What these policies are for
Long-term care insurance exists to cover exactly the kind of extended personal care that health insurance and Medicare generally will not: help with daily living at home, in assisted living, or in a nursing facility.
Many people bought a policy years or decades ago and have forgotten the details. If a parent mentions they have one, find the policy document — it is worth reading carefully before assuming anything about what it covers.
What usually triggers benefits
Most policies begin paying when the policyholder needs help with a set number of 'activities of daily living' — typically bathing, dressing, eating, toileting, transferring and continence — or when a cognitive impairment such as dementia is documented.
The specific number of activities required, and how they must be assessed and documented, is written into the policy. Do not guess at it; read the wording or ask the insurer directly.
Terms worth checking before you file
- Daily or monthly benefit amount — the maximum the policy pays
- Elimination period — the waiting days you pay out of pocket before benefits start
- Benefit period — how long payments continue, or the lifetime maximum
- Whether home care is covered, and at what percentage of the facility rate
- Whether the policy requires a licensed agency rather than a private caregiver
- Inflation protection — whether the benefit amount rises over time
How a claim usually proceeds
- Contact the insurer to open a claimAsk for their claims department and request the forms. Note the date — elimination periods are usually counted from a specific point.
- Complete the assessment they requireMost insurers arrange their own assessment of the policyholder's needs, often by phone or an in-person nurse visit.
- Provide the care plan and provider detailsInsurers typically want a written care plan and confirmation that care is provided by a licensed agency. We can supply this.
- Submit care records on an ongoing basisOnce approved, most policies require regular documentation of the hours and services delivered. We maintain those records.
How we support a claim
We can provide the documentation insurers commonly ask for: a written care plan, records of visits and services delivered, and invoices in the format required.
What we cannot do is interpret your policy, tell you whether a claim will be approved, or communicate with the insurer on your behalf as your representative. Those conversations need to happen between you and the insurer.