Guide

Long-term care insurance: how to use a policy to pay for care

Updated October 15, 2026 · Reviewed against official sources

Many families discover that mom or dad bought this insurance years ago when they go through their papers at a difficult time. Others don't know whether a policy exists. This guide explains how to find it, how to claim the benefit and what to ask. It is not a recommendation to buy a policy.

What this insurance covers

Unlike health insurance, this policy is designed for personal and custodial care. Medicare and Medigap (Medicare Supplement Insurance) policies don't pay for that care, either at home or in a nursing home; we explain this in what Medicare covers.

Most policies sold today are comprehensive and let you use the benefit in several settings:

• At home, with nursing, therapy and personal help. Many policies also pay for household tasks, like cooking or cleaning, when they come along with personal care.
• Adult day centers.
• Respite care for the caregiver, and hospice.
• Assisted living, special memory care units for Alzheimer's, and nursing homes.

Each policy has limits: a maximum daily or monthly benefit and a benefit period (for example, 2 to 5 years; few pay for life). The daily benefit multiplied by the number of days gives the policy's total maximum. Some include inflation protection, which makes that benefit grow over the years.

How to find out if your loved one has a policy

• Look through their papers: the policy itself, yearly letters from the company or notices of premium increases.
• Check their bank statements: a fixed monthly or yearly payment to an insurance company may be the premium.
• Ask the benefits office at their former employer. Many employers, including the federal government, offer or have offered group programs.
• Call the insurance agent your loved one used to work with.

When you find it, write down the policy number and the claims phone number. Also ask whether you can name a contact person who will get a notice if a payment is late, so the policy isn't canceled just because someone forgot to pay. If your loved one has memory problems, the company will ask for permission to talk with you, such as a power of attorney; see power of attorney and advance directives.

When it starts paying: the "benefit triggers"

Insurance companies call the conditions for starting to pay "benefit triggers." In tax-qualified policies, a licensed health care professional must certify that the person:

• Can't do at least 2 of these 6 activities without substantial help, and the situation is expected to last at least 90 days: eating, using the toilet, moving from the bed to a chair (transferring), bathing, dressing and controlling the bladder and bowels (continence), or
• Needs constant supervision because of a severe cognitive impairment, such as Alzheimer's or another dementia, to stay safe.

That certification must be from the last 12 months. Older policies, or policies that aren't tax-qualified, may use other rules: read them carefully. To get an idea ahead of time, use our Katz and Lawton scales, which are only a guide.

The waiting period (elimination period)

It's like a deductible, but measured in days. Many policies allowed buyers to choose 30, 60 or 90 days at the time of purchase. During that time, the family pays for care. Some policies only count the days when the person receives paid care, so ask how days are counted in your policy and keep receipts from day one.

How to claim the benefit, step by step

1. Call the company and open a claim. Write down the date, the claim number and the name of the person who helps you.
2. Ask for a complete copy of the policy, including its riders, and the claim forms.
3. Ask the doctor for the certification of the need for care.
4. Get ready for the assessment. The company usually sends a nurse or a social worker to assess your loved one. Be there and describe what a normal day is like, without downplaying the difficulties.
5. Review the plan of care approved by the company's case manager. It says which services the policy pays for.
6. Ask which providers it accepts (a licensed agency, an independent caregiver, a family member, a care facility) and how it pays: some policies reimburse expenses up to the daily maximum; others pay a fixed amount for each day the benefit trigger is met.
7. Send in the bills every month and keep copies.
8. Ask about the waiver of premium: with many policies, you don't pay the premium while you're receiving the benefit.

Before you choose a place of care, confirm that the policy accepts it. You can look for options in our senior living directory, among home care agencies or adult day centers, and estimate costs with the home care cost calculator.

If the company denies or reduces payment

Ask for the explanation in writing and ask how to appeal within the company. It's often resolved with more medical information. If you need guidance, contact your State Insurance Department, which regulates these policies. If you don't know how to find it, Medicare can give you the phone number: 1-800-633-4227 (TTY 1-877-486-2048).

Hybrid policies and life insurance

Some policies combine life insurance with long-term care benefits (hybrid policies). Other life insurance policies let the policyholder receive part of the death benefit while still alive (an accelerated death benefit) if they need long-term care. Whatever is used during life is subtracted from what the beneficiaries will receive, and it can affect Medicaid eligibility. There's also the option of selling the policy (a life settlement), which has tax and family consequences. It's wise to go over this with an advisor before deciding.

