If your loved one bought a long-term care insurance (LTCi) policy any time between the late 1980s and roughly 2010, you may be sitting on a benefit worth $200,000 or more — and most families never fully use it because they don't understand how to file the claim. This guide walks you through it.
What LTCi actually pays
Most policies pay a daily benefit amount (e.g., $150/day) when the policyholder needs help with at least 2 of 6 activities of daily living, or when they have severe cognitive impairment. The daily benefit is paid for as long as the policy's benefit period lasts — often 3 to 5 years, though some policies are lifetime.
Many policies also include an inflation rider that raises the daily benefit each year. A 1995 policy with a 5% compounded inflation rider can now pay $400+/day.
The benefit is paid after an elimination period — typically 30, 60, 90, or 100 days. We'll explain why this matters below.
Step 1 — Find the policy
Don't assume. Many policies were bought decades ago and the paperwork is lost. Places to look:
- A safe deposit box
- The policyholder's tax records (premiums are deductible — there will be a 1099-LTC or premium statement)
- The insurance company directly (call the customer service line on any old statement)
- A spouse or adult child's records if they were a co-applicant
- Old employer records (some policies were employer-sponsored)
- An elder-law attorney or estate planner who handled prior matters
If you can't find a policy but think one might exist, call the NAIC Life Insurance Policy Locator at 1-855-784-1490.
Step 2 — Read the elimination period
This is the single biggest mistake families make. The elimination period is a deductible measured in days, not dollars. Most policies require you to receive (and pay for) care for 30, 60, 90, or 100 days before the policy starts paying.
Two important details most families miss:
- The clock often starts only on days you actually pay for care. If the policy has a "service-day" elimination period (most common), a day with zero hours of paid care doesn't count toward the deductible. A 90-day elimination period can take 4–6 months of part-time care to satisfy.
- Days in a hospital don't usually count. Inpatient hospital days are typically Medicare-covered and excluded from LTCi elimination.
Plan to pay out of pocket for the elimination period. After it, the daily benefit starts.
Step 3 — Trigger the benefit
Most policies trigger benefits in one of two ways:
- ADL trigger. The policyholder needs hands-on help with 2 of 6 activities of daily living: bathing, dressing, eating, toileting, transferring, continence.
- Cognitive trigger. Severe cognitive impairment requiring supervision (dementia, advanced Alzheimer's, traumatic brain injury).
To trigger, you'll need a licensed health care practitioner to certify the ADL or cognitive deficiency in writing. The policyholder's primary care doctor can do this, or some LTCi carriers send their own nurse for an assessment.
Step 4 — Pre-claim notification
Most LTCi carriers want a pre-claim notification before you incur care expenses. Some carriers also require pre-approval of the care provider.
Florida nurse registry caregivers — like TrustWise's — qualify for most LTCi policies because the policy language typically requires a licensed home care provider (which we are, under AHCA) or specifies CNA/HHA credentials (which our caregivers have). Some older policies require W-2 home health agency employees — a registry's 1099 model can be a question for them.
Get the carrier's confirmation in writing that TrustWise Care qualifies before incurring expenses. This takes 5–15 business days. The carrier will assign a claims adjuster.
Step 5 — Document, document, document
This is where claims get denied. The carrier needs:
- Provider invoices showing the date, hours, services, and rate
- Caregiver logs — what was done each shift
- Periodic plans of care — most carriers require quarterly or semi-annual updates from a nurse or physician confirming care is still needed
- Receipts of payment — proof you actually paid
We provide all of this automatically. Every TrustWise client receives a monthly invoice that includes the carrier-required level of detail, and our RN Administrator signs the periodic plans of care.
Step 6 — Submit and wait
Once the elimination period is satisfied, you submit claims monthly. Reimbursement typically takes 30–60 days from submission. Carrier funds either go to the family (who paid the provider) or, with assignment of benefits, directly to TrustWise.
Common policy details to look up
Pull out the policy and find:
- Daily benefit amount ($X/day)
- Inflation rider (compounded 3%/5% or simple)
- Elimination period (days, and what counts)
- Benefit period (years or lifetime)
- Pool of money cap (some policies have a maximum lifetime dollar amount)
- Maximum monthly benefit vs daily benefit (some pay the unused daily amounts forward)
- Spousal/shared benefits if applicable
- Cash benefit alternative — some policies pay a lower flat-rate cash amount in lieu of reimbursement; useful for families who want to use the money flexibly
- Home care definition — make sure it covers non-medical care from a licensed provider; some only cover skilled nursing
Specific Florida LTCi carriers and their quirks
Common LTCi carriers our Volusia families file with:
- Genworth — claims line 1-800-456-7766. Strong documentation requirements but generally reasonable approvals.
- John Hancock — claims line 1-800-377-7311. Will pay direct to the provider with a signed assignment of benefits.
- Mutual of Omaha — claims line 1-800-775-1541. Family-friendly. Cash-benefit policies common.
- MetLife (legacy block) — now serviced via Brighthouse Financial. Older policies, larger daily benefits often inflation-indexed.
- CNA — claims line varies. Older policies, often discontinued; service has been spotty.
- Federal Long-Term Care Insurance Program (FLTCIP) — for federal employees. Excellent benefits but rigid documentation requirements.
- Bankers Life and Casualty — Florida market exposure; mid-tier benefits.
If your loved one has a TexasLife, MAA, or Penn Mutual policy from before 1995, those carriers transferred their LTCi blocks to other carriers; the old policy is still in force but you may call a different number.
What can disqualify the claim
- Care provided by a family member (most policies)
- Care that doesn't meet the policy's "qualified care" definition — check the policy
- Care that's not directed by a written plan of care — we provide one
- Failing to renew the periodic recertification — schedule reminders quarterly
The hybrid policy question
Newer LTCi policies (since ~2015) are usually hybrid life-LTC products — a life insurance policy with an LTC rider. These pay differently: typically a monthly cash benefit as an acceleration of the death benefit, with simpler triggers and no rigorous service-day elimination.
If your loved one has a hybrid policy from Lincoln Financial, Nationwide, OneAmerica, Pacific Life, or similar, the claim process is usually much easier — often a simple ADL certification and monthly cash payment.
How TrustWise supports the LTCi claim
We've walked families through more LTCi claims than I can count. Our standard support includes:
- Pre-claim provider verification. We provide our license, NPI, and credentialing documents to the carrier on request.
- Monthly carrier-ready invoicing. Date, hours, caregiver, services rendered, rate, total.
- Caregiver shift logs. Every visit documented to LTCi standard.
- Quarterly plan-of-care reviews. Signed by our RN Administrator.
- Direct billing where the carrier allows it. With a signed assignment of benefits, we can bill the carrier directly and the family never floats the cash.
There is no extra charge for any of this. It's just how we run the office.
Bottom line
If your loved one has an LTCi policy, don't leave it on the shelf. Even a 1990s-era $100/day policy with inflation can be paying $300+/day today — and a flat $34/hour TrustWise rate of care is well within most policy benefits.
Read the policy. Trigger early. Document everything. And don't be afraid to call the claims line — they handle this every day and generally want to help.
If you'd like us to review your loved one's policy and outline the claim process specific to that carrier, call us. No charge for the consultation.
Reviewed by the TrustWise Care clinical team. This article is general guidance, not insurance advice. Every policy is different; read yours.