Before you sign, use the policy illustration to compare daily benefits, benefit triggers, elimination periods, inflation protection and premium guarantees side by side.
This guide is general information, not insurance, tax or legal advice. Rules, limits and deadlines change each year, so check HealthCare.gov, Medicare.gov or your insurer for your situation.
Key points
- Most long-term care policies pay benefits when you need help with two or more activities of daily living or have a cognitive impairment.
- Elimination periods of 30, 60 or 90 days can be counted in calendar days or service days, and service days can stretch a 90-day wait to about seven months.
- Premiums rise with the age at which you apply, typically 2 to 4 percent per birthday and 6 to 8 percent a year in your 60s, which is why buying in your mid-50s is often recommended.
- Standard policies are use-it-or-lose-it: if you cancel, the insurer keeps your premiums unless you paid extra for a return-of-premium feature.
- Medicare generally does not cover ongoing long-term care, which is why private coverage or savings fill the gap.
Long-term care insurance is closer to a one-time purchase than most coverage. Standard policies are use-it-or-lose-it: cancel years from now and the insurer keeps every premium you paid unless you bought a costly return-of-premium feature. Contracts typically run 40 or 50 pages and arrive after you apply and pay, so the time to catch problems is while you are comparing illustrations, not after. Here is how to work through them in order.
Step 1: Decide What Daily Benefit and Length of Coverage You Need
Before comparing companies, set the two numbers that drive everything else: how much the policy pays per day and how long it keeps paying. Most policies cover costs up to a pre-set daily limit until a lifetime maximum is reached. Others pay a set cash amount for each day you meet the benefit trigger, whether or not you receive paid care that day. Those cash policies offer more flexibility but generally cost more.
Base the daily benefit on care costs where you live, whether nursing home, assisted living or home care. Remember what public programs do not do: Medicare generally does not cover ongoing long-term care, and our article on whether Medicare pays for nursing home care explains the short, limited situations where it can help. For the bigger picture, our planning timeline walks through costs by decade.
Step 2: Compare Benefit Triggers Across Policies
A benefit trigger is the standard an insurer uses to decide whether you qualify for benefits. Most policies pay when you need help with two or more of six activities of daily living, such as bathing or dressing, or when you have a cognitive impairment. After you file a claim, a nurse and social worker team assesses your condition, and the insurer’s care manager approves a plan of care listing the benefits you can receive.
Trigger wording differs between contracts, so compare how each one counts the activities and what evidence it requires. A policy that is hard to trigger is worth less, however low its premium looks.
Step 3: Look Closely at the Elimination Period
The elimination period works like a car insurance deductible, except it is measured in days instead of dollars. It is the time that must pass after a benefit trigger occurs before payments begin, and most policies let you choose 30, 60 or 90 days when you buy. You cover the cost of any services during that stretch, and some policies require that you receive paid care or pay for services for the period to count at all.
This is where comparisons most often go wrong, because insurers use two different counting formulas:
| 90-day elimination period | Roughly how long until benefits start |
|---|---|
| Calendar days | About three months |
| Service days, at three days of care per week | About seven months |
Important: Ask the agent to show you the contract wording that says whether the elimination period counts calendar days or service days, and get the answer in writing. The difference can add months to your wait for benefits.
Step 4: Weigh Inflation Protection Options
Claims often come decades after purchase; the American Association for Long-Term Care Insurance notes that most claims occur when people are in their 70s or 80s. A daily benefit fixed at today’s care costs will buy less by then. Inflation protection is the policy feature that raises the benefit over time, and it is usually optional and adds to the premium.
Compare illustrations with and without the rider, and check exactly how the daily benefit grows and at what point growth stops. Two policies with the same starting benefit can end up far apart if their inflation features differ.
Step 5: Check Whether the Premium Can Rise
Premiums are set by your age and health when you apply, so an application at 60 generally costs less than the same coverage at 65. Waiting gets more expensive on its own too: annual premiums typically rise 2 to 4 percent with each birthday, and 6 to 8 percent a year once you reach your 60s. That timing math is why the American Association for Long-Term Care Insurance recommends buying in your mid-50s; our guide to when to buy long-term care insurance covers the age and health trade-offs.
Then read the premium language itself. Ask whether the quoted premium is guaranteed to stay level or can be raised, and under what conditions. A lower starting premium that the insurer can raise may cost more over the years you hold the policy.
Step 6: Review Exclusions and Whether Money Comes Back
Use your free look period, the window after delivery when you can cancel for a refund, to read the exclusions and claim rules in the actual contract rather than relying on the summary. Also compare what happens to the money if you never claim, since standard policies pay nothing back if you cancel.
That trade-off is what combination products try to solve. Hybrid policies pair life insurance with long-term care benefits, and some life policies offer accelerated death benefits. Those advances are typically capped at 50 percent of the death benefit, and the monthly payment for nursing home care usually equals about 2 percent of the face value, half that for home care. On a $200,000 policy, that is $4,000 a month for a nursing home or $2,000 for home care. Payments taken while alive reduce what your beneficiaries receive.
Step 7: Verify the Insurer and Agent Through Your State Insurance Department
State insurance departments license insurers and agents and handle complaints, and rules vary by state, so confirm both the company and the agent are licensed where you live before paying anything. For free local help understanding long-term care services and options, the Eldercare Locator, a public service of the federal Administration for Community Living, connects older adults and their families with community services at 1-800-677-1116.
Once you have illustrations in hand, line them up using the steps above, and get the calendar-days-versus-service-days answer in writing from each agent before you sign.
Frequently asked questions
What is a benefit trigger on a long-term care policy?
It is the standard an insurer uses to decide whether you qualify for benefits. Most policies pay when you need help with two or more of six activities of daily living or have a cognitive impairment, confirmed through an insurer-sponsored assessment.
What is the difference between calendar days and service days for the elimination period?
Calendar days count every day. Service days count only days you receive care, so with three days of care a week, a 90-day elimination period can take about seven months to satisfy.
Can my long-term care insurance premium go up after I buy?
Your starting premium is based on your age and health when you apply. Ask whether the quoted premium is guaranteed to stay level or can be raised, and check the contract wording rather than the sales summary.
What is an accelerated death benefit?
It is a feature in some life insurance policies that lets you receive an advance on the death benefit while you are still alive, often to pay for care. The advance is typically capped at 50 percent of the death benefit and reduces what your beneficiaries later receive.