Long-term care insurance questions for families
This guide is general educational information, not medical, legal, or financial advice. Talk with your own attorney, financial advisor, or care professional about your situation. Elder Living Guide provides education and referrals; we are not a care provider, facility, agency, or medical practice.
Short answer: If your parent has a long-term care insurance policy, find the policy and its outline of coverage first, then answer four questions in writing: what care and settings it covers, what "benefit trigger" starts benefits, how long the elimination (waiting) period is and how its days are counted, and how much it pays per day and in total. Most policies pay when a person needs help with two or more of six activities of daily living or has a cognitive impairment, and you pay for care yourself during the elimination period (LongTermCare.gov). Keep paying the premium while you sort it out, and name a third-party contact so the policy can't quietly lapse.
This page is for the family member who has just found (or been handed) a parent's long-term care policy and needs to know what it's worth and how to use it. It covers where each answer usually sits in the paperwork, the questions to ask the insurer, how a claim generally starts, what to do with a premium increase letter, and how to keep the policy from lapsing. It ends with a free one-page policy summary sheet. It doesn't review any policy, file claims or recommend an insurer. For whether a family should buy a new policy, the free counselors below are a better start than this page.
First, what Medicare won't do
Medicare and most health insurance, including Medicare Supplement Insurance (Medigap), don't pay for long-term care services, including care in a nursing home or in the community, because most long-term care is non-medical help with everyday tasks like dressing and bathing (Medicare.gov). Medicare.gov adds that a person may be eligible for long-term care through Medicaid if they meet their state's eligibility requirements. That's why an existing long-term care policy matters so much: for many families it's the only insurance that pays for this kind of help. To see where the policy sits beside Medicaid, VA benefits and private pay, read how families pay for senior care.
Find the paperwork before anyone calls the insurer
Gather everything in one folder. You're looking for:
- The policy itself (or, for a group plan through an employer or association, the certificate of coverage). The section called "Eligibility for Benefits" is where the benefit triggers are described (NAIC Shopper's Guide).
- The outline of coverage, a summary of the benefits and important features that the insurer gives buyers (NAIC).
- The copy of the application. NAIC notes most states require the insurer to give the buyer a copy when the policy is delivered, and suggests keeping it with the insurance papers.
- Any partnership notice. If it's a long-term care insurance partnership policy, the insurer either says so in writing with the policy or sends a letter, and NAIC calls it very important to keep that notice.
- The latest premium bill and any rate increase letters, so you know what's due and when.
Write the policy number, the insurer's claims contact from the paperwork, and the premium due date on the summary sheet at the end of this page. If the policy can't be found, ask your parent which company it was with and contact that company directly.
What to look for in the policy, and what to ask
These are the terms that decide whether, when and how much the policy pays. The first two columns come from LongTermCare.gov and the NAIC Shopper's Guide; the questions are ours.
| Policy term | What the official guides say | Question to ask the insurer (get the answer in writing) |
|---|---|---|
| Covered care and settings | Long-term care insurance is designed to cover long-term services and supports, including personal and custodial care at home, in a community organization or in another facility (LongTermCare.gov). | Does this policy cover care at home, adult day, assisted living, memory care and nursing home care? Are any settings paid at a lower amount? |
| Benefit trigger | Most policies pay when the person needs help with two or more of six activities of daily living, or has a cognitive impairment. Most companies decide this with a specific assessment form filled out by a nurse/social worker team that the company sponsors (LongTermCare.gov). NAIC lists the six most policies use: bathing, continence, dressing, eating, toileting and transferring. | Which trigger does this policy use? Does it count "stand-by" help or only "hands-on" help? Is the trigger for home care different from the one for facility care? |
| Elimination (waiting) period | Time that must pass after the trigger before benefits pay. Most policies let the buyer choose 30, 60 or 90 days when the policy is bought, you must cover the cost of care during it, and some policies count a day only if paid care was received (LongTermCare.gov). NAIC notes the period can be 20, 30, 60, 90 or 100 days, and explains two ways days are counted: "calendar days" (every day the trigger is met) and "service days" (only days of paid professional care). | How many days, counted which way? Do days start counting before we pay for care? Is it a one-time period, or does it restart with each new episode of care? |
