Long-Term Care Insurance Claims Resources

Free Long-Term Care Insurance Claims Processing - Find Quality Care

Long-Term Care Insurance claims are generally much easier than many people expect. Unlike health insurance, qualified Long-Term Care Insurance policies are designed to pay for ongoing assistance when you need help with everyday activities or require supervision because of cognitive impairment. Most claims are approved when the policyholder meets the benefit eligibility requirements and submits the required documentation.

When you or a loved one needs long-term care services, you already have enough on your plate. You shouldn't have to decode insurance paperwork on top of everything else.

LTC News has partnered with Amada Senior Care to process your Long-Term Care Insurance claim and coordinate quality care, at no cost and with no obligation to you. Read below how you and your family can utilize this help.

How to Process a Long-Term Care Insurance Claim

Filing a claim on your own can feel overwhelming. Understanding each step and working with a trusted professional makes the process far less stressful.

1. Locate the Policy

Start by finding your or your loved one's Long-Term Care Insurance policy. If you're not sure where it is, check bank statements for recurring premium payments or look through mail for correspondence from an insurance carrier.

Once you've located the policy, you can review your coverage and confirm how comprehensive it is.

Tip: Before beginning the claims process, confirm the policy is still active and premiums are current. Some older policies may have been placed on automatic bank draft or annual billing, and carriers can quickly verify coverage over the phone.

2. Review the Policy Details

Most Long-Term Care Insurance policies are comprehensive, but coverage varies. As you review yours, look for the following:

• Benefit amount and duration: Find the daily or monthly benefit limit and the maximum total the policy will pay. Many policies include inflation protection, which increases available benefits over time. If you can't locate your copy, you can request one from your carrier; expect a 20 to 30-page contract that spells out exactly what's covered and for how much.
• Benefit triggers: Most federally qualified Long-Term Care Insurance policies begin paying benefits when a licensed healthcare professional certifies that the policyholder requires substantial assistance with at least two of the six Activities of Daily Living (ADLs) expected to last at least 90 days, or requires substantial supervision because of severe cognitive impairment, such as Alzheimer's disease or another dementia.
• The six Activities of Daily Living include:
• Bathing
• Dressing
• Toileting
• Continence
• Transferring
• Eating
• Elimination period: Check whether there's a waiting period before benefits begin, during which you pay for care out of pocket. Medicare and health insurance can cover up to 100 days of skilled care after a qualifying hospital stay, which sometimes overlaps with and offsets your elimination period.
• Covered services and providers: Confirm which types of care your policy covers, including in-home care, adult day care, assisted living, memory care, and nursing home care, so you know your chosen provider will be reimbursed. Most policies require care to be provided by licensed or qualified caregivers or agencies that meet policy requirements. Family members generally cannot be paid for providing care unless the policy specifically allows it.

Tip: Search for long-term care searches with the LTC News Caregiver Directory

3. Gather Necessary Documentation

Before you file, collect these documents:

• Policyholder statement: Completed by you or your legal representative, this gives the insurer an overview of your situation and the nature of your claim.
• Healthcare provider statement: A physician, nurse practitioner, physician assistant, or other licensed healthcare professional, depending on the insurance carrier's requirements.
• Nursing assessment and plan of care: A licensed nurse evaluates your needs and outlines the required level of care. Amada Senior Care can help arrange this evaluation and the related paperwork.
• Plan of care: A case manager or healthcare provider documents the specific services you need going forward.
• Authorization to release information: A signed HIPAA authorization allows your insurer to access your protected health information to verify your claim.

4. Initiate the Claim

Contact your insurance company's claims department directly to start the process. Each carrier has its own forms and procedures, and many now offer online portals or mobile apps that speed things along. LTC News has contact phone numbers for major insurance companies that have issued Long-Term Care Insurance. Find that list of contact information below. Each insurance company will provide specific forms and detailed instructions in accordance with its procedures. Some insurers offer online portals or mobile apps to streamline this process. 

5. Submit the Claim and Await Assessment

Once you've submitted your paperwork, your insurer will review it. This may involve a medical assessment to confirm you meet the policy's benefit triggers, along with a review of your care plan to ensure it aligns with what your policy covers.

