Pay for Assisted Living in Utah

Wondering if your elderly loved one’s medical insurance will cover assisted living in Utah? Well, it may now, even if it is a long-term care policy. Covering nursing care and covering assisted living care are two different things altogether.

Long-term care insurance (LTCI) can be very tricky to understand. It’s important to know what to look for to ensure that your loved one’s LTCI policy is useful when you need it most. Not all of them are alike. If you’re not familiar with the lingo and technicalities, you and your family may end up paying for assisted living expenses out-of-pocket.

Paying Out-of-Pocket for Assisted Living

It’s happened numerous times in the past. A person pays for expensive medical coverage for decades. Then, at some point, that person becomes elderly, and needs long-term assisted living. That’s when the entire family finds out that the insurance their loved one has been paying for all this time, doesn’t cover it. The entire family ends up having to pitch to help pay for the out-of-pocket costs related to assisted living home care.

Unfortunately, for many people who bought their policies between the late 80s and early 90s, this is the case. That was before ideas about assisted living became so popular, as opposed to nursing homes. Back then, insurance policies weren’t as comprehensive when it came to covering various forms of long-term elderly care. In many cases, these are people from the Baby Boomer Generation.

Baby Boomers Ready for Assisted Living Communities

Now, Baby Boomers and their parents are trying to clear LTCI benefits. Many are coming to the realization that their policies are sufficient for their needs. According to Utah Health Advocates, their insurance claims may get denied. And, if they are honored, they may be online partially covered.

That’s because oftentimes, policies written before the mid-90s contain requirements that are out-of-date. Therefore, they rarely up-to-date changes in regards to long-term care, providers and services. Here are some of the coverage issues being faced by the elderly wondering how to pay for assisted living in Utah:

  • Some of the requirements for long-term care payments to get paid are: a 3-day stay in the hospital, AND no less than 14 days of care within a nursing home facility, WITHIN 30 days of the 3-day hospital stay.
  • Assisted living may not be covered if the special insurance requirements regarding services, staffing and design aren’t met. For example, a policy may stipulate that there must be 24-hour on-site nursing care at the facility, or that the place must have a certain amount of beds.
  • Even if the plan is a newer one, it may contain a clause for “alternative plan for care.” It is enforced at the insurance company’s discretion, which can trigger the company’s refusal to pay.

It’s Probably Time to Update Your Long-Term Care Insurance Policy

So, what’s the answer to how to pay for assisted living in Utah? Make sure your LTCI policy is always up-to-date. If your loved one purchased a policy before assisted living was widespread, it’s time to check out the coverage and clauses. Many of these policies do include long-term care, but they were specifically written to cover long-term care in nursing homes in Utah, not assisted living communities in Utah.

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