Long-term care insurance

Long-term care insurance helps pay for help with daily life over a long time. This includes help with bathing and dressing at home, at an adult day center, in assisted living, or in a nursing home.^1,3

For a person living with dementia, a policy bought years earlier can be a big help, if the family knows how to use it. This page explains claims, the memory trigger, hybrid policies and Virginia rules.

What a policy pays for

Most policies sold today are "comprehensive." That means you can use the benefit in several places:³

• Care at home, including personal care like bathing and dressing
• Adult day care centers
• Assisted living and Alzheimer's special care units, often called memory care
• Nursing homes
• Respite care, short breaks for the family caregiver, often 14 to 21 days a year
• Hospice care

Many policies also pay for cooking and housekeeping, but only when the person also gets personal care.³ Most policies do not pay family members who give care.⁶ Each company defines assisted living a little differently, so check that your policy covers the kind of place you plan to use.⁶

Policies do not pay forever. Most set a top amount per day or month and a total limit, such as two to five years of care. A few pay for life.¹

Good news for dementia. Most policies leave out mental and nervous disorders, but they make an exception for Alzheimer's disease and other dementias.⁶

The cognitive trigger: why it matters in dementia

A "benefit trigger" is the rule the insurer uses to decide when you can start getting paid.² Most policies have two kinds.

The daily activities trigger. The person cannot do at least 2 of 6 basic activities without a lot of help from someone else. The six are bathing, dressing, eating, using the toilet, moving in and out of a bed or chair (transferring), and bladder and bowel control (continence). The need must be expected to last at least 90 days.^6,7

The cognitive trigger. The person has a severe cognitive impairment (serious problems with memory, thinking or judgment). Because of it, they need substantial supervision to keep them safe from harm.⁷

Many people with dementia can still dress and eat on their own, yet may wander, leave the stove on or fall for scams. A person may qualify through the cognitive trigger even if they can still do most daily tasks.^6,7

Virginia rules. Policies sold in Virginia must treat cognitive impairment as its own trigger. They cannot demand more than supervision or verbal cues (spoken reminders) to protect the person or others. They also cannot require trouble with more than three daily activities.⁸

How a claim works, step by step

Every insurer has its own forms, but the path usually looks like this:

1. Find the policy. Look for the benefit triggers, the waiting period, the daily or monthly limit, the total benefit, where care can happen, and any inflation increases. If the person can no longer manage this, the agent named in a durable power of attorney can usually act. Ask the insurer what papers they need to talk with you.
2. Call the insurer to open a claim. Ask for claim forms and a list of what they need. Write down the date, the name of each person you talk to, and what they said.
3. Get the doctor's report. For tax-qualified policies, a licensed health care practitioner, such as a doctor, registered nurse or licensed social worker, must certify that the person meets a trigger.⁷ Ask the doctor to include the dementia diagnosis, test results, and how much supervision is needed.
4. Expect an assessment. The insurer usually sends a nurse or social worker to check how the person is doing, often using a set form.² Be there if you can. People with dementia often seem better than they are with strangers.
5. Get a plan of care. The insurer's care manager approves a plan of care that lists the services the policy will pay for.² Tax-qualified policies pay for services given under a plan of care from a licensed practitioner.⁷
6. Get through the waiting period. This is called the elimination period. It works like a deductible measured in days. You pay for care during it.² Some policies count every calendar day. Others count only days you get paid care. Some make you start a new waiting period if care stops and starts again.⁶
7. Send bills or receive payments. Most policies pay back what you spent, up to the daily limit. Some pay a set cash amount for each day the person qualifies, even with no paid care that day.^2,6
8. Recertify. The person must be certified as qualifying within the past 12 months, so expect the insurer to ask for updates at least once a year.⁷

Premiums may stop. Most policies have a "waiver of premium." Once benefits start, you stop paying premiums. Some policies stop them right away. Others wait 60 to 90 days.⁶ Keep paying until the insurer tells you in writing that the waiver applies.

If the claim is denied. Ask for the reason in writing. Virginia requires policies to explain how to appeal a benefit decision, so follow that process.⁸ Send any new medical records that show the need for supervision. In Virginia, the State Corporation Commission, through its Bureau of Insurance, sets the rules for these policies. You can contact the Bureau if you think a claim was handled unfairly.^8,10 An elder law attorney can help with a hard case.

Do not let the policy lapse

People with dementia may forget to pay bills. A policy that lapses can be lost right when it is needed.

