When it’s time to use your long-term care insurance (LTCI) policy, you may have questions about how to file a claim and what to expect. The good news? Most policies are designed to make the claims process straightforward, and your family won’t have to navigate it alone. Here’s a clear overview of how LTCI claims work.

When Can You File a Claim?

You can typically file a claim once the benefit triggers in your policy are met. Most LTCI policies begin coverage when:

• You need help with at least two Activities of Daily Living (ADLs), such as bathing, dressing, eating, or mobility.

OR

• You are diagnosed with a severe cognitive impairment, such as Alzheimer’s disease or dementia.

The Claims Process: Step by Step

1. Reach Out to the Insurance Company

Contact your insurance provider or agent to start the claims process. They’ll walk you through what’s needed and send you the necessary forms.

2. Submit Documentation

You may need to submit medical records, a plan of care, or proof of services received. The insurance company will likely request a physician’s statement and care provider information.

3. Assessment and Approval

The insurer will review the documents and may schedule a care needs assessment, often over the phone or in person.

4. Elimination Period Begins

Most policies include a waiting period (commonly 30–90 days) before benefits begin. You may need to pay for care during this time.

5. Benefit Payments Start

Once approved, your policy will begin covering eligible long-term care expenses, either by reimbursing you or paying the provider directly, depending on the policy type.

What Can Be Covered?

Long-term care insurance can help pay for:

• In-home care from a licensed caregiver
• Assisted living or memory care facilities
• Nursing home care
• Adult day care services
• Home modifications or care coordination services

Your exact benefits depend on the policy’s design, benefit amount, and chosen coverage options.

Support for You and Your Family

Filing a claim doesn’t have to be overwhelming. Insurance companies often have dedicated claims support teams to guide you. If your policy was set up with the help of an LTC Advocate, you or your family can also contact them for help navigating the process.

Plan ahead, so you’re ready when the time comes.

Understanding the claims process in advance can make it easier to use your policy when you need it. If you’re considering purchasing LTCI, our LTC Advocates can help you choose a policy with a clear, reliable claims process.

Talk to an LTC Advocate today and plan with confidence.