How to Use Your Long-Term Care Insurance for In-Home Care: Benefit Triggers, the Elimination Period, and the Claim

Maryland and Washington, DC 

How to Qualify for Long-Term Care Insurance Coverage for Home Care

Most long-term care insurance (LTC insurance) policies turn on when the policyholder needs help with two or more activities of daily living (ADLs) or has a cognitive impairment, and a licensed home care provider documents it. Whether you are the policyholder or the family caregiver for an elderly parent, the steps are the same. Then an elimination period runs before the policy pays. Families lose months here because nobody tells them that on many policies the clock only runs on days care is actually received. Here is the order of operations, and what we take off your plate.

Step 1: Find the policy and call the claims line 

Locate the policy documents or the most recent premium statement. Call the carrier's claims number and ask for five things in writing: 

1. The benefit triggers (which activities of daily living, and whether cognitive impairment qualifies on its own) 
2. The daily or monthly benefit amount for home care 
3. The elimination period, and whether it counts calendar days or days of paid care 
4. Whether care must come from a licensed home care agency 
5. The claim forms and whether the carrier accepts an Assignment of Benefits 

If you cannot find the policy, call us. We help families track down the carrier more often than you would think. 

Step 2: The nurse assessment and plan of care 

The carrier needs documentation from a licensed provider that the policyholder meets the benefit triggers. Our registered nurse (RN) visits the home, assesses each activity of daily living (bathing, dressing, toileting, transferring, continence, eating) and cognitive status, and writes a plan of care in the format carriers expect. This document is what opens the claim. Vague paperwork is the most common reason claims stall. 

Step 3: Satisfy the elimination period 

The elimination period is a deductible measured in days instead of dollars. On many policies, only days when you receive and pay for covered care count toward it, so starting care sooner can mean the policy pays sooner. Some policies count calendar days once you qualify. We read your policy's language with you and schedule so the period is met as efficiently as the policy allows. 

Step 4: Assignment of Benefits and direct billing 

Once the claim is approved, a signed Assignment of Benefits lets Specialty Care Services invoice the carrier directly. We send the invoices and the visit notes, and we follow up on payment. Your family is not writing checks and waiting for reimbursement. 

Step 5: Keep the benefit paying 

Carriers ask for ongoing proof that in-home care is still needed. Our nurse reassesses on a regular schedule and our aides document each visit, so recertifications are routine instead of a scramble. 

Veterans and Surviving Spouses

A long-term care policy and Department of Veterans Affairs benefits can work side by side. Veterans may also qualify for VA home care through the Homemaker and Home Health Aide program, and qualifying veterans and surviving spouses may be eligible for Aid & Attendance, a pension add-on that can go toward privately paid care. See our VA pages, or ask us.

Contact Us

Call us or request a call back. Have the policy handy, and we will walk through it together.