What triggers long-term care insurance benefits?
Benefits typically start when you cannot do at least two of the six activities of daily living without help, or you have severe cognitive impairment such as dementia. A licensed professional must certify it, and the need must be expected to last at least 90 days.
Long-term care policies pay when you meet specific benefit triggers. For tax-qualified policies (nearly all sold today), you qualify when either:
- You need help with at least two of the six activities of daily living — bathing, dressing, eating, toileting, transferring, and continence (see activities of daily living); or
- You have a severe cognitive impairment, such as Alzheimer's or another dementia, that requires supervision for your safety.
The need must be expected to last at least 90 days, a licensed health practitioner must certify it, and a plan of care is put in place. After that, your elimination period runs before benefits begin.
General information only. This is educational and not insurance, legal, tax, or financial advice. Rules and products vary and change — confirm the specifics with a licensed professional.
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