Paying for Care

It depends on your policy. If this is your first time using your benefits for home care, it’s best to contact your insurance provider to confirm that you have an active plan, understand any applicable elimination period, and clarify the services covered under your policy.

TheKey is an approved provider with most major long-term care insurance carriers, and we have a free service to help our clients navigate all aspects of the claims process. Our Long-Term Care Center of Excellence team can help you understand your policy, determine coverage, and file claims.

Each LTC policy varies, and that’s why we’re here to help. Typically, benefit eligibility is determined based on an individual’s need for assistance with Activities of Daily Living (ADLs) or due to cognitive impairment, such as dementia or Alzheimer’s disease.

Benefits may also be subject to an elimination period (also known as a waiting period or deductible period), which is the number of calendar days or service days that must be paid as out-of-pocket expenses before benefits are payable and reimbursement begins.

Our LTC insurance team can review your policy with you and help you understand when your benefits will start.

There are six ADLs that are most commonly defined in LTC policies. You should think about initiating your LTC benefits claim when assistance (ranging from supervision to full dependency) with two of these ADLs is necessary, or there are health and safety concerns due to a cognitive impairment:

• Bathing – Assistance getting in/out of shower or tub, or help washing
• Dressing – Help selecting clothes or putting them on
• Toileting – Assistance using the bathroom or managing incontinence
• Transferring – Help moving from bed to chair, chair to standing, etc.
• Incontinence Care – Managing incontinence products and hygiene
• Eating – Assistance with feeding or eating

If your loved one needs help with two or more of these activities, it may be time to contact your LTC insurance provider to initiate a claim.

Also known as a waiting period or deductible period, an elimination period is the number of calendar days or service days that must be paid as out-of-pocket expenses before benefits are payable and reimbursement for services begins.

Think of it like a deductible for health insurance. You pay for care during this period, then your insurance benefits begin. Elimination periods vary by policy, commonly ranging from 30 to 90 days.

Our team can help you understand your policy’s elimination period and plan accordingly.

Yes. LTC policies can cover additional services beyond home care assistance. These services must be provided along with other ADL assistance that’s related to an individual’s diagnosis or care needs.

Additional covered services might include:

• Home modifications for safety (grab bars, ramps, etc.)
• Medical equipment (walkers, wheelchairs, hospital beds)
• Adult day care programs
• Respite care for family caregivers
• Care coordination and case management services

Coverage varies significantly by policy. Our LTC insurance team can review your policy to identify all available benefits and help you maximize what’s covered.

Absolutely. Many families combine payment methods; for example, using LTC insurance to cover part of the cost and paying out-of-pocket for additional hours or services not covered by their policy. Or combining veterans benefits with private pay to bridge any gaps.

We’ll work with you to structure a Care Plan that maximizes available benefits while staying within your budget.

Care plans can be adjusted as your financial situation or needs change. If you need to reduce hours temporarily, pause services, or scale up coverage, we’ll work with you to find solutions that maintain quality care while respecting your budget constraints.

Your Client Success Manager is always available to discuss adjustments and explore options.