Long Term Care Insurance Support

Long-term care insurance is designed to cover services that traditional health insurance and Medicare typically don’t, such as non-medical home care, assisted living, memory care, and skilled nursing. It helps offset the cost of care when you need help with daily activities or have a cognitive impairment.

ADLs refer to everyday tasks like bathing, dressing, eating, toileting, continence, and transferring (such as getting in and out of bed). Most LTCI policies require that you need help with at least two ADLs—or have a cognitive condition like dementia—before you can qualify for benefits.

Eligibility is based on what’s called a benefit trigger, which is usually the inability to perform two or more ADLs or a diagnosed cognitive impairment. A licensed healthcare professional typically needs to certify your condition before benefits are approved.

Also known as a waiting period, this is the number of days you must receive and pay for care out-of-pocket before your policy begins to pay benefits. Some policies count only the days care is received, while others count every calendar day.

Each policy includes a Daily Benefit Amount—this is the maximum amount your insurance will cover per day of care. It may be a flat daily rate or capped at a certain dollar amount depending on your plan.

The Maximum Policy Benefit is the total amount your long-term care insurance policy will pay over its lifetime. This could be expressed as a dollar amount (e.g., $300,000) or as a benefit period (e.g., 3 years). Once you reach this limit—either in total payouts or time—your policy will stop covering care expenses, even if you still need care.

Most LTCI policies include a Waiver of Premium, which means once your claim is approved and benefits begin, you no longer need to pay your monthly premiums.

The first step is to locate your policy and contact your insurance carrier to verify your coverage. From there, you’ll need to complete and submit specific forms, typically including:

• A Policyholder Statement
• An Attending Physician Statement
• A Nursing Assessment or Plan of Care
• A Provider Statement from your care provider
• An Authorization to Release Medical Information (HIPAA form)

Filing a claim can be complex—especially if the policy is older or the requirements are unclear. Common challenges include:

• Locating the policy and understanding the fine print
• Gathering required documentation, such as physician statements, care assessments, and provider credentials
• Meeting the elimination period before benefits begin
• Interpreting benefit triggers, like ADL limitations or cognitive impairment criteria
• Delays or denials due to incomplete paperwork or missing details

That’s why our team offers guidance to help you stay organized, avoid common mistakes, and move through the process with confidence.

Yes! While we can’t file the claim for you, our team will guide you through every step. We’ll explain what documents are needed, how to complete them, and how to avoid common delays. We’re here to support you and make the process feel manageable.

Yes. Once your claim is active and care has begun, we handle all required documentation and bill your insurance provider directly. This reduces paperwork for you and helps ensure timely reimbursement.

We work with a wide range of long-term care insurance providers and third-party administrators. Some of the companies we frequently work with include:

• Genworth
• American Fidelity Group
• CalPERS
• Prudential
• UNUM
• AIG
• Bankers Life
• Cincinnati Life
• CNA Individual
• Mutual of Omaha
• CNO
• Thrivent
• Allianz
• New York Life
• Pacific Life
• Colonial Life
• National Life Insurance
• Nationwide
• Transamerica
• John Hancock
• Knights of Columbus
• Northwestern Mutual
• (…and many more)

If you don’t see your insurance company listed, just reach out—we’re happy to check your policy and confirm if we can assist.