How to Use Long-Term Care Insurance for Home Care in Houston

The average Houston long-term care insurance (LTCI) policy we review in our Galleria office was written between 1996 and 2010, has an original daily benefit between $150 and $250, and has an inflation rider that has pushed the current benefit to $250 to $400+ per day. That is a real amount of money. It is usually enough to cover most or all of a well-designed home care schedule.

But that money does not move on its own. The carrier is not looking for the claim. The family has to build the claim. Most families give up somewhere in the middle, which is why the industry data shows so many policies going partly used or unused.

This is the sequence I would run if I were the family sitting on a Houston LTCI policy today. The same sequence we run for every family that hands us a policy at our office.

The seven-step sequence

### Step 1: Find the policy

Sounds obvious. It is where most families stall.

The physical policy is a bound document, usually 40 to 80 pages, that was mailed to the policyholder somewhere between 1990 and 2020. It is in a file cabinet, a safe deposit box, a home office, a bookshelf, or (increasingly) a scanned PDF on an old computer.

If you cannot find the policy, three ways to recover it.

Call the carrier. Genworth, John Hancock, MetLife, Northwestern Mutual, Mutual of Omaha, TransAmerica, Prudential, CNA, and a handful of others wrote most of the policies Houston families are holding today. The policyholder's name, date of birth, and Social Security number are usually enough for the carrier to find the policy. Some carriers require a signed authorization from the policyholder before they will release information, and if the policyholder has cognitive impairment, a power of attorney or authorized representative form.

Check bank records for premium payments. If the annual or quarterly premium was being paid, the check or the bank draft names the carrier. Look at the last two years of statements.

Check the tax return for the LTCI premium deduction. If it was itemized, it is on Schedule A.

If we cannot locate the policy on the family's own attempts, our Galleria office does the recovery. Free. The recovery calls with carriers are the same ones we make every week, and they usually take less than a day.

### Step 2: Confirm the policy is in force

An in-force policy is one that has current premiums paid, has not lapsed, and has not been surrendered. A lapsed policy is one where premiums stopped and the policy is either terminated or (for some policies) reduced to a limited paid-up status.

The carrier will confirm in-force status by phone. Ask specifically.

One common Houston situation. A policyholder who developed cognitive impairment stopped paying premiums three or four years ago because they did not remember to. The policy may be lapsed. It may be in a non-forfeiture status. It may be recoverable if the lapse was caused by the same cognitive condition the family is now trying to file on. Some carriers have a specific process for this called a reinstatement due to cognitive impairment. It requires documentation, but it works often enough that we always ask.

### Step 3: Read the daily benefit and the elimination period

Two numbers matter more than any others.

The daily benefit. Original daily benefit, current daily benefit (which reflects any inflation rider), and total pool of benefits. A policy written in 1998 with a $200 per day benefit and a 5 percent compound inflation rider now pays around $360 to $400 per day in 2026. A policy from 2005 with a $150 per day benefit and a 3 percent inflation rider pays somewhere around $215 per day. A policy from 2015 with a $250 per day benefit and no inflation rider still pays $250 per day.

The elimination period. The waiting period, measured in days of qualifying care, that has to pass before the carrier starts paying. Most policies are 30, 60, 90, or 180 days. A meaningful minority are 0 days (rare, valuable) or 365 days (rare, expensive to burn through).

A common Houston policy structure, for illustration. $200 per day original, 5 percent compound inflation to a current $360+, 5-year benefit duration, 90-day elimination period, home care covered at 100 percent of the daily benefit. A policy like this covers a 24-hour rotating arrangement almost fully, or covers a companion care schedule with margin to spare.

Two other terms to write down while you are in the policy.

Home care benefit percentage. Some older policies pay 50 percent or 75 percent of the daily benefit for home care versus 100 percent for facility care. Newer policies usually pay 100 percent for both.

Inflation rider type. 5 percent compound, 5 percent simple, 3 percent compound, or none. Compound is the most valuable. Simple is less. None is a policy that has stayed flat since it was written, which for a 1998 policy is a much smaller current benefit than the same face value with compound.

### Step 4: Understand cash-benefit versus reimbursement versus Assignment of Benefits

There are three ways an LTCI policy actually pays.

Reimbursement. The family pays the agency, then submits receipts and paperwork to the carrier. The carrier reimburses the family, usually 30 to 60 days later. This is where most policies get partly used, because the family gets tired of the paperwork and stops filing.

Cash benefit / indemnity. The carrier writes the family a check for the full daily benefit for every qualifying day, regardless of the actual care cost. The family then pays the agency. Cash benefit policies are much less common than reimbursement.