6. Monitor the Claim Status

Stay in regular contact with your insurer to track progress. Most claims take three to four weeks to process, sometimes less. Respond quickly to any requests for additional information to avoid delays.

7. Begin Receiving Benefits

Once approved, your insurer disburses benefits according to your policy's terms. In many cases, you can assign benefits directly to your care provider, who bills the insurer for services rendered. Some policies instead pay cash benefits directly to you without requiring invoices.

Confirm which payment structure applies to your policy, whether reimbursement-based or direct payment to providers, and understand any ongoing documentation your insurer requires.

👉 - File a Long-Term Care Insurance Claim Now

Ongoing Claim Reviews

Many insurance companies periodically review approved claims to confirm the policyholder continues to meet benefit eligibility requirements. This review may include updated physician statements, nursing assessments, or care plans. Staying current with requested documentation helps avoid interruptions in benefits.

NOTE: Benefits received from federally qualified Long-Term Care Insurance policies are generally income tax-free , subject to IRS limits for certain cash indemnity policies.

Additional Tips for a Smoother Claims Process

• Keep detailed records. Save copies of every form, communication, and receipt tied to your claim. Thorough records matter most if a dispute arises later.
• Get professional help if you need it. Most claims are approved without major issues, but some require an appeal. Working with LTC News and Amada Senior Care makes either path easier to navigate.

When a Family Member or Legal Representative Files the Claim

Many Long-Term Care Insurance claims are not filed by the policyholder. Instead, an adult child, spouse, trusted family member, or other legal representative often steps in because the insured person is recovering from an illness, living with Alzheimer's disease or another dementia, or is otherwise unable to manage the paperwork.

If you're helping a loved one, gather important legal and financial documents before beginning the claims process. Depending on the situation, you may need:

• Durable Financial Power of Attorney: This legal document authorizes a trusted person to manage financial and insurance matters on behalf of the policyholder. Depending on state law and the document's language, this may include communicating with the insurance company, completing claim forms, signing required documents, managing benefit payments, and paying care providers.
• Healthcare Power of Attorney (Healthcare Proxy): This document authorizes someone to make healthcare decisions if the policyholder is unable to do so. While it generally does not provide authority over financial or insurance matters, it can help the designated representative coordinate physician certifications, nursing assessments, and other medical documentation required to support a Long-Term Care Insurance claim.
• HIPAA Authorization: Federal privacy laws generally prevent healthcare providers from sharing medical information without the patient's permission. A signed HIPAA authorization allows physicians, hospitals, therapists, and other healthcare providers to release medical records directly to the insurance company or an authorized family member assisting with the claim.
• Guardianship or Conservatorship Documents: If a court has appointed a guardian or conservator, the insurance company will typically require copies of those legal documents before discussing the policy, processing the claim, or paying benefits.

Some insurance companies also provide their own authorization forms that allow an adult child, spouse, or other trusted individual to discuss the policy and assist with the claims process, even if a Durable Financial Power of Attorney has not been activated. Requirements vary by insurance carrier.

Important: Simply being a spouse or adult child does not automatically authorize someone to access policy information or make decisions on behalf of the policyholder. Likewise, an executor named in a will has no legal authority while the policyholder is living. Authority to assist generally comes through a Durable Financial Power of Attorney, court-appointed guardianship or conservatorship, or authorization provided directly by the policyholder.

👉 - File a Long-Term Care Insurance Claim Now

Plan Before a Crisis

The best time to organize these documents is before long-term care is needed. Waiting until a health crisis occurs can make obtaining legal authority much more difficult, particularly if the individual has already lost the legal capacity to sign a Power of Attorney.

Discuss who will help manage finances, healthcare decisions, and insurance claims if the need arises. Keep copies of your Long-Term Care Insurance policy, powers of attorney, HIPAA authorizations, and other important legal documents in a secure location that trusted family members can easily access.

Every insurance company has its own claims procedures and authorization requirements. Through the LTC News partnership with Amada Senior Care, experienced claims specialists can explain what documentation is needed, coordinate with the insurance carrier, and help families avoid delays that commonly occur when paperwork is incomplete.

