Questions to Ask About Long-Term Care Insurance
Written for people in their fifties and sixties pricing a long-term care policy, and for adult children sitting in on a parent's meeting with the agent. The list starts with whether to buy at all and which kind of policy, then works through the contract: what has to happen before it pays, how much and for how long, where care is covered, what the premiums can do, and how the insurer handles a claim. Policy terms and the rules around them differ by insurer, state and country, so many of the notes point you to a page of the contract instead of giving a general answer.
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The questions
Each question, and why to ask it
Fit and type
Do I need long-term care insurance, or could my savings and income pay for care on their own?
Why ask it
Bring rough figures for savings, income and the value of your home, and expect an honest agent to run the numbers both ways. Some people have too little to protect and others have enough to pay their own way, and either of those should be said out loud if it describes you. A yes that comes before anyone has asked for a figure is a pitch.
Doesn't my health insurance or Medicare already cover long-term care?
Why ask it
Ordinary health coverage is built around medical treatment and short spells of rehabilitation. The term to listen for is custodial care, meaning help with bathing, dressing and supervision: ask whether the coverage you hold pays for it when that is the only care you need, and for how long. Then check the agent's answer with the program's own helpline, since the agent has a policy to sell.
What does care cost near me today: at home, in assisted living and in a nursing home?
Why ask it
Every other number in the policy is sized against these three, so ask for local figures and where they came from, not a national average. You can check them in an afternoon by phoning one home care agency and one facility. Keep the figures: several later questions use them.
Is this the right age to buy, and what would waiting five years change?
Why ask it
Waiting generally means a higher price for the same benefit and more chance that a change in health closes the door, while buying early means more years of premiums. Have the policy quoted at your age now and at five years older, side by side. 'The sooner the better' with no figures attached does not answer the question.
Which health conditions or medications could get me declined or charged more?
Why ask it
Hand over the full list before any application goes in: diagnoses, prescriptions, a cane or walker, any worry about memory. Each insurer has its own cutoffs, so a good agent pre-screens you informally and says which company is likeliest to accept you. Later applications often ask whether you have been turned down before, which is why the pre-screen comes first.
What will underwriting check: my medical records, a phone interview, a memory test?
Why ask it
Expect the insurer to pull records from your doctors, and quite often to schedule an interview by phone or in person that includes a short memory exercise. Have the agent list the steps and the usual wait, then book the interview for the time of day when you are sharpest. A test result or specialist visit still pending is worth mentioning first, because some insurers set a file aside until it is settled.
How does a traditional long-term care policy differ from a hybrid built on life insurance?
Why ask it
In broad terms a traditional policy pays only for care, and a hybrid attaches care benefits to life insurance or an annuity so that something is paid whether or not you ever need care. Which one costs less for the same care benefit depends on the products in front of you, so ask for both quoted at the same monthly benefit. If only one type is on the table, find out whether that is the agent's judgment or the limit of what they are licensed to sell.
Is this a true long-term care rider or a chronic illness rider, and how do the two differ here?
Why ask it
The two read alike in a brochure and can work quite differently. Some chronic illness riders pay only when a condition is expected to be permanent, or reduce the amount they advance. Have the rider's name pointed out on the contract page along with its conditions for payment, and wait for a clear answer before going further.
My spouse and I are both applying. Should we link our policies so one of us can draw on the other's benefits?
Why ask it
A shared-care arrangement lets one partner use the other's unspent benefit, which helps when one of you needs far more care than the other. The follow-up is what remains for the survivor if the first to need care uses most of the pool. Then find out what becomes of the sharing after a death or a divorce.
Is long-term care coverage through my employer or an association worth setting beside this quote?
Why ask it
Group plans sometimes ask fewer health questions, which matters if your history is complicated. Price and portability are the two unknowns: put both to the benefits office and get the replies in writing, including what the coverage costs once you have left the job. Then lay that offer next to the agent's quote, benefit by benefit.
Does this policy qualify for a partnership program where I live, and what would that do for me?
Why ask it
Some US states run partnership programs that let a person who uses up a qualifying policy keep more of their assets if they later apply for Medicaid. Whether your state has one, which policies count and whether another state would honor it all vary, so read the state's own page on it; outside the US, the parallel question is how a private policy sits alongside public funding for care. In some programs the inflation rider decides whether a policy counts, so settle this first if you were planning to trim that rider to save money.