Insurance and Medicaid: Partnership policies

Some states have Partnership policies, which work together with Medicaid. If the policy runs out and your loved one then applies for Medicaid, they can keep assets equal to the amount the policy paid, on top of the normal limit, and the state doesn't recover that amount after their death. These policies must include inflation protection when they're sold to people under 76. Ask your state's insurance department whether your policy is a Partnership policy. Learn more about assets and housing in Medicaid and the family home.

Taxes in 2026

With tax-qualified policies, part of the premium can count as a medical expense on your tax return, up to this limit per person, based on age at the end of the year:

Fixed daily payments from these policies are tax-free up to $430 per day in 2026, or up to the actual cost of care if that's higher. Ask a tax preparer about your situation.

💬Frequently asked questions

Can my mom buy a policy now that she already needs help?

Usually not. Companies usually turn down people who already receive care, need help with daily activities or have dementia. In that case, see how to pay for long-term care.

Will the policy pay a family member who provides care?

It depends on the policy. Some only pay licensed agencies, and others pay a daily amount that the family can use however they want. Ask in writing. For other options, read getting paid to care for a family member.

What do I do if the premium goes up and we can't afford it anymore?

Companies can raise premiums. Before you stop paying, ask whether you can reduce the benefit to lower the premium; in general, it's easier to lower coverage than to raise it.

This guide is for information only and is not legal, financial or insurance advice.

Sources

• ACL (LongTermCare.gov), What is Long-term Care Insurance?: https://acl.gov/ltc/costs-and-who-pays/what-is-long-term-care-insurance (accessed October 15, 2026)
• ACL (LongTermCare.gov), Receiving Long-Term Care Insurance Benefits: https://acl.gov/ltc/costs-and-who-pays/what-is-long-term-care-insurance/receiving-long-term-care-insurance-benefits (accessed October 15, 2026)
• ACL (LongTermCare.gov), What Long-term Care Insurance Covers: https://acl.gov/ltc/costs-and-who-pays/what-is-long-term-care-insurance/what-long-term-care-insurance-covers (accessed October 15, 2026)
• ACL (LongTermCare.gov), Long-term Care Insurance Costs: https://acl.gov/ltc/costs-and-who-pays/what-is-long-term-care-insurance/long-term-care-insurance-costs (accessed October 15, 2026)
• ACL (LongTermCare.gov), Where to Look for Long-term Care Insurance (includes Partnership): https://acl.gov/ltc/costs-and-who-pays/what-is-long-term-care-insurance/where-to-look-for-long-term-care-insurance (accessed October 15, 2026)
• ACL (LongTermCare.gov), Buying Long-term Care Insurance: https://acl.gov/ltc/costs-and-who-pays/who-pays-long-term-care/buying-long-term-care-insurance (accessed October 15, 2026)
• ACL (LongTermCare.gov), Using Life Insurance to Pay for Long-term Care: https://acl.gov/ltc/costs-and-who-pays/who-pays-long-term-care/using-life-insurance-to-pay-for-long-term-care (accessed October 15, 2026)
• Medicare.gov, Long-term care: https://www.medicare.gov/coverage/long-term-care (accessed October 15, 2026)
• U.S. Code, 26 U.S.C. 7702B (tax-qualified policies and chronically ill individuals), GovInfo: https://www.govinfo.gov/content/pkg/USCODE-2023-title26/html/USCODE-2023-title26-subtitleF-chap79-sec7702B.htm (accessed October 15, 2026)
• IRS, Revenue Procedure 2025-32 (2026 amounts: long-term care premiums and daily limit): https://www.irs.gov/pub/irs-drop/rp-25-32.pdf (accessed October 15, 2026)
• U.S. Code, 42 U.S.C. 1396p(b)(1)(C) (long-term care insurance Partnership programs), GovInfo: https://www.govinfo.gov/content/pkg/USCODE-2023-title42/html/USCODE-2023-title42-chap7-subchapXIX-sec1396p.htm (accessed October 15, 2026)

This is general information, not medical, legal or financial advice. Rules vary by state and by year: confirm with the official agency that applies to you.

👉Keep reading

How much care costs

Nursing home, assisted living, adult day care, and home care prices by state (CareScout 2025). What the rate includes, what's extra, and how to pay.

What does Medicare cover?

Medicare pays for up to 100 days of rehab after a 3-day inpatient stay, not long-term nursing home care. 2026 costs, home health and hospice.

Home care

A caregiver from an agency or hired by your family, Medicare home health and Medicaid (IHSS, STAR+PLUS): typical costs and your duties as an employer.

Power of attorney and directives

What a power of attorney, health care proxy, advance directive, and guardianship are in the U.S., when to prepare them, and forms in Spanish.