Long-term care insurance: what it covers for home care

A long-term care insurance policy can pay for home care, but whether yours does depends entirely on its wording. Here is what to look for and how claims usually work.

The benefit triggers

Most policies start paying when the insured cannot perform a set number of activities of daily living (usually two of six) for at least 90 days, or has a cognitive impairment such as dementia. Those two routes are often the only ways in.

The terms that decide your money

• Daily or monthly maximum — the ceiling the policy pays, often below the real cost
• Elimination period — the days you pay for yourself before benefits start
• Benefit period — how long the pool lasts, usually expressed in years
• Inflation rider — whether the maximum grows over time; an old policy without one may cover only a fraction of today’s rates
• Home care vs facility — older policies sometimes pay a lower percentage for home care

Starting a claim

• Get the triggering condition documented by a clinician
• Notify the insurer and request the claim forms in writing
• Keep a dated log of care hours and invoices from day one
• Ask what they require to keep paying: reassessments are common

The honest warning

We cannot read your policy, and neither can a website. The definitions section is the part that decides whether you get paid — read it, or have someone read it for you before you need it.

Related

• Cost calculator
• Medicaid eligibility screener
• What helps pay for care
• How many hours do you need
• Medicaid HCBS waivers