If I cannot qualify, or cannot afford this, what else is there?
Why ask it
A useful agent has more than a shrug: a smaller policy, a short-term care policy, an annuity with care benefits, or a referral to a person who knows the public programs in your area. What those programs pay for and who qualifies is set country by country and state by state. Take that part to someone local who is not selling anything: a lawyer who works in elder law, or a public insurance counseling service.
Triggers and waiting
What exactly has to be true about my health before the policy starts paying?
Why ask it
Most policies turn on needing help with a set number of everyday activities, or on severe cognitive impairment, often with a requirement that the need is expected to last a minimum time. The wording is the policy's own, so ask for the definitions page and test it on someone you know: a parent, say, who could dress alone but not bathe. 'When you need care, it pays' is a worrying answer.
Which daily activities count, and does 'help' mean hands-on help or someone standing by?
Why ask it
The usual list is bathing, dressing, eating, toileting, continence and getting from bed to chair. Standby help, where someone stays within reach in case you fall, is an easier standard to meet than hands-on help. That distinction decides claims for people who are unsteady but still do most things themselves.
How is dementia or other cognitive impairment assessed, and does it qualify with no physical need at all?
Why ask it
A person with dementia may wash and dress without help and still not be safe alone. The answer to listen for treats the need for supervision as a trigger of its own, and names the tests or medical records the insurer relies on. Dementia is the reason a lot of families claim at all, so do not let the answer be hurried.
Who certifies that I qualify: my own doctor, or someone the insurer chooses?
Why ask it
Policies commonly want a licensed health practitioner to certify the need and write a plan of care, and some send their own nurse to assess you at home. What matters is the tiebreak when your doctor and the insurer's assessor disagree. A written route to a second opinion is a good sign.
How long is the elimination period, and what would I pay out of my own pocket during it?
Why ask it
The elimination period is the wait between qualifying and the first payment, and it works like a deductible counted in days. Multiply it by the daily cost of care near you to see the sum in dollars. A longer wait lowers the premium, so have it priced at two or three lengths before you choose.
Are elimination days counted on the calendar, or only on days I receive paid care?
Why ask it
With three aide visits a week, a ninety-day wait counted in days of service takes about thirty weeks to satisfy. Calendar days are the friendlier design. If this policy counts service days, find out whether a rider shortens or waives the wait for care at home.
Do I satisfy the elimination period once in my life, or again for every new claim?
Why ask it
Care often comes in episodes: a fall and a recovery, then a longer decline years later. If the wait starts over each time, ask how long you must go without care before it resets and whether days from the first episode carry forward. The best version is a wait you serve once in a lifetime.
Benefit amount
How much would it pay per day or per month, and how far does that go against care prices here?
Why ask it
Set the figure beside the local costs you collected and work out the gap you would be paying yourself. A monthly limit is more forgiving than a daily one, because a heavy day of home care can be balanced by a light one. Full coverage is seldom the aim: a gap you know about and can afford is.
How long would benefits last, and is the limit a number of years or a pool of money?
Why ask it
Many policies multiply the benefit by a period to make a total pool, and the pool stretches further if you spend less than the maximum each month. Get it as a dollar figure, and ask what becomes of money you never use. If unlimited benefits are on offer, see what they add to the premium before deciding.
On a hybrid policy, how much is there for care, and what is left for my heirs after I use it?
Why ask it
Care payments typically come out of the death benefit first, so each month claimed shrinks what is left behind. Have two cases put on paper: you never need care, and you need it for four years. Some hybrids keep a small minimum death benefit however much care is paid; check whether yours would.
Does the hybrid keep paying for care after the death benefit has been used up?
Why ask it
That depends on a rider whose name changes from insurer to insurer: extension of benefits, continuation of benefits and similar. Without it, care money stops when the life cover is spent, which may be only a few years. Get the total months of care with and without the rider, and the rider's own price.
Does the policy reimburse actual bills, or pay the full benefit in cash once I qualify?
Why ask it
A reimbursement policy pays back what you were charged, up to the limit, and wants invoices. An indemnity policy pays the full set amount for any day of covered care, and a cash policy pays it whether or not you buy care at all, which leaves you free to pay a relative or alter the house. That freedom is usually priced in, so learn which of the three this is and what a monthly claim takes in paperwork.
