How to Activate & Use Your Long-Term Care Insurance Policy: A Step-by-Step Guide

Introduction: The Promise in Your Policy

You’ve paid into your policy for years. Now that you need it, how do you activate your long-term care insurance policy and actually use it?

This guide breaks down the entire process into small, easy-to-follow steps. With the right understanding, you can avoid delays, get the benefits you’ve earned, and find peace of mind.

30-Seconds Summary

• Understand your policy before you file for a claim. Carefully review your long-term care insurance policy to identify benefit triggers (like needing help with 2+ ADLs), the elimination period, your daily benefit amount, and whether services like in-home care or assisted living are covered.
• Start the claims process with a health assessment, a physician-certified Plan of Care, and the right documents. Then, call the insurer’s claims department to submit your claim and clarify payment terms.
• Your policy won’t pay until the elimination period is met, typically 30 to 90 days of paid care. Keep detailed logs, receipts, and care notes to prove you’ve fulfilled this requirement properly.
• After approval, continue receiving benefits by submitting updated logs, invoices, and care plans each month. Staying organized helps prevent delays and gives you full reimbursement under your long-term care insurance benefits.

Step 1: Understand Your Policy’s Key Terms

Before making any calls, take time to thoroughly review your long-term care insurance (LTC) policy document. Knowing what you need beforehand helps avoid confusion or delays when you contact the insurance company and begin your claim.

1.1 Finding the “Benefit Triggers”: What are ADLs?

Most LTC (long-term care) policies start paying benefits when the insured person needs help with at least two Activities of Daily Living (ADLs).

The six ADLs are:

• Bathing
• Dressing
• Toileting
• Eating
• Transferring (e.g., getting in and out of bed)
• Continence (managing bladder/bowel control)

Some policies also trigger benefits with severe cognitive impairment, like Alzheimer’s.

1.2 The “Elimination Period”: Your Deductible in Days

The elimination period is the number of days you must pay for care yourself before benefits start. It is like a waiting period.

Pro Tip: A 90-day elimination period does not mean 3 months. If care is only given 3 days a week, it may take 30 weeks to fulfill 90 care days.

1.3 The “Daily Benefit”: How Much Will the Policy Pay?

Every policy has a daily or monthly benefit limit. This is the maximum the insurer will pay per day (or month) for care.

You need to know:

• The dollar amount (e.g., $150/day)
• The lifetime cap (e.g., 3 years or $200,000)

1.4 Covered Services: What Does the Policy Pay For?

What does long-term care insurance cover? Most policies pay for:

• Assisted living facilities
• Skilled nursing care
• In-home health aides from a licensed home care agency
• Home modifications (like grab bars or ramps)

Check if your policy includes insurance for in-home care services or if it only covers facility care. If you are unsure, ask: Does insurance cover home health care?

Need care at home? Loving Home Care provides trusted, licensed services covered by many insurance plans for in-home care services. Explore our In-Home Care Options today.

Step 2: The Official Activation Process

Now that you know your policy’s basics, it’s time to activate your long-term care insurance policy by proving eligibility and submitting a claim.

2.1 Get a Professional Health Assessment

First, the insurance company needs proof that care is truly necessary. This usually starts with a professional health evaluation.

You might have to arrange for:

• A registered nurse, licensed social worker, or similar professional should visit and assess the care recipient’s condition.
• An evaluation that includes physical ability, memory, and how well the person can perform daily activities like bathing, dressing, or eating.

This assessment must clearly show that the person needs help with at least two activities of daily living (ADLs) or has a cognitive impairment like dementia.

The assessment will be written down as an official report and is a key part of the claim.

2.2 Obtain a Physician-Certified “Plan of Care”

Once the assessment is complete, you need a doctor to confirm that care is medically necessary and create a written Plan of Care.

