---
title: "Long-Term Care Insurance: What It Covers | Riskado"
description: "Long-term care insurance helps pay for ongoing care at home, in assisted living or in a nursing home, after a trigger and waiting period, up to set limits."
url: "https://riskado.com/insurance-terms/long-term-care-insurance/"
lang: "en"
published: "2026-06-08"
modified: "2026-10-01"
image: "https://riskado.com/og/default.jpg"
alternates:
  es: "https://riskado.com/es/terminos-de-seguros/seguro-de-cuidado-a-largo-plazo.md"
---

# Long-term care insurance

[Life and Health](https://riskado.com/life-and-health-insurance/) · Updated Oct 1, 2026

Long-term care insurance helps pay for eligible ongoing care outside an acute-care hospital, such as care at home, in assisted living or in a nursing facility. It pays only after the policy's eligibility trigger and waiting period are met, and only up to its daily or monthly benefit, benefit period and lifetime maximum.

Also called: long-term care, ltc, long term care insurance

Long-term care insurance pays toward help with daily living over months or years, the kind of care ordinary [health insurance](https://riskado.com/insurance-terms/health-insurance/) and Medicare generally leave alone. Medicare generally does not pay for ongoing custodial care in a nursing home, assisted-living facility or community setting, according to [Medicare.gov (opens in a new tab)](https://www.medicare.gov/coverage/long-term-care), though it may cover limited skilled nursing or home-health services under specific conditions. A [policy](https://riskado.com/insurance-terms/policy/) starts paying once you meet its trigger and [waiting period](https://riskado.com/insurance-terms/elimination-period/), and it stops at its benefit [limits](https://riskado.com/insurance-terms/limit-of-liability/).

## How a daily benefit limits what the policy pays

On an expense-incurred policy, the [insurer](https://riskado.com/insurance-terms/insurer/) pays your covered costs up to the daily maximum. [New York DFS (opens in a new tab)](https://www.dfs.ny.gov/consumers/health_insurance/long_term_care_insurance/glossary) gives the example of $200 in covered daily expenses against a $100 daily maximum. Carried over 30 days for illustration:

$200 of covered daily care against a $100 daily maximum

Hover or tap a row to highlight it.

| Item | One day | 30 days |
| --- | --- | --- |
| Covered care expense | $200 | $6,000 ($200 times 30) |
| Policy payment at the daily maximum | $100 | $3,000 ($100 times 30) |
| Left for you to pay | $100 | $3,000 ($6,000 minus $3,000) |

The 30-day figures leave out an elimination period, [coinsurance](https://riskado.com/insurance-terms/coinsurance/), exclusions and benefit exhaustion. An indemnity policy works differently, paying a stated dollar amount not tied to your exact expense.

## Policy choices and what each changes

A handful of settings decide what a policy can pay, and each moves the premium too.

- **Daily or monthly benefit.** A daily benefit caps each day, while a monthly benefit creates a monthly pool that can flex when costs vary. California's 2025 comparison system uses a $100 daily benefit for sample plans and $130 for Partnership plans, according to the [California Department of Insurance (opens in a new tab)](https://www.insurance.ca.gov/01-consumers/105-type/95-guides/05-health/01-ltc/ltc-insurance.cfm). A higher amount raises the payment limit and usually the premium.
- **Benefit period.** California's sample plans use three-year and five-year periods, and its comparison materials list one-year through seven-year and lifetime options. A longer period enlarges the pool and generally raises the premium.
- **Inflation protection.** Compound protection grows the benefit from the prior year's increased amount, while simple protection adds a fixed percentage of the original amount; California describes 5% versions of each. Either generally raises the premium and the future benefit.
- **Elimination period.** California lists common options of 0, 30, 90 or 100 days. A longer period shifts more early cost to you and generally lowers the premium, and under some policies a new elimination period can apply for each period of care.
- **Covered settings.** Options range from nursing-home care, assisted living and home care to adult day care, hospice, respite care or comprehensive coverage. Narrower coverage may cost less but leaves more unpaid.
- **Nonforfeiture and Partnership features.** A nonforfeiture benefit can keep reduced coverage if premiums stop and normally raises the premium. A Partnership policy may protect assets under Medicaid when the policy and state program qualify.