What inflation protection is included, and what will the benefit be when I am 80 or 85?
Why ask it
You may be buying decades before you claim, so the benefit on the day you use it matters more than the one in the quote. Have the benefit printed year by year. Then get the premium with compound growth, with simple growth and with none, because this one choice can move the price a great deal.
Is the inflation increase automatic, or an option to buy more coverage later at the price for my age then?
Why ask it
A future purchase option looks inexpensive at the start because each increase is priced at the age you accept it, and the offers can become hard to afford just as they become most useful. Ask what declining one does: some policies stop making offers after a refusal. Automatic increases cost more now and ask nothing of you later.
Does the benefit keep growing while I am on claim?
Why ask it
A claim can run for years while care prices go on rising. Check two things: whether the monthly limit still grows once payments start, and whether the remaining pool does. The answer is in the contract, so let the agent look it up instead of guessing.
Covered care
Which settings are covered: my home, adult day care, assisted living, memory care, a nursing home?
Why ask it
Take the settings singly and mark yes or no against each. Some policies, older ones especially, cover facilities only, and care very often begins at home. For every yes, ask whether it pays the full benefit or a percentage of it.
For care at home, must the caregiver come from a licensed agency, or can I hire someone myself?
Why ask it
An agency-only rule can raise the hourly cost and narrow the choice in a rural area. Some policies accept an independent caregiver with certain credentials, and what counts is partly a matter of local licensing, so get the answer for your own town. If you already know who you would want, describe that person and ask whether they would qualify.
Would the policy pay a family member who looks after me?
Why ask it
Reimbursement policies commonly exclude relatives, or allow them only when they are licensed and live elsewhere. Cash benefit policies leave the choice to you. If family care is your real plan, this answer should decide which kind of policy you buy.
How does the policy define an assisted living facility, and would the places near me meet it?
Why ask it
Facility definitions written into a contract do not always match the way communities are licensed, and the licensing categories are not the same everywhere. Take the definition to a community you would consider and ask its office whether residents with this insurer have been paid. Finding a mismatch now costs you nothing.
Beyond hands-on care, does it pay for home modifications, equipment, respite or a care coordinator?
Why ask it
A ramp, grab bars, a stair lift or an alert pendant can put off a move out of the house, and a few days of respite keeps a caregiving spouse going. Policies pay for these from the main pool, from a separate allowance, or not at all. If a care coordinator is part of the policy, ask whether using the insurer's own is required or only offered.
What is excluded, and is there a waiting period for conditions I already have?
Why ask it
Go to the exclusions page of the contract, since a brochure tends to shorten it. Lists differ, and can include certain mental health conditions, alcohol or drug dependence, self-inflicted injury and care received outside the country. Any clause about pre-existing conditions should come with a time limit you can write down.
Will it still pay if I move to another state, or retire abroad?
Why ask it
A move inside the country usually leaves the policy standing, though facility definitions and any state partnership feature may not travel with you. Care abroad is often limited to a shorter period or a smaller amount, or left out. If a move is a real possibility, name the place and have the clause read to you.
What rate increases has this insurer made on policies like this one?
Why ask it
A specific answer has years and percentages in it, and your insurance regulator may publish the same history. What happened to older policies does not predict yours. Still, an agent who says there have been none should be able to show it, and it is prudent to budget as though an increase will come.
If a rate increase arrived when I was 78, what could I do besides pay it?
Why ask it
The usual offers are a shorter benefit period, a lower monthly amount, a trimmed inflation rider or a smaller paid-up policy. Ask which of those the contract promises and which are only customary. It helps to settle now which of them you would part with first.
Which two or three choices in this quote would you change to bring the price down, and what would I lose with each?
Why ask it
The common levers are a longer elimination period, a shorter benefit period and a lighter inflation rider, and each takes away something different. Get the new premium after each change made on its own, so you can see what every lever is worth.
Which discounts are in this quote: for couples, for good health, for paying once a year?
Why ask it
Each insurer sets its own, so have every discount shown as a separate line with its dollar value. That shows which ones rest on something that could change. The couples rate is the one to press on: does it hold if only one of you is approved, and after one of you dies?
Can I pay it off in one payment or over ten years, instead of every year for life?