This document should include:

• Diagnosis and explanation of the condition
• Which ADLs require assistance
• Type of care needed (e.g., in-home care, assisted living, nursing home)
• Frequency and schedule (e.g., help with bathing 5 days a week)

This plan must be signed by a licensed physician or care coordinator. Without it, the insurance company won’t process your claim.

2.3 Gather the Required Documents

After the Plan of Care is ready, you must collect several documents for the insurance claim. Missing even one can delay the process.

Here is what you will usually need:

• Claimant statement: This form gives your basic info and why you’re filing the claim.
• Physician’s Plan of Care (from above)
• Health assessment or nursing report
• Doctor’s certification of medical need
• Proof of services already being used (like invoices or a signed letter from a care provider)
• Power of attorney or guardianship papers (if someone else is filing on the recipient’s behalf)

Check the insurer’s website or call to confirm exactly which forms are needed. Some companies let you download a “claims packet.”

2.4 Make Your First Call

Now you’re ready to contact the insurance provider. Call the claims department (not customer service) and be prepared to take notes.

What to say:

• “I need to activate a long-term care policy and file a claim.”
• “Can you walk me through what documents are required to open the claim?”

Questions to ask:

• “What documents are needed for a long-term care claim?”
• “What is the waiting period for long-term care insurance?”
• “Does my long-term care policy pay me or the care agency?”
• “How often do I need to submit proof or invoices?”

Write down:

• The name of the person you spoke with
• The date and time of the call
• Their answers to each question

This information will help you follow up and avoid surprises later.

Give your loved one the support they need with Loving Home Care. We offer Dementia Care services, which may be eligible under in-home health care insurance.

Step 3: Navigating the Elimination Period

Once your claim is initiated, you will usually need to wait through the elimination period. This is a set number of days (like 30, 60, or 90) that you must pay out-of-pocket before your LTC insurance benefits begin.

3.1 What to Expect During This Time

You don’t just have to wait during your elimination period; you have to show proof as well. Most insurance companies require that the policyholder:

• Actively receive care during this time (not just qualify for it)
• Pay for that care personally
• Track the number of care days (not calendar days)

If care is not provided daily, it can take longer to satisfy this period. For example, getting care three days a week could take 10 weeks to fulfill a 30-day elimination requirement.

3.2 Keep Detailed Records

Documentation is key. Keep a full record of:

• Each date care was given
• Who provided the care (name and license info if applicable)
• Type and duration of service
• Invoices, signed care logs, and receipts

These records help prove that the elimination period is being met and that services are legitimate.

3.3 Work with Your Care Provider

Your in-home care insurance provider should:

• Be from a licensed home care agency
• Provide detailed service notes and monthly invoices
• Help submit documentation to the insurance company

You may want to choose a provider familiar with the long-term care claims process, as they can help reduce errors and delays. Regular communication between your care provider and insurance carrier can help speed up benefit approval once the elimination period ends.

Worried about costs? Learn smart ways to manage care expenses, from in-home care insurance to Medicaid planning. Read How to Pay for Long-Term Care: A Complete Guide.

Step 4: Submitting Ongoing Claims for Reimbursement

Once the elimination period ends and your claim is approved, you’ll start receiving long-term care insurance benefits. But the work doesn’t stop there. To keep receiving those payments, you must submit updated documentation every month. This makes sure that the insurer continues to verify your eligibility and that services are being delivered as described.

4.1 Who Gets Paid?

There are two common models of LTC benefit payment. Make sure you understand how your specific policy handles this.

• Reimbursement Model: You (the policyholder or their representative) pay the care provider first. Then, you submit receipts and get reimbursed by the insurance company. Most policies work this way.
• Indemnity Model: The insurance company sends a preset daily benefit (like $150/day) directly to you, regardless of how much care actually costs. This gives more flexibility, but also more responsibility.

You should ask your provider: “Does my long-term care policy pay me or the care agency?”

Knowing the answer helps you avoid confusion and missed payments.