Assignment of Benefits (AOB). The carrier pays the agency directly. The family never handles the money. This is what we do at our agency. Almost no other Houston agency offers true AOB, because it requires the accounting infrastructure to work directly with each carrier and to absorb the 30 to 60 day timing gap.

If a family calls our office with a policy, the answer to "will the carrier pay you directly?" is yes for 15+ carriers and we say which ones on the initial call. A short list of the carriers we currently bill direct: Genworth, John Hancock, MetLife, Northwestern Mutual, Mutual of Omaha, TransAmerica, Prudential, CNA, State Farm, MassMutual, Bankers Life, Lincoln Benefit Life, Allianz, and several regional carriers. If a family's carrier is not on that list, we often set up direct billing for them within a week.

Our full [long-term care insurance page](/paying-for-care/long-term-care-insurance/) has the current list and detail on how AOB works at our agency.

### Step 5: Get the physician certification

The carrier will not activate benefits without physician documentation. The typical requirement is a physician-completed statement, or a certified plan of care, showing the person needs either:

Two or more Activities of Daily Living (ADLs) requiring substantial assistance. The six ADLs are bathing, dressing, toileting, transferring, continence, and eating. "Substantial assistance" is defined in the policy, usually as either hands-on assistance or standby assistance where the person cannot safely complete the activity alone.

A cognitive impairment requiring supervision. Alzheimer's, other dementias, or a cognitive condition that impairs judgment and safety.

Most Houston primary care physicians are familiar with the form. Some are not, especially if it is their first LTCI patient. If the physician is unsure, the carrier's own physician assessment form usually has clear instructions on the page.

A common Houston mistake. The family calls the primary care physician's office, the receptionist takes a message, the form ends up in a stack, and three weeks go by. If we are the agency, our RN sends the physician form directly with a cover letter explaining the specific ADLs or cognitive triggers we have documented in our assessment. The paperwork moves faster.

### Step 6: File the claim

A complete LTCI claim usually includes:

- A signed claim form from the carrier.

- A HIPAA authorization signed by the policyholder or their authorized representative.

- The physician certification.

- The plan of care (ours is written by an RN).

- Documentation of licensure and qualifications for the caregiver or agency.

Most Houston-area LTCI claims are handled through a specific carrier claims department that runs by phone, mail, and secure portal. Turnaround from submission to activation is usually 4 to 8 weeks, sometimes longer for older carriers or unusual policies.

Once the claim is filed, the carrier does two more things.

A telephonic assessment of the policyholder. The carrier sends a nurse assessor to the home, or does the assessment by phone, or subcontracts to a national assessment company. The assessor confirms the ADL or cognitive triggers documented in the claim. If the family has been on top of the paperwork this is usually straightforward. If the paperwork has been thin, the assessment can result in a denial that has to be appealed.

An elimination-period clock start. The clock counts days of qualifying care, not calendar days. A 90-day elimination period does not mean 90 days from the claim date. It means 90 days of care delivered under the plan of care. If care is intermittent, the elimination period takes longer to burn through. This is where documentation matters, because if care days are not properly logged, the clock does not run.

We log every shift on every LTCI case with the exact detail the carriers require, because the elimination period is where most claims get delayed.

### Step 7: Recertification and ongoing documentation

Once benefits are active, the carrier requires periodic recertification, usually annually. The family (or the agency, if the case is set up right) submits updated documentation, a fresh physician form, and continued proof of care.

If the person's condition changes (worsens or improves), the plan of care is updated and re-submitted. If the person is hospitalized, most policies have a specific handling for that period.

This is the step where families using a reimbursement policy often fall off. Every year the paperwork resets. If the family is running the case on their own, that annual paperwork is one more burden. If an agency is running the case, recertification is invisible to the family, because we do it.

Real numbers, three Houston examples

Example 1: 1998 Genworth policy on a River Oaks widow with mid-stage Alzheimer's.

Original benefit: $200 per day. 5 percent compound inflation. Current benefit in 2026: about $400 per day. 5-year benefit duration. 90-day elimination period. Home care at 100 percent.

Companion care schedule: 6 hours per day, 6 days per week. At $38 per hour (dementia care rate), that is $228 per day of care, well below the $400 daily benefit.

Once the elimination period is met (about 4 to 5 months of daily care given the schedule), the carrier is paying the full daily bill. Net out-of-pocket to the family: the pre-elimination-period care, plus any weeks the family adds coverage above the daily benefit.

Example 2: 2005 MetLife policy on a Memorial-area retired teacher, post-stroke recovery.

Original benefit: $150 per day. 3 percent compound inflation. Current benefit in 2026: about $216 per day. 3-year benefit duration. 30-day elimination period. Home care at 100 percent.