Why ask it
Limited-pay schedules are found mostly on hybrids. They cost more per year and end the bills before retirement income has to carry them. Have the total paid on each schedule set next to the others, with what you would get back if you gave the policy up in year five.
Do premiums stop while I am receiving benefits?
Why ask it
A waiver of premium is common, but its start date varies: the first day of the claim, or only after the elimination period. Check that it applies to home care as well as to a facility. Couples should ask whether one partner's claim also waives the other's premium, which tends to be an extra-cost rider.
What do I keep if I stop paying after fifteen or twenty years?
Why ask it
Without a nonforfeiture feature you may walk away with no coverage, whatever you paid in. With one, a reduced benefit stays in place after you stop. Ask as well about contingent nonforfeiture, a protection some places require after steep rate increases, and whether it applies to this policy in your state or country.
If I miss a payment because my memory is failing, what keeps the policy from lapsing?
Why ask it
Unpaid bills are sometimes the first visible sign of the very condition the policy exists for. Many policies let you name a second person to receive any lapse notice, and some allow reinstatement when cognitive impairment is shown inside a time limit. Name someone on the application, and tell that person you have done it.
Are the benefits taxed, and are the premiums deductible or payable from a health savings account?
Why ask it
The answer changes with the country, with whether the policy meets the local definition of a qualified one, and sometimes with how the benefit is paid. The agent can tell you how the policy is classified. What that means on your own return is for a tax preparer, and a firm tax promise from the person selling the policy deserves a second opinion.
Once the policy is delivered, is there a window to send it back for a full refund?
Why ask it
This is usually called a free look, and the number of days is set by local rules and by the kind of policy. Spend the window reading the real contract against what you were told in the meeting, starting with the trigger definitions and the inflation rider. Get the last day of the window in writing.
Insurer and claims
How long has this company sold long-term care insurance, and is it still writing new policies?
Why ask it
Some insurers have left this market and now only look after old policies, and how they have treated those customers is worth hearing about. On financial strength, write down the grade and which rating agency issued it, then confirm both on that agency's own site. You could be claiming thirty years from now, so the company matters as much as the contract.
As long as I keep paying, can the company cancel my policy or cut the benefits because I got older or sicker?
Why ask it
The words to find in the contract are guaranteed renewable: the policy stays in force on its terms while premiums are paid, although the premium may still rise for a whole class of policyholders. You should be shown the page they sit on. 'Conditionally renewable' or 'cancellable' is a weaker promise, and you should not go further until it has been explained.
What would protect my policy if this insurer ran into financial trouble?
Why ask it
Many places have a guaranty fund or compensation scheme that stands behind policies when an insurer fails, usually up to a cap that can be well below a large long-term care benefit. Agents are not always allowed to bring it up as a selling point, so get the cap from your insurance regulator yourself. A benefit pool bigger than the cap is a reason to weigh the company's rating more heavily.
How is a claim started, what documents are needed, and how long does the first payment usually take?
Why ask it
Have the steps laid out in sequence: the phone call, the assessment, the plan of care, proof of the provider's license, the invoices. Then listen for how many days a first payment takes and what usually holds one up. A family member will probably be doing this during a hard month, so request the claim forms now and keep them with the policy.
Can the insurer pay the care provider directly, or do I pay first and wait?
Why ask it
Paying a facility for two or three months before any reimbursement arrives is a strain on most households. Direct payment, where the provider agrees to it, removes that. If the agent is unsure, have them check with the claims department, not estimate.
If a claim is denied or payments are cut off, how does the appeal work?
Why ask it
There should be an internal review with a deadline, and in many places an outside review or a regulator who takes complaints. Which of those you have is a matter of local rules, so ask where the process is set out. Disputes tend to turn on the trigger definitions, which is the best argument for reading those before anything else.
Will you be the person my family calls at claim time, and what will you do for us then?
Why ask it
Some agents help file a claim and chase it, and others pass you a phone number. You can live with either, provided you know in advance. Put the agent's answer and the insurer's claims line on the first page of the policy folder, where your family will find them.
Do you sell for one insurer or several, and what do you earn on a traditional policy compared with a hybrid?
Why ask it
Commission on these products is often weighted toward the first year and can differ between traditional and hybrid policies, which is fair context for any recommendation. An independent agent should be able to put quotes from more than one company in front of you. Asked plainly, it is a question a professional answers without bristling.
