Using Long-Term Care Insurance for Home Care

Guide · Paying for care

There is a policy in a drawer. Your parent bought it twenty years ago, paid the premiums without complaint, and has never once mentioned it since.

That policy was bought for exactly this moment. And a surprising number of families pay for home care out of pocket for a year or more before anyone thinks to look for it.

Long-term care insurance usually does cover home care

This is the part families get wrong. Because Medicare does not cover ongoing non-medical home care, people assume no insurance does.

Long-term care insurance is a different product entirely. It exists to pay for custodial care — help with everyday living — in exactly the situations Medicare excludes. Most modern policies cover care delivered at home, and many were specifically marketed on the promise that you would not have to move into a facility.

Find the policy first

Before anything else, get hold of the actual document. Not the marketing brochure — the policy with the schedule of benefits.

Places to look: a filing cabinet or safe, the tax paperwork (premiums sometimes show up as a deduction), old bank statements for an annual premium payment, or a former employer’s benefits department. If you know the insurer but not the policy number, call them with the name, date of birth and address.

The five things to read

1. The daily or monthly benefit. The maximum the policy pays out. Older policies often have low daily limits that have not kept pace with what care costs now — that does not make them worthless, it makes them a contribution.

2. The elimination period. A waiting period, commonly 30, 60 or 90 days, during which you pay yourself before benefits begin. Crucially, on many policies the clock only starts once care actually begins. Waiting to start care does not run it down.

3. The benefit trigger. Almost always defined as needing help with a set number of activities of daily living — typically two out of six — or having a cognitive impairment. A physician usually has to certify it.

4. Who is allowed to provide the care. This is where claims most often fail. Many policies require a licensed or registered agency and will not pay for a privately hired individual. Check this before engaging anyone.

5. Inflation protection. If the policy has it, the daily benefit has been growing quietly for years and may be far higher than the number originally written on it.

How a claim usually runs

1. Call the insurer and open a claim. Get the claim number and write down who you spoke to.
2. They send claim forms and usually arrange an assessment — sometimes a nurse visiting the home, sometimes a phone interview.
3. A physician certifies the need for help with activities of daily living.
4. The elimination period runs while care is delivered and paid for.
5. Care logs and invoices go to the insurer, typically monthly.
6. Benefits are paid — either reimbursed to the family or, on some policies, direct to the agency.

Expect it to take weeks rather than days, and expect paperwork.

Where families come unstuck

• Waiting to start care until the claim is approved. On most policies the elimination period cannot run until care is actually being provided, so waiting just delays everything.
• Hiring privately, then discovering the policy requires an agency. Those months are usually unrecoverable.
• Poor record-keeping. Insurers want dates, hours, services and signatures. Reconstructing six months of care from memory is miserable.
• Assuming a low daily benefit is not worth claiming. Even a partial contribution over several years is a large sum.
• Not appealing. Initial denials are frequently overturned with better documentation.

How we help with the paperwork

We keep proper care records — dates, hours, services delivered — in the form insurers ask for, and we provide invoices and documentation on whatever schedule the claim requires.

What we cannot do is interpret the policy, advise on coverage, or deal with the insurer on your behalf. That is a conversation for the insurer, an elder law attorney, or a licensed insurance professional.

This page is general information, not insurance, legal or financial advice. Policy terms vary considerably — read yours and confirm details with the insurer.