| Daily or monthly benefit, and lifetime maximum | Policies reimburse a daily amount up to a pre-selected limit, and the daily maximum times the number of days sets the lifetime maximum (LongTermCare.gov). Most policies pay costs up to a pre-set daily limit until the lifetime maximum is reached; other "cash disability" policies pay a pre-set cash amount for each day the trigger is met, whether or not paid care was used, and LongTermCare.gov says those offer more flexibility but are potentially more expensive. NAIC says most policies sold today pay the actual expense or the policy's dollar limit, whichever is less. | What is today's daily (or monthly) benefit, and how much of the lifetime maximum is left? Is it reimbursement or a cash benefit? |
| Inflation protection | Automatic inflation protection raises the daily benefit each year by a fixed percentage; with "special offer" protection the policyholder chooses increases from time to time. NAIC adds that some policies keep making inflation offers while benefits are being paid, but most don't (NAIC). | Has the benefit grown since the policy was bought? If increases are offered, what happens if we turn one down, and do offers stop once benefits start? |
| Who can be paid | NAIC says companies don't pay for care provided by family members during or after the elimination period, and most policies may not count care family members give toward the elimination period either. It points readers to the policy's exclusions or definitions section. | Which caregivers or agencies does the policy accept? What invoices, care notes or licenses does it need from them? |
| Waiver of premium | Lets the policyholder stop paying premiums once eligible and the insurer starts paying benefits. Many policies include it automatically; some offer it only as an option. Some companies waive premiums as soon as they make the first benefit payment; others wait until benefits have been received for 60 to 90 days (NAIC). | Does this policy have it, and exactly when do premiums stop? Until the insurer confirms that in writing, keep paying. |
| Partnership status | Partnership policies can protect some assets if the person later applies for Medicaid; they vary by state and aren't offered in every state (NAIC). | Is this a partnership policy? Please confirm in writing. |
How a claim usually starts
Every insurer has its own process, so the policy and the insurer's claims team are the final word. In general terms, LongTermCare.gov describes it this way: benefits need both the benefit trigger and the elimination period to be met; most companies use a specific assessment form filled out by a nurse and social worker team; and once the person is assessed, the insurer's care manager approves a plan of care that sets out the benefits they're eligible for (LongTermCare.gov). A practical order that follows from that (our suggestion):
- Call or write the insurer early, as soon as care looks likely, and ask for its claim forms and the steps it requires. If you aren't the policyholder, ask what permission the insurer needs from your parent before it will talk with you.
- Ask how the elimination period will be counted for your parent's care plan, so you know which days count. Under a service-days policy, NAIC notes that using paid care three days a week makes benefits start later than five days a week.
- Book the insurer's assessment and have someone who knows your parent's daily routine there for it.
- Get the approved plan of care in writing and share it with the agency or community you choose. Ask the provider whether they bill your family while the insurer reimburses, and what invoices they can send.
- Keep a log of every call (date, name, what was said) and every document sent. The summary sheet below has room for this.
If the claim is denied or you think the insurer got something wrong, ask for the reason in writing and how to appeal. Your state insurance department handles insurance questions and complaints (find yours on the NAIC state insurance departments list). For the legal side of a disputed claim, talk with your own attorney.
Keep the policy from lapsing
A policy that lapses for an unpaid premium can be lost right when it's needed. NAIC describes a third-party notice: the policyholder can name someone, such as a relative, friend or professional, whom the insurer must contact if coverage is about to end because premiums aren't paid, and that person then has some time to arrange payment. NAIC notes this matters most for people with cognitive impairments who might forget to pay (NAIC). Some states require insurers to let policyholders name a contact and update the list from time to time. With your parent's agreement, ask the insurer to add or update that contact. NAIC also suggests thinking about having the premium taken out of a bank account automatically, since that may keep coverage from ending over a forgotten payment; set it up only if your parent is comfortable with it.