My parent already holds an older policy. Can you help us work out what it covers and what it is worth today?
Why ask it
An older policy can carry benefits that would cost far more to buy now, so a letter announcing a rate increase is no reason, taken alone, to drop it. Ask the insurer for a current statement of the daily benefit, the remaining pool and the inflation rider. Decide with that statement on the table, never from the premium notice alone.
How to question an agent about long-term care insurance
Practical guidance for the conversation itself
Before the meeting
Price care locally first
Phone one home care agency and one facility near where you expect to grow old and ask for the hourly and monthly rates. Twenty minutes gives you the yardstick for every benefit figure the agent shows you, and a check on the seller's numbers.
Write out your health history
List diagnoses, prescriptions with doses, operations and their dates, and anything a doctor has said about memory or mobility. The agent needs it to pre-screen you, and a quote built on a guess about your health is a quote you may never be offered.
Decide what you are protecting, and what you can spend
It might be a spouse's standard of living, the house, an inheritance, or simply the freedom to choose where you are cared for. Someone protecting a spouse at home wants strong home care terms, while someone protecting savings from a long nursing home stay cares more about the size of the pool. Settle a yearly figure too, one you could keep paying out of retirement income with room left for an increase.
Bring the person who would file the claim
The policyholder is rarely the one who makes the phone calls when care is needed. If a son, daughter or spouse is likely to handle it, have them hear the answers on triggers and claims, and tell them where the policy will be kept.
In the meeting
Start with triggers, not price
Most of an hour can vanish into premiums and discounts. Spend the first part on Triggers and waiting and on Covered care, because a policy that is hard to claim on is expensive at any price. Fit and type can largely be handled by email beforehand.
Ask for the contract, not the brochure
Request a specimen policy for the exact product being quoted and have the agent find each answer in it: the trigger definitions, how elimination days are counted, the inflation rider, the premium clause. A brochure describes the product in general terms. The contract is what a claims examiner will read.
Change one thing at a time
Have the same policy requoted with a longer elimination period, then a shorter benefit period, then a different inflation rider, each as a separate run. Seeing what each lever does to the premium tells you where your money is going, and it stops a cheaper quote from quietly being a thinner policy.
Confirm four answers by email
The same day, email the agent your notes on four points: rate increases, how elimination days are counted, family caregivers, and whether the benefit grows during a claim. Ask for a reply that confirms or corrects each one. A point the agent leaves unconfirmed is one to read for yourself in the contract before you sign.
Comparing two or three quotes
Put them on one page
For each quote write the monthly benefit, the total pool in dollars, the elimination period and how its days are counted, the inflation rider, the yearly premium, and whether that premium can change. Quotes are laid out differently by every insurer, and the differences only show once they share a format.
Compare the benefit at 85, not today
Two policies with the same starting benefit can be far apart thirty years on, depending on the inflation rider. Ask each agent for the projected monthly benefit and pool at 80 and 85 and compare those rows. The cheaper quote is often the one that stands still.
Traditional against hybrid
Line up the total you would pay into each by age 85, then what each returns in three cases: no care at all, two years of care, six years of care. A hybrid tends to look better in the first case and a traditional policy with a large pool in the last. Which case worries you more is a personal call, and the table makes it visible.
Weigh the insurer with the price
Add a row for the financial strength rating, how long the company has sold this kind of cover and what it has done to rates on earlier policies. A lower premium from a company with a history of steep increases may not stay lower.
Reasons to slow down
'The premium will never go up'
If the contract lets the insurer raise rates for a class of policyholders, a spoken assurance changes nothing. Ask for the clause. An agent who knows the product will explain what the contract allows and what the company has done before, without promising the future.
Pressure to sign before a birthday
Prices do step up with age, and an honest agent will tell you when your next step is. Use the date to keep things moving, not as a reason to sign a contract you have not read. Ask what the step would cost in dollars, and weigh that against a week with the definitions page.
Replacing a policy you already hold
Switching restarts underwriting when you are older than you were the first time, and it usually earns the seller a fresh commission. Before dropping existing cover, have the old and new benefits written out in two columns and shown to someone who is not selling either.
A trigger nobody can explain
If the agent cannot say in plain words what has to be true before the policy pays, or keeps steering back to price, the hardest part of the product is the part they know least. Find an agent who can, or put the question to the insurer directly.