Long-Term Care Insurance: A Step-by-Step Claims Process for Home Care

Starting a long-term care insurance (LTCI) claim can feel overwhelming—especially when your family is already focused on caring for a loved one. Between medical forms, care plans, and ongoing documentation, many families worry about delays or doing something incorrectly.

At Caring Companions, we help families navigate the long-term care insurance process every day. While each policy is different, most claims follow a similar structure. This guide walks through the step-by-step process so families know what to expect and how to keep claims moving smoothly.

Step 1: Review the long-term care insurance policy

Before filing a claim, locate the policy and confirm key details, including:

• Whether in-home care is covered

• Benefit triggers (Activities of Daily Living or cognitive impairment)

• Daily or monthly benefit limits

• The elimination period (waiting period)

• Any requirements for licensed or agency-provided care

Understanding these details early helps prevent delays later.

Step 2: Confirm eligibility for benefits

Most long-term care insurance policies begin paying benefits when a policyholder:

• Needs help with two or more Activities of Daily Living (ADLs) such as bathing, dressing, transferring, toileting, eating, or continence, or

• Has a cognitive impairment that requires supervision

Eligibility is typically certified by a physician or licensed healthcare provider.

Step 3: Contact the Insurance Company

Initiate the claim by contacting the insurer’s claims department (often by phone or online portal). This opens a claim file and allows you to request a claim packet or forms from the insurance provider.

Be prepared with:

• Policyholder information and policy number

• The care start date or expected care start date

• Contact information for care providers (agency or caregivers)

Prompt notification ensures the insurer knows the claim is underway

Step 4: Complete medical and claim paperwork

The insurance company will provide a set of forms—commonly including:

• Claimant/Policyholder Statement

• Physician’s Statement or Attending Provider’s Report

• Policyholder’s basic information and a summary of care needs

• Documentation of why the services are medically necessary

A physician may need to certify that your loved one meets the benefit triggers required under the policy.

Step 5: Care assessment and care plan documentation

Most long-term care insurance companies require a care assessment and care plan that clearly outlines your loved one’s needs and the services being provided.

Caring Companions completes and submits our care assessment directly to the long-term care insurance company to help ensure:

• The care plan aligns with policy requirements

• Services meet benefit triggers

• Documentation is clear and consistent

This step is critical to claim approval and continued coverage.

Step 6: Satisfy the elimination period

Most policies include an elimination period, commonly 30, 60, or 90 days. During this time:

• Care is typically paid out of pocket

• Services must still meet policy requirements

• Documentation must continue

The elimination period usually counts only days when covered care is actually provided.

Step 7: Ongoing invoices and care notes (handled by Caring Companions)

Once care begins, ongoing documentation is required to keep benefits active.

Caring Companions submits ongoing invoices and detailed care notes to your long-term care insurance provider on a weekly basis.

This helps:

• Keep claims moving consistently

• Reduce delays caused by missing paperwork

• Ensure services are properly documented

• Take administrative stress off families

Families still receive copies for their records, but we handle routine submissions so you can focus on your loved one’s care—not insurance follow-up.

Step 8: Receive benefit payments

How payments are issued depends on the policy type:

• Reimbursement policies: Families pay for care first and are reimbursed after documentation is reviewed

• Indemnity policies: A fixed daily or monthly benefit is paid once eligibility is approved

Payments are typically issued on a regular schedule as documentation is reviewed.

How Caring Companions supports families using long-term care insurance

At Caring Companions, we support families throughout the entire long-term care insurance process by:

• Explaining how policies apply to in-home care

• Completing and submitting care assessments

• Sending weekly invoices and care notes to the insurance provider

• Adjusting care plans as needs change

• Being honest when a policy does not support a certain level of care

Our goal is to help families use their benefits effectively while ensuring care remains safe, appropriate, and sustainable.

A note for families

Long-term care insurance can be an invaluable resource, but the claims process requires organization and consistency. Understanding each step—and having support with documentation—can make the process far less stressful.

If you’re unsure where to start or feel overwhelmed by the paperwork, a conversation can often bring clarity. You don’t have to navigate this process alone.