Understanding and Using Your LTC Policy: What You Need to Know

You Have a Policy, Now What?

Owning a long-term care insurance policy is a strong first step. But knowing how and when to use it—and how to file a claim effectively—can make all the difference between unlocking coverage and letting benefits go unused.

Industry data shows that the lifetime chance of using LTC benefits is only 35–50%, even among those with coverage. That means many policyholders may never tap into their benefits—often due to uncertainty, overlooked triggers, or complex claims processes. This makes it essential to review your policy before care is needed, to avoid missing out.

Think of your policy as a toolkit: when to use the appropriate tool is key so, start by confirming your policies eligibility clauses.

Coverage typically begins when you’re unable to perform at least two Activities of Daily Living (like bathing, dressing, or eating), or receive a diagnosis of severe cognitive impairment, such as dementia. Once that threshold is met, your elimination period (usually 30–90 days) begins—during which you cover care costs out of pocket.

After that period, benefits kick in—but details vary:

• Does your policy reimburse actual expenses, or pay a fixed daily rate?
• Which care settings are covered—home health, assisted living, or skilled nursing?
• How much benefit remains—is it capped by years or dollars, and has it been adjusted for inflation?

One of the most important (and often overlooked) steps is involving your primary physician early. Most LTC policies require a doctor’s certification that care is medically necessary. It’s important to clearly communicate your desire to access your policy benefits and ask your physician to help advocate on your behalf if needed. Having them complete evaluations of your ability to perform daily activities—or document cognitive concerns—can help establish eligibility and avoid delays in getting the care and coverage you need.

Coordinating Care: Who Does What?

When it’s time to begin care, one of the biggest points of confusion is how all the moving parts come together. Some care providers will bill insurers directly. Others may require the family to submit invoices for reimbursement. In most cases, having a single point of contact—whether a family member or advocate—helps keep communication streamlined between the care provider, insurer, and financial team.

Your LTC insurance agent can explain policy specifics, but they typically aren’t involved in day-to-day care planning. That’s where having a trusted advisor in your corner becomes essential.

Where We Come In

We regularly help clients understand how their long-term care strategies fit within their overall financial plan. If you already have coverage in place—or are considering it—we can connect you with trusted professionals in our network. They can work alongside a family member to navigate policies, care options, and claims, or step in as the lead to ensure you are maximizing your policy.

Our role is to make sure your LTC planning supports what matters most.

Let’s talk about what matters most.

Whether you’re looking to review an existing policy or explore whether LTC should be part of your financial picture, we’re here to help you prepare with clarity and confidence.

*The foregoing content reflects the opinions of Van Hulzen Asset Management DBA "Van Hulzen Financial Advisors" and is subject to change at any time without notice. Content provided herein is for informational purposes only and should not be used or construed as investment advice or a recommendation regarding the purchase or sale of any security. There is no guarantee that the statements, opinions or forecasts provided herein will prove to be correct. Past performance may not be indicative of future results. Indices are not available for direct investment. Any investor who attempts to mimic the performance of an index would incur fees and expenses which would reduce returns. Securities investing involves risk, including the potential for loss of principal. There is no assurance that any investment plan or strategy will be successful. 

Investment advisory services offered through Van Hulzen Asset Management, insurance products and services through Citadel, an affiliated company. Any references to guarantees relate only to insurance products and are based solely on the claims paying ability of the underwriting company.