If you consider buying Long Term Care Insurance, it's easy to find a salesperson. But as with any insurance, you need to know how the claims work. Here I will describe my experience with CNA LTC purchased in 1990, used in 2005-2021.
In 2005 my father fell, went into the hospital. After this he went to a care facility where Medicare pays up to 21 days, and then LTC kicks in, right? no.
LTC won't pay the first 3 months of care. At the 3 month mark, CNA tells me that his facility is not qualified. I wish they had told me earlier. While shopping for a different facility, he passed so no claim was filed.
Around 2012 my mother received a telephone call from CNA suggesting she drop her LTC insurance. "Don't you want to have a little bit of extra money per month?" Fortunately I was at her house at the time and confirmed that CNA was indeed trying to get her to verbally agree to drop her LTC insurance - at age 85.
They tried several ways to get her to voluntarily drop it, including returning her premium checks and issuing refunds which, if deposited, would effectively cancel the policy.
In 2016 she needed in-home care, so I called CNA claims. They said her premiums are paid up but in-home care is not covered. I requested the full policy to verify; they sent me a summary of benefits which is not the same. I wanted to see the fine print. Thankfully, in my father's files I found the original 34-page contract and indeed it was covered - except for those first 3 months. Fair enough
During that 3 months, I requested CNA to review the agency. They didn't even start until 3 months had already passed. It was denied because the agency "did not provided the requested paperwork." In fact CNA had never requested the paperwork!
All this communication was interfering with my work, so I hired a Lawyer to represent her in this matter. Lawyer was very familiar with this situation, wrote a nastygram to CNA, and within a week all was resolved: covered at 75% of the max of $100 per day.
After half a year she entered an Assisted Living Facility. CNA tried to stop until they evaluated, but thankfully the Lawyer stepped in to expedite the evaluation and to ensure no payments were missed.
She passed a few weeks ago, so my Lawyer and I are waiting to see what kind of shenanigans are awaiting us from CNA.
In summary, I would recommend (based on my experience - I'm not a Lawyer nor a CPA):
Obtain the policy - not the glossy summary of benefits, but the full policy, typically 30-100 pages. Don't just download a PDF from a menu, but get them to mail it to you, so you can be sure you've got the right one.
Read it with someone experienced in dealing with LTC claims. I used an Ombudsman at the Campbell Senior Center (cheaper than the Lawyer and just as helpful at that stage). Many hospitals have a Patient Advocate, they may be helpful. But make sure it's someone working for the patient.
Communicate in writing - mail, fax, or if need be, email - but not telephone; I found that to be a trap.
When it comes time to file a claim, do enlist the help of a Lawyer. I hesitated for months, should have done it from the start - even if only for general advice.
Is my experience abnormal? According to the director of my mother's ALF, my experience is not abnormal at all. Many of their residents have simply given up trying to claim benefits, even some who use not a private company but the state of California! Lawyer cost was $2k on claims that totaled about $100k.