Policies are "guaranteed renewable." The company cannot cancel your policy because your health changes or you file claims, as long as you pay.^6,7

Premium increases

A "level" premium does not mean it can never go up. Companies can raise rates for a whole group of policyholders in a state, with state review.⁶

If a new premium is hard to pay, you have options before you drop the policy:⁶

• Lower your coverage. Most insurers let you reduce your coverage if the premium is hard to pay. This lowers the premium, and the benefits too. Ask what choices they offer, such as a smaller daily benefit.
• Contingent nonforfeiture. In some states, when a premium rises past a set point, the insurer must offer a way to keep some coverage without paying the higher rate.
• Nonforfeiture benefits. If you bought this option, you keep some value even if you stop paying.

If the person already has dementia, think hard before dropping a policy, because they likely cannot buy a new one.⁴

Buying a policy: who and when

The average age of people who buy their own policy is about 60. For policies offered through work, it is about 50.⁴ The price depends on your age when you buy, the daily benefit, how many years it pays, and extras like inflation protection.¹ Before you buy, ask for the company's history of rate increases.¹ One rule of thumb: premiums above about 7% of your income may be too hard to keep paying.⁶

Health questions matter. Most individual policies check your health first. Insurers usually decline people who already have Alzheimer's or other dementia, a progressive brain disease like Parkinson's, or who already need help with daily activities.⁴ Each company has its own rules, so one "no" does not always mean every company will say no.⁴

Never leave out a diagnosis or symptom on an application. The insurer can cancel the policy, usually within two years, and at any time if hiding it was on purpose.⁶

Free look. In most states you have 30 days after the policy arrives to cancel for a full refund.⁶

Federal workers. The Federal Long Term Care Insurance Program has stopped taking new applications. As of October 2026, current enrollees also cannot raise their coverage.¹¹

Hybrid policies

A hybrid (or "combination") policy joins life insurance, or sometimes an annuity, with long-term care benefits. If you need care, it pays for care. If you never need care, your heirs get a death benefit.^5,6

Accelerated death benefits. Some life policies let you take part of the death benefit early if you need long-term care.⁵ Payouts are often limited. A common pattern is about 2% of the policy's face value per month for nursing home care, and half that for home care. For example, a $200,000 policy might pay about $4,000 a month in a nursing home, or about $2,000 a month at home.⁵

Virginia Long-Term Care Partnership

Virginia has a Partnership program that links private insurance with Medicaid.¹⁰ Normally Medicaid requires you to spend down most of your savings first. With a partnership policy, in most states you can keep savings equal to what the policy paid out. Details vary by state.⁶ Our Medicaid page explains how this protected amount is also shielded from estate recovery after death.

In Virginia, a partnership policy must:¹⁰

• Be issued on or after September 1, 2007
• Cover a person who lived in Virginia when the coverage began
• Include inflation protection if bought before age 76 (compound inflation protection if bought before age 61)

Look in the policy for a "Partnership Disclosure Notice." Virginia requires it in every partnership policy.¹⁰ Having a partnership policy does not by itself make a person eligible for Medicaid.¹⁰

Taxes

Benefits from a tax-qualified policy are generally not counted as income.⁷ Policies that pay a set daily amount have a tax-free limit. Payments above it may be taxed unless your actual care costs that day were as high. For 2026, the limit is $430 a day.^7,12

Premiums for a tax-qualified policy can count as a medical expense, up to a limit based on age.^7,12 For 2026, the limits are:

Source for the table: IRS Revenue Procedure 2025-32.¹² See tax help for caregivers and ask a tax preparer how this fits your return.

Questions to ask

We just got a dementia diagnosis. Can we still buy a policy?

Usually not. Insurers generally decline people with Alzheimer's or other dementia.⁴ Use any policies you already have, and look at Medicaid, VA benefits and Medicare for the care they do cover.

Will the policy pay me to care for my parent?

Most policies do not pay family members.⁶ Some indemnity or cash policies pay a set amount for each day the person qualifies, and the family can choose how to use it.² Read your policy or call the insurer.

Does it cover adult day care or memory care?

Most comprehensive policies list adult day centers and Alzheimer's special care facilities.³ Check how your policy defines each one, and whether the place you choose must have a state license.⁶

How much will the policy really pay?

Find the daily or monthly limit, any inflation increases added since you bought it, and the total benefit left. Then compare it with local prices on what dementia care costs. The gap is what the family or other programs must cover.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.