Common Long-Term Care Insurance Claims Mistakes to Avoid

Filing a Long-Term Care Insurance claim doesn't have to be complicated, but a few common mistakes can delay approval or temporarily interrupt benefits. Avoiding these issues can help you receive care more quickly and make the claims process much smoother.

• Waiting Too Long to File Many families delay filing a claim because they believe they should wait until a loved one enters an assisted living facility or nursing home. In reality, most Long-Term Care Insurance policies also cover qualified care provided at home. If you or a loved one already needs substantial assistance with two or more Activities of Daily Living (ADLs) or requires supervision because of cognitive impairment, it may be time to begin the claims process.
• Submitting Incomplete Paperwork Missing physician statements, unsigned forms, incomplete care plans, or omitted medical records are among the most common reasons claims are delayed. Before submitting your claim, review every document carefully and confirm that all required forms have been completed and signed.
• Choosing Caregivers Who Don't Meet Policy Requirements Most Long-Term Care Insurance policies require services to be provided by licensed agencies or qualified professional caregivers. While some newer policies offer flexibility, many older policies will not reimburse care provided solely by family members or caregivers who don't meet the policy's requirements. Review your policy or speak with a claims specialist before arranging care.
• Waiting Too Long to Respond to the Insurance Company Insurance companies may request additional medical records, updated physician certifications, or clarification about your care plan. Responding promptly helps keep your claim moving forward and reduces the risk of unnecessary delays in receiving benefits.
• Not Keeping Records and Receipts Maintain copies of all claim forms, correspondence, invoices, receipts, care plans, and Explanation of Benefits (EOB) statements. Organized records make it easier to answer questions from your insurance company and are especially valuable if you need to appeal a claim decision or document expenses during the elimination period.
• Assuming Medicare Will Pay for Long-Term Care One of the biggest misconceptions is that Medicare pays for ongoing long-term care. Medicare generally covers only limited skilled nursing or rehabilitation services after a qualifying hospital stay and only when specific medical requirements are met. It does not pay for ongoing custodial care, such as assistance with bathing, dressing, eating, or supervision due to dementia. Qualified Long-Term Care Insurance is specifically designed to help cover these types of extended care services at home, in adult day care centers, in assisted living, in memory care, or in a nursing home, whether the services are skilled or custodial.

Understand How Your Benefits Are Paid

Long-Term Care Insurance policies generally pay benefits in one of three ways:

• Reimbursement: The most common type of policy. The insurance company reimburses covered long-term care expenses up to your available daily or monthly benefit limit. You'll typically submit invoices or proof of payment for covered services, or assign the benefits directly to the provider.
• Cash Indemnity: Once you qualify for benefits, the policy pays a predetermined daily or monthly cash benefit regardless of your actual expenses, up to the policy's maximum. You generally have flexibility in how the money is used, including paying family caregivers if permitted under the policy.
• Disability or Income-Style Benefits: Some older Long-Term Care Insurance policies pay a fixed daily or monthly benefit once you qualify, with fewer restrictions on documenting expenses. These policies are less common today but remain in force for many policyholders.

Not sure which type of policy you own? The LTC News partnership with Amada Senior Care will explain how benefits are paid before you file a claim.

Understanding how your policy pays benefits helps you know what documentation will be required and how much flexibility you'll have in using your Long-Term Care Insurance benefits.

👉 - File a Long-Term Care Insurance Claim Now

Partnership Policies

If your Long-Term Care Insurance policy is Partnership-qualified, benefits paid under the policy may also protect an equal amount of assets should Medicaid ever become necessary. Partnership programs currently exist in most states.

What Happens if the Claim Is Denied?

If your insurer denies your claim or won't reimburse certain expenses, the company must explain the denial in writing or by phone. Most denials happen because a policyholder submitted a claim for services or expenses the policy doesn't cover, or because the policyholder hasn't yet met the required benefit trigger.

If you filed on your own and your claim was denied, don't assume that's the final answer. Reach out for help with the appeals process right away.