If a premium increase letter arrives
NAIC explains that long-term care insurance is guaranteed renewable, which means the policy can be kept as long as premiums are paid on time, but not at the same premium. Insurers can raise premiums only for a whole class of policies in a state, the increase must be filed with or approved by the state insurance department, and a company can't single out one person because they filed a claim or their health changed (NAIC).
Before deciding anything, read the letter for the choices it offers. NAIC describes options that may be available:
- Downgrade: most insurers let you reduce coverage for a lower premium, which may let you keep the policy instead of dropping it.
- Nonforfeiture benefit: if the policy has one, dropping it can still leave some paid-up coverage instead of nothing.
- Contingent benefit upon lapse: in some states, when premiums rise past a set level, the insurer must offer ways to keep the policy without paying the higher premium, such as reduced benefits at the same premium or a paid-up policy with a shorter benefit period.
Don't let a policy lapse while you think it over. If the choices are confusing, the state insurance department or your State Health Insurance Assistance Program (SHIP) can help you understand them; NAIC points policyholders to both, and you can find your local SHIP. A financial advisor can help you weigh the cost against the rest of the care budget.
Who in the family owns the policy
Pick one person to hold the policy binder, track the elimination period and send claim paperwork, so the insurer hears one voice and nobody opens a duplicate claim. Agree on roles using our guide to sharing caregiving with siblings, and if that person lives far away, pair it with a long-distance check-in plan. Bring the summary sheet to the family meeting about changing care needs.
Fit the policy into the care budget
Agencies and communities usually quote their own rates whether or not there's a policy, so build the monthly numbers first with how to build a private-pay senior care budget. Then subtract what the policy will actually pay after the elimination period, up to its daily limit, and note when the lifetime maximum would run out. NAIC points out that a policy may not cover the full cost of care, and the family pays the difference, so plan for that gap. To check a community's fee sheet line by line, use how to compare assisted living fees and the senior care cost comparison, and before signing, read the residency agreement for how billing works. If the choice of setting is still open, compare the types of senior care side by side; for memory care in particular, see when to tour memory care and what to ask.
A made-up example
This example is invented to show how the pieces fit. It isn't a real family or a real policy. Dana finds her father's policy in a desk drawer. The outline of coverage shows home care and assisted living are covered, the benefit trigger is help with two of six activities of daily living or a cognitive impairment, and the elimination period is 90 service days. Dana calls the insurer, learns the 90 days count only days with paid professional care, and asks the home care agency to start on a schedule the family can afford, knowing every paid day moves the clock. She asks the insurer to add her as the third-party contact, books the assessment, and writes each call on the summary sheet. When the plan of care arrives, she sends it to the agency and asks which invoices it can provide each month.
Free policy summary sheet
Download our blank long-term care policy summary sheet (a CSV file that opens in any spreadsheet app). It has a row for each term in the table above, plus rows for the claim steps and a call log, with blank columns for what the policy says, where you found it, and the date the insurer confirmed it in writing.
Next step: one call this week
Find the policy and outline of coverage, fill in the summary sheet as far as you can, then call the insurer with the questions you couldn't answer. If you're still deciding what kind of care your parent needs, start with our senior care planning guide or how families pay for senior care, or the care options overview / contact us if you'd like help thinking through care options. We can't review a policy or tell you what it will pay; only the insurer can.
How this page is made
Every statement about how long-term care insurance works is taken from LongTermCare.gov (run by the U.S. Administration for Community Living), Medicare.gov, and the National Association of Insurance Commissioners' A Shopper's Guide to Long-Term Care Insurance, and was checked on October 8, 2026, then re-checked against those sources on October 11, October 15, and October 17, 2026 (including the afternoon promotion re-check). Policies differ, and state rules differ, so your parent's own policy and insurer always come first. The questions, the claim order, the example and the summary sheet are ours. We didn't review any family's policy for this page, and we have no relationship with any insurer.
Keep reading: How to build a private-pay senior care budget · How to compare assisted living fees · Senior care planning: the complete family guide
Elder Living Guide provides education and referrals. We are not a care provider, facility, agency, or medical practice. Not a Medicaid guide.