The alternative, self-funding, means paying from income and savings. Most Americans pay for long-term services out of pocket, sometimes until their resources run out and Medicaid becomes available, according to [HHS (opens in a new tab)](https://aspe.hhs.gov/reports/caregivers-ltss).

## Where you meet the term

Long-term care insurance comes as a standalone individual or group policy, a group certificate, a [rider](https://riskado.com/insurance-terms/rider/) on life insurance, a benefit attached to an annuity, or a Partnership-qualified policy. It is not a coverage inside auto, home, renters, pet or business policies.

You will see it on quotes, applications, outlines of coverage, schedule pages, premium-increase notices, benefit statements and claim letters. In the policy itself, the benefit triggers, covered settings, benefit maximums, elimination period and premium provisions carry the most weight, and claim letters often refer to activities of daily living or a plan of care.

## How Connecticut and New York regulate it

Connecticut defines an individual long-term care policy as one paying for necessary care of an injury, illness or loss of functional capacity outside an acute-care hospital, covering nursing-home care, home care or both, under [Conn. Gen. Stat. § 38a-501 (opens in a new tab)](https://www.cga.ct.gov/current/PUB/chap_700c.htm#sec_38a-501). The same section requires a 60% loss-ratio standard and rate approval by the Insurance Commissioner, and a premium increase of 20% or more must be spread over at least three years. Group policies follow comparable rules under [§ 38a-528 (opens in a new tab)](https://www.cga.ct.gov/current/pub/chap_700c.htm#sec_38a-528), and life and annuity products with long-term care benefits fall under [§ 38a-458 (opens in a new tab)](https://www.cga.ct.gov/current/pub/chap_700b.htm#sec_38a-458).

In New York, long-term care insurance must cover at least 24 consecutive months for each covered person, subject to eligibility requirements, under [11 NYCRR § 52.12 (opens in a new tab)](https://govt.westlaw.com/nycrr/Document/I5001a5d3cd1711dda432a117e6e0f345). Group certificates below that minimum must be labeled nursing-home only, home-care only or nursing-home-and-home-care insurance. Disclosure is required before a policy with home-care or nursing-home benefits is executed, under [Insurance Law § 1117 (opens in a new tab)](https://www.nysenate.gov/legislation/laws/ISC/1117). DFS must approve initial premiums and class-based increases, and an insurer cannot single out one person for an increase because that person aged or became ill, according to the [DFS consumer guide (opens in a new tab)](https://www.dfs.ny.gov/consumers/health_insurance/long_term_care_insurance/consumer_guide).

## Questions to ask an agent or insurer

1.  What exact event makes benefits payable, and do I need to be unable to perform a set number of activities of daily living or have a cognitive impairment? A diagnosis or a doctor's recommendation may not satisfy the trigger by itself.
2.  Which services and settings are covered, and must the provider be licensed? Coverage may be limited to named settings, and family or informal care may be excluded.
3.  What are the daily or monthly benefit, total pool, benefit period and inflation method? These decide how much the policy can pay as care costs rise.
4.  How long is the elimination period, how is it counted, and can it apply again later? You may pay for care yourself before benefits begin.
5.  Can premiums increase, and what are my options if one is approved or I can no longer pay? A level premium does not guarantee an unchanging one.

## Frequently asked questions

These questions come up most when families review a policy or prepare a claim.

### Can long-term care insurance premiums go up?

Yes. Increases usually need state approval and apply to a class of policyholders, and at renewal you may face a choice between paying more, reducing benefits, taking a reduced paid-up option or letting the policy lapse.

### Is a long-term care rider the same as a standalone policy?

No. A rider on life insurance or an annuity pays long-term care benefits under that contract's own terms, and an annuity is not long-term care insurance unless its rider or provisions say so.

### Does my policy still work if I move to another state?

Policy benefits may remain payable after a move. Partnership asset protection, Medicaid eligibility, reciprocity and tax treatment can change, so confirm them with the new state's insurance department and Medicaid agency.

## Related terms