Many denied claims result from incomplete documentation rather than ineligibility. Missing physician certifications, incomplete care plans, or questions about the level of assistance needed can often be corrected through the appeals process. Experienced claims professionals can frequently resolve these issues without litigation.

In the last reporting year, insurers paid a record $16.8 billion in traditional Long-Term Care Insurance claims. Denials are the exception, not the rule. Carefully reviewing your policy's terms and following the steps above improves your odds of approval, even if your first submission is denied.

Free Long-Term Care Insurance Claims Processing: Find Quality Care

LTC News has partnered with Amada Senior Care to process your Long-Term Care Insurance claim and coordinate quality care, at no cost and with no obligation to you.

Amada Senior Care is a national in-home healthcare agency with local offices across the country. The company can process a claim from any Long-Term Care Insurance policy, regardless of which carrier issued it, and there's never a fee for this service.

Amada is also the preferred home care provider for LTC News readers and their families. If you or your loved one needs in-home care, Amada can connect you with services in your area. If Amada doesn't have a provider where you live, or you need or prefer assisted living, memory care, or a nursing home, the team will help you locate quality care options nearby.

NOTE: In addition to Amada's local resources, you can search the LTC News Caregiver Directory to locate home care agencies, assisted living communities, memory care residences, rehabilitation centers, and nursing homes throughout the United States.

👉 - File a Long-Term Care Insurance Claim Now

How the LTC News and Amada Partnership Works

Amada Senior Care has existing relationships with the leading Long-Term Care Insurance carriers and third-party administrators. That means their trained professionals already know how each insurer processes claims, which makes the experience smoother for you and your family.

These professionals can help you:

• Review your Long-Term Care Insurance policy and explain what's covered.
• Make informed care decisions, such as whether to use benefits now for recovery care or preserve them so a loved one can age in place.
• File your claim from start to finish.
• Find high-quality care facilities or home care services that match your specific needs.

👉 - The LTC News and Amada LTC Concierge service is free, and you're never obligated to use any provider Amada recommends.

The team can also communicate directly with your insurance provider, activate your benefits, and work to ensure you receive the maximum monthly payout available under your policy.

Get the Care You Need Now

Don't wait to use benefits you've already paid for. You or your loved one purchased Long-Term Care Insurance for exactly this reason, and the sooner you file a claim, the sooner care can begin.

Beyond paperwork, care coordination is often the most valuable part of the claims process. Families frequently need help identifying reputable home care providers, assisted living communities, memory care facilities, and skilled nursing facilities. Coordinating both the insurance claim and care arrangements helps reduce delays in receiving services.

If you don't own Long-Term Care Insurance but still need help finding quality in-home care, Amada Senior Care can help with that too. Fill out the form on Amada's home care resources page, and a trained professional will reach out to help you build a care plan.

Processing your claim or finding appropriate care through this partnership is completely free, with no obligation at any step.

Don't Delay

Purchasing Long-Term Care Insurance was an important step your loved one took to protect retirement income, savings, preserve their independence, and reduce the burden on those they love. Filing a Long-Term Care Insurance claim allows the policyholder to receive the benefits they've been paying for, so they can focus on receiving quality care rather than managing paperwork. Through the LTC News partnership with Amada Senior Care, experienced professionals can guide you through every step of the process at no cost and with no obligation.

👉 - File a Long-Term Care Insurance Claim Now

No Long-Term Care Insurance? A Life Settlement Could Help

If your loved one doesn't own Long-Term Care Insurance but does have a life insurance policy, selling that policy through a life settlement can turn it into cash today, cash that goes directly toward the cost of care.

A life settlement lets you sell an existing life insurance policy to a third-party buyer for more than its cash surrender value, though less than the full death benefit. Your loved one stops paying premiums, and the proceeds can cover home care, assisted living, or nursing home costs right away.

The option works best for older adults whose life insurance needs have changed, or whose policy would otherwise lapse or get surrendered for a fraction of its worth.

Frequently Asked Questions About Long-Term Care Insurance Claims

Direct Insurer Claims Departments

Below you will find the major insurance companies who offered Long-Term Care Insurance and their phone numbers.