Skip to content
Back to Top

How LTC Benefits Work

You pay a premium and then the policy pays for covered services when you need them, up to limits in your policy. Policies offer varying amounts and types of coverage. Most will pay for or reimburse policyholders a limited amount for qualified services.

Benefit Period

Policies normally pay benefits by the day, week, or month. You may choose a benefit period that is a specific number of days, months or years. A maximum benefit period may range from one year to the remainder of your lifetime.

It is important to ask if the benefit amounts will increase with inflation and if that coverage increases your premium.

Qualifications / Requirements for Coverage

Coverage is not guaranteed until you satisfy certain requirements. For example, you must be unable to perform two of the six daily living activities: dressing, bathing, continence, eating, transferring, and toileting.

Many policies further limit payment to qualified services consistent with a coordinated plan of care established by specific individuals under the policy.

Also, most policies have a benefit trigger for cognitive impairment. For example, you may only qualify for these benefits if you are unable to pass a mental functioning assessment.

Exclusions Elimination Period Changing Policies How Premiums are Determined