24-hour rotating for the first four weeks post-discharge from Memorial Hermann: $750 per day. Well above the $216 daily benefit. Once the 30-day elimination period is met, carrier pays $216 per day; family pays the remaining $534 per day. Not a full solve, but a meaningful cut in the bill.

After the intense first month, care steps down to 8 hours per day of personal care at $40 per hour, or $320 per day. Carrier pays $216 per day; family pays $104 per day.

Example 3: 2015 Northwestern Mutual policy on a Tanglewood couple, husband with Lewy Body dementia.

Original benefit: $300 per day. No inflation rider. 6-year benefit duration. 60-day elimination period. Home care at 100 percent.

Live-in care: $550 per day. Once the 60-day elimination period is met, carrier pays $300 per day; family pays $250 per day. Compared to the pre-carrier out-of-pocket of $550 per day, the LTCI coverage cuts the bill by more than half.

The 6-year benefit duration means the policy pays out for up to 6 years at that rate before the pool is exhausted. Well-timed relative to Lewy Body's typical trajectory.

None of these are the only right way to build a schedule. All three are common outcomes at our office once we have read the policy and matched the schedule to the benefit.

Elimination period gotchas

Four specific ways elimination periods trip families up.

"Days of qualifying care" versus calendar days. A 90-day elimination period on a 3-days-a-week schedule burns through slower than most families expect. Some carriers count only days when care meets a minimum hour threshold. Some count any day with any care. Read the policy language.

Once the elimination period is met, most carriers do not require it again for the same care episode. But if care pauses for a long period (some carriers, 6 months of no care) and then resumes, some policies restart the elimination period.

Some old policies have separate elimination periods for home care versus facility care. Rare but real.

Some policies have a "one-time" elimination period per policy. More common in newer policies. Older policies sometimes have a per-benefit-period reset.

Our free [LTCI policy review](/resources/ltci-policy-review/) reads the elimination period language and tells families exactly what to expect on their specific policy.

What we do at our Galleria office

The pattern for every LTCI family who calls us is the same.

Send us the policy PDF or the carrier name and policy number. If the family cannot find it, we do the recovery calls.

We read the policy and send back a one-page summary. Daily benefit (original, current, and after inflation), elimination period, home care percentage, waiver of premium language, benefit duration. In plain English.

We coordinate with the physician on the certification. We send our RN plan of care with the physician form, so the physician has something to review rather than a blank page.

We file the claim. The carrier gets a complete submission on the first pass, which cuts the activation time.

We set up Assignment of Benefits. Once the claim is approved, the carrier pays us directly. The family never handles the money.

We handle recertification and ongoing documentation. Annual, invisible to the family.

That entire flow is included in the cost of care, not a separate fee.

Frequently Asked Questions

How do I know if my long-term care insurance policy is still in force?

Call the carrier and ask. You will need the policyholder's name, date of birth, and usually the Social Security number. Some carriers require a signed authorization if the policyholder has cognitive impairment.

What is the elimination period on a long-term care insurance policy?

The waiting period, in days of qualifying care, that has to pass before the carrier starts paying benefits. Most Houston LTCI policies have a 30, 60, or 90-day elimination period. It counts days of care, not calendar days, so it usually takes longer than families expect.

Will my LTCI carrier pay my home care agency directly?

Only if the agency is set up for Assignment of Benefits with that carrier. We bill 15+ carriers direct including Genworth, John Hancock, MetLife, Northwestern Mutual, Mutual of Omaha, TransAmerica, and others. Many Houston agencies still require the family to pay first and file for reimbursement.

How much does my LTCI actually pay in 2026?

Depends on the policy. A 1998 policy with a $200 per day benefit and a 5 percent compound inflation rider is now paying $360 to $400+ per day. A policy without inflation protection still pays the original daily benefit. A free [LTCI policy review](/resources/ltci-policy-review/) tells you exactly what your policy pays today.

Does LTCI cover 24-hour care?

Yes, up to the daily benefit. If the daily benefit is $300 and the 24-hour care rate is $750 per day, the carrier pays $300 and the family pays $450. Once the daily benefit meets or exceeds the daily rate (common with older policies with strong inflation riders), 24-hour care can be fully covered.

What if my policy has lapsed because my mother stopped paying premiums during her dementia?

Some carriers have a reinstatement process for lapses caused by cognitive impairment. Not all. It is worth asking the carrier specifically about a reinstatement due to cognitive impairment. We handle this call for families whose policy has lapsed under those circumstances.

If you have a policy and are not sure what it says

Send it to our Galleria office. A registered nurse and our LTCI team read every policy that comes in, and you get back a one-page summary of what it actually covers in 2026 language. Free. No sales call attached.

Call 713-766-0908 or upload the policy to [our free LTCI policy review](/resources/ltci-policy-review/).