Most policies written in the last two decades cover home care, but nearly all of them impose an elimination period, a daily or monthly benefit cap, and a benefit trigger tied to needing help with a set number of activities of daily living or having a cognitive impairment. Several also require that care be delivered by a licensed agency rather than a privately hired caregiver.
If there is a long-term care policy, this is usually the best answer available — and it is also the answer families most often fail to claim correctly, because the policy has conditions nobody read in 1998.
The five things to check in the policy, in order
The benefit trigger
Nearly all policies pay only once the insured needs substantial assistance with a set number of activities of daily living — usually two of six — or has a documented cognitive impairment. The assessment that establishes this is not optional and is usually done by the insurer.
The elimination period
A waiting period, commonly 30, 60 or 90 days, during which you pay and the policy does not. Critically: check whether the clock counts calendar days or days on which service was actually delivered. Under a service-day policy, three visits a week means a 90-day elimination period takes seven months.
The daily or monthly benefit cap
The policy pays up to a limit. If the cap is $150 a day and care costs more, the difference is yours.
Whether it requires a licensed agency
Many policies will not reimburse a privately hired caregiver, or require the caregiver to hold a specific credential. This one alone often decides agency versus private hire.
Inflation protection
A policy written in 1999 with no inflation rider may have a daily benefit that has not kept pace with anything. Know the number before you build a plan on it.
How to actually get it paid
Call the insurer and open a claim before care starts, not after. Ask what documentation they need — usually a care plan, a physician's statement, and agency invoices in a specific format. Then ask the agency directly whether they bill LTC insurers, and whether they will bill the insurer or expect you to pay and seek reimbursement. That is a meaningful cash-flow difference over a 90-day elimination period.
A practical tip. Agencies that regularly handle LTC claims are noticeably better at the paperwork, and the paperwork is where claims fail. Ask how many active LTC-funded clients they have. A specific number is a good sign; “we work with all insurances” is not an answer.
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Common questions
Will my long-term care policy pay for in-home care?
Most policies written in the last two decades do, subject to a benefit trigger — usually needing help with two of six activities of daily living or having a documented cognitive impairment — an elimination period, and a daily or monthly benefit cap. Many also require a licensed agency rather than a privately hired caregiver.
What is an elimination period?
A waiting period before benefits begin, commonly 30, 60 or 90 days. Check whether it counts calendar days or days on which service was actually delivered — under a service-day policy, care three days a week means a 90-day elimination period takes about seven months.
Sources for this page
- CareScout Cost of Care Survey 2025 — state data tables — CareScout (Genworth), 2025. More than 25,000 rates collected from long-term care providers nationwide between July and November 2025. Annual figures assume 44 hours a week for 52 weeks.
Reviewed by the Vegas Senior Advisor care team. Last updated November 11, 2026. Spot something wrong? Call (725) 465-8617 and we will correct it within one business day.
