If your parent has a long-term care insurance policy, that’s good news. It means someone, at some point, planned ahead for exactly this moment. But knowing the policy exists and knowing how to actually use it are two very different things. Most families we work with have never filed a claim before. The result? The process can feel like its own part-time job on top of everything else you’re managing.

Here’s what the process typically looks like, so you’re not figuring it out for the first time while also trying to arrange care.

Start With the Policy Itself, Not the Insurance Company

Before you call anyone, track down the actual policy document. You’re looking for a few key details:

• The elimination period (sometimes called a waiting period): This refers to the period of care your family generally pays out of pocket before the policy starts paying. Importantly, not all policies count this the same way. Some count calendar days after your parent meets the benefit trigger, while others count only service days on which qualifying care is actually received.
• The benefit amount: Policies may pay a set amount per day, per month, or from a total lifetime pool of money. Some also include inflation protection, which may increase the original benefit amount over time.
• The benefit trigger. This refers to the specific criteria your parent must meet before benefits activate.

These details shape almost every decision you make next, including when paid care can start counting toward the policy and how much of it will ultimately be covered.

Understand How the Policy Pays

Long-term care policies generally pay in one of a few ways:

• Reimbursement-based: The policy reimburses actual covered expenses up to the benefit limit. This usually requires invoices and documentation.
• Indemnity or cash-based: The policy pays a fixed amount once your parent qualifies, regardless of actual care costs.

This matters because it affects how much paperwork your family will need to submit and how directly benefits can be paid.

Get the Eligibility Determination on Record

Most policies won’t pay out on your family’s word alone. They require documentation that your parent meets the benefit trigger. Typically, this means a licensed healthcare practitioner or the insurer’s own assessor confirms one of the following:

• Your parent needs hands-on or standby help with at least two of the six standard Activities of Daily Living (ADLs). ADLs include bathing, dressing, eating, toileting, transferring, and continence;
  or
• Your parent has a severe cognitive impairment requiring substantial supervision to protect their health or safety

It’s worth noting that a dementia or Alzheimer’s diagnosis alone doesn’t automatically activate benefits. The policy typically requires documented evidence of the impairment and the supervision need, not just the diagnosis itself. It’s also common for the insurance company to send its own nurse or assessor to evaluate your parent and approve a plan of care, rather than relying solely on your parent’s regular physician.

Contact the Insurer Early to Understand the Elimination Period

As soon as you believe your parent may meet the benefit trigger, contact the insurance company to formally open the claim and ask them to confirm, in writing, how the elimination period is counted for your specific policy. Because some policies count only qualifying service days rather than calendar days, starting care before confirming this could mean paying for care that doesn’t actually count toward satisfying the waiting period. Care provided during the elimination period is generally not reimbursed. It exists to satisfy the waiting period, not to be paid back later.

Submit the Claim — and Expect Some Back-and-Forth

Once eligibility is documented, you’ll submit the formal claim, usually including:

• The practitioner’s or assessor’s documentation
• Care provider information (your home care agency’s license, invoices, or care plan)
• Proof of the care being provided — timesheets, visit logs, or invoices

Most insurers require ongoing proof of care, not just one-time approval — typically submitted monthly or periodically for as long as your parent is receiving paid care.

Keep Your Home Care Agency in the Loop

A good home care agency has usually been through this process many times, even if your family hasn’t been through it once. Griswold Home Care for Wilmington can provide the documentation insurers typically ask for — licensed provider information, itemized invoices, and detailed care logs — and, with the policyholder’s authorization, we can coordinate directly with the insurance company or assigned care manager on your family’s behalf.

Ask About CareScout Preferred Pricing

Some long-term care insurance policyholders may have access to preferred home care pricing through the CareScout Quality Network. CareScout is a Genworth company which also works with other long-term care insurance carriers, including John Hancock. Griswold Home Care for Wilmington is an approved CareScout provider, which means eligible policyholders may qualify for preferred pricing when receiving services from us. Because eligibility varies by individual policy and carrier arrangement, ask CareScout or your insurance carrier directly whether this option applies to your parent’s policy — and if so, be sure to obtain a CareScout ID before services begin.

A Few Things Worth Double-Checking

• Does the policy count calendar days or service days toward the elimination period?
• Is the benefit stated per day, per month, or as a total pool of money?
• Has inflation protection increased the original benefit amount since the policy was issued?
• Does the insurer require proof that invoices have already been paid, or will they pay the provider directly?
• Can benefits be assigned or paid directly to the home care agency, rather than reimbursing the family after the fact?
• Does the policy include a waiver of premium once benefits begin?
• Does the insurer require prior approval of the agency or plan of care?
• Does the policy cover home care specifically, or only facility-based care?
• Is there a lifetime maximum benefit, and how quickly might your parent’s current hours draw it down? This matters most for families needing 20+ hours a week, since higher-hour care depletes a lifetime maximum faster than occasional visits.

You Don’t Have to Sort This Out Alone

Filing an LTC insurance claim while also trying to arrange care for a parent — especially from out of town or in the middle of a health crisis — is a lot to carry at once. If your family has a long-term care policy and isn’t sure where to start, Griswold Home Care for Wilmington can walk through the policy with you, help gather the documentation insurers ask for, and check whether CareScout preferred pricing applies to your parent’s plan.

Call (910) 515-1378 to talk through your parent’s policy and next steps.