4.2 Monthly Documentation Checklist

Every month, you’ll need to send in updated paperwork. Create a system to track deadlines and what’s due.

Your monthly claim packet should include:

• Caregiver service logs: Daily or weekly notes showing services provided (bathing, dressing, etc.)
• Signed time sheets or care logs (especially important for personal assistance care insurance) showing exact hours worked
• Agency invoices: Clearly itemized, dated, and matching the caregiver logs
• Updated Plan of Care: Some insurers require this every 90 days or when care needs change
• Proof of loss forms: These are insurance company forms confirming the claim is still valid. Some are required monthly.

Pro Tip: Keep scanned or digital copies of every document. This helps if anything gets lost in transmission.

4.3 Streamline the Process

Managing monthly claims takes effort, but consistency helps avoid issues. Here is how you can stay on track:

• Stick to one caregiver agency (if possible). Switching agencies can confuse documentation and delay payments.
• Use calendar reminders to stay ahead of deadlines for submitting paperwork.
• Keep a physical or digital folder for each month’s submission. Label clearly by date.
• Ask your care agency if they can submit documents on your behalf. Many do this regularly and know exactly what insurers need.
• Submit via email or upload on the portal if allowed. It is faster and easier to track, and avoids mailing delays.

Staying organized ensures your long-term care reimbursement continues without gaps and that you get full value from your policy.

Did you know that long-term care insurance premiums may be tax-deductible up to $6,020 in 2025 for individuals over 70? Couples can deduct even more, i.e, up to $12,040, depending on age. Learn how this can lower your out-of-pocket costs and make using your LTC policy easier.

To learn more, check the AALTCI guide on 2025 tax-deductible limits.

Common Roadblocks and How to Handle Them

Even with careful planning, you may face challenges when trying to use long-term care insurance. Here is how you can spot some of the most common issues and what you can do about them.

5.1 Why Was My Long-Term Care Claim Denied?

Claim denials are frustrating, but are often preventable. Here are some of the most common reasons why claims get denied:

• Care was not provided by a licensed home care agency. Most policies require licensed providers. Always confirm licensing before starting care.
• Not enough documentation of ADL assistance. Remember, policies usually require help with at least two activities of daily living (ADLs). If your logs don’t show this, the claim may be rejected.
• The elimination period was not fulfilled correctly. You may need to prove that services were provided each day, not just that time passed.
• Incomplete paperwork. Missing physicians’ statements, unsigned logs, or outdated plans of care can all result in denial.

How to fix it:

• Ask for the exact reason in writing.
• Recheck every form and log for missing info.
• Resubmit with full documentation.
• Get help from your care agency; they’ve often handled these cases before.

5.2 What if the Benefit Doesn’t Cover All Costs?

A common question is: “Does long-term care insurance cover assisted living fully?” In most cases, no. Policies usually pay a set daily benefit, not the full bill. If your care costs more than the daily amount, you must cover the rest.

Here’s what you can do:

• Use personal savings to fill the gap.
• Reduce hours of care (if safe and realistic).
• Apply for Medicaid if your assets are limited.
• Ask if you qualify for supplemental aid through your insurer or a local program.
• Prioritize services covered by your policy to get the most value.

Key Tip: Always review your policy’s “Schedule of Benefits” to see exactly how much it pays, and for how long.

Click here to find The True Cost of Care.

Conclusion: From Policyholder to Beneficiary

Getting LTC insurance benefits takes effort, but with the right steps, you can get the care you need.

Start by learning what your policy covers and what documents you need. Then, work with your care provider to complete each step: the health assessment, care plan, initial claim, and ongoing monthly paperwork.

With this guide, you can confidently activate long-term care insurance benefits and secure the care your loved one deserves.

Need help with in-home care and your long-term care insurance?

Loving Home Care is a licensed provider experienced in working with LTC policies. We have helped families coordinate home health care, submit claims, and get the most out of their policies.

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