Franchise Opportunities
Click here
Paying for Care

Using Long-Term Care Insurance to Pay for In-Home Care

Does long-term care insurance cover home care? Learn how benefits are triggered, what the elimination period means, how to file a claim, and what to check.

If your parent bought a long-term care insurance policy years ago, now may be the time it pays off. Many policies cover in-home care, but the details can be confusing, and families sometimes leave benefits unused simply because they don’t know how to start. Here’s what you need to know.

Quick answer: Most long-term care insurance policies cover in-home care once the policyholder needs help with at least two activities of daily living or has a severe cognitive impairment, as certified by a licensed health care practitioner. Benefits usually begin after an elimination period and are paid up to a daily or monthly limit.

Five steps to using long-term care insurance for in-home care: find and read the policy, understand the benefit trigger, understand the elimination period, file the claim, and plan around the benefit.

Step 1: Find and Read the Long-Term Care Insurance Policy

Start by locating the policy and any updates the insurer has sent over the years. Look for:

  • Covered services: Does the policy include home care, and does it require care from a licensed agency?
  • Benefit trigger: What level of need qualifies for benefits?
  • Elimination period: How long you must pay for care before benefits begin
  • Daily or monthly benefit: The maximum the policy pays
  • Benefit period or lifetime maximum: How long or how much the policy will pay in total
  • Inflation protection: Whether benefits have grown over time

If the paperwork is missing, call the insurance company. They can send a copy and explain benefits.

Step 2: Understand the Benefit Trigger

Most policies begin paying when a licensed health care practitioner certifies that the policyholder:

  • Needs substantial help with at least two activities of daily living, such as bathing, dressing, eating, toileting, continence, or transferring (moving between bed and chair), for an expected 90 days or more, or
  • Needs substantial supervision because of a severe cognitive impairment, such as Alzheimer’s disease or another dementia

This is why dementia care is often covered even when someone is physically able. See our guide to dementia care at home.

Step 3: Understand the Elimination Period

The elimination period works like a deductible measured in time, commonly 30, 60, or 90 days. During this period, the family pays for care. Important details:

  • Some policies count calendar days once eligible; others count only days when paid care is received.
  • Some policies waive the elimination period for home care.
  • The clock usually doesn’t start until the claim is filed and eligibility is established, so file early.

Step 4: File the Claim

  1. Call the insurer to start a claim and request claim forms.
  2. Get the physician’s statement completed by your loved one’s doctor.
  3. Expect an assessment. Many insurers send a nurse or use a phone interview to confirm eligibility.
  4. Submit a plan of care. Many policies require a written plan of care from a licensed health care practitioner or the home care provider.
  5. Keep records. Save invoices, care notes, and correspondence. Submit invoices on the schedule the insurer requires.

Ask whether the insurer pays the agency directly or reimburses your family. Some home care providers can help with paperwork or bill the insurer directly.

Step 5: Plan Around the Benefit

Compare the daily benefit with the cost of care your loved one needs. If the benefit covers six hours a day and your loved one needs eight, you’ll plan to pay the difference privately or adjust the schedule. Also check the lifetime maximum so you know how long benefits may last. For a full view of options, read our guide on how to pay for home care.

Common Pitfalls to Avoid

  • Waiting too long to file. The elimination period can’t start until you do.
  • Assuming any caregiver qualifies. Many policies require a licensed agency, not a private hire. See our guide to questions to ask a home care agency.
  • Letting premiums lapse. Many policies waive premiums once benefits begin, but confirm before you stop paying.
  • Missing paperwork deadlines. Track every request from the insurer.

Frequently Asked Questions

Does long-term care insurance pay family caregivers?

Some policies allow payment to family members, but many don’t. Check your policy or ask the insurer.

Can long-term care insurance be used for companion care?

Usually only if the policyholder meets the benefit trigger and companionship is part of the care plan. Coverage varies by policy.

Is it too late to buy long-term care insurance?

Eligibility and cost depend on age and health. Premiums rise with age, and people with certain conditions may not qualify, so earlier planning is best.

How Briggs Home Care Can Help

Many Briggs Home Care locations work with long-term care insurance and can help families understand what documentation the insurer needs. Ask about it during your free consultation. Explore our services, find a location near you, or call 1-833-960-CARE (2273).

This article is general information, not insurance or financial advice. Review your specific policy and talk with your insurer.

Related Reading

Trusted outside resource: Medicare.gov

Related Resources