For the care health insurance won't pay for.
Coverage for help with daily living at home, in assisted living or in a nursing home, with the triggers, waiting periods and inflation choices explained before you apply.
Quick answer Long-term care insurance covers help with everyday tasks such as bathing, dressing and eating, at home, in assisted living or in a nursing home, when chronic illness, disability or cognitive decline makes them hard to manage alone.
- Long-term care policies can cover facility care only, home care only, or both under comprehensive coverage.
- Medicare doesn't pay for long-term custodial care, such as help with bathing or dressing, at home or in a facility.
- A tax-qualified long-term care policy pays when you can't perform two of six activities of daily living without substantial help, or need substantial supervision because of severe cognitive impairment.
- The elimination period in a long-term care policy is the number of days you pay for care yourself before benefits start.
- Individual long-term care policies are guaranteed renewable, so they can't be cancelled for age or health, but premiums can rise if the state regulator allows it.
By Sam Alishahi · CA Insurance License #4348151 · Reviewed November 2026 · How this page is researched
Medicare doesn't pay for custodial care
Long-term care is help with everyday tasks such as bathing, dressing and eating when a chronic illness, a disability or cognitive decline makes them hard to manage alone. Medicare doesn't pay for it, and neither does most health insurance, Medigap included. Medicaid can, for people who meet their state's eligibility rules, sometimes only after they've spent down their own savings.
A long-term care policy pays once you need help with a set number of daily activities or need supervision because of severe cognitive impairment. You choose a daily benefit, how long benefits can last and how long you wait before they start. The choices with the biggest long-run effect are inflation protection and whether you can keep paying, because premiums on existing policies can rise if the state insurance regulator allows it.
- Daily benefitThe most the policy pays per day. Multiplied by the days covered, it sets the lifetime maximum.
- Elimination periodDays you pay for care yourself before benefits start. Common choices are 0, 30, 90 or 100.
- Inflation protectionIn California insurers must offer it, including 5% compound annual increases.
- Where care is coveredFacility care only, home care only, or comprehensive coverage of both.
What underwriters will ask
Having these ready means I can go to market on the first call. The quote form asks for the same things, and anything you don’t know yet can wait.
- Ages: date of birth for each person applying.
- Care preference: at home, assisted living, a nursing home, or all of these.
- Benefit: a daily amount and how many years of benefits you want.
- Waiting period: how long you could pay for care yourself.
- Budget: a yearly premium you could keep paying even if it went up.
- Health: leave it off the web form. We'll go through the insurance company's medical questions together.
Keeping a policy from lapsing by accident
A long-term care policy can end over one missed payment years after purchase. California Insurance Code section 10235.40 builds in three protections for individual policies, and I walk every applicant through them.
- A second person on the lapse notice. An individual policy cannot be issued until you have been given the right to name at least one other person to be told if it is about to lapse or terminate for nonpayment. The insurer must receive either that person's name, address and telephone number, or a waiver you sign and date. I suggest naming an adult child or someone else who handles family paperwork.
- Thirty days of notice by mail. The policy cannot lapse for nonpayment unless the insurer gives notice to you and your designee at least 30 days before the lapse takes effect. Notice goes by first-class mail to the address you gave for lapse notices, not less than 30 days after a premium is due and unpaid.
- Reinstatement after cognitive impairment. The policy must provide for reinstatement if the insurer receives proof of your cognitive impairment or loss of functional capacity and the request is made within five months after termination. The insurer may collect past-due premium, if appropriate. The proof standard cannot be stricter than the policy's own benefit eligibility criteria.
The insurer must remind you at least once every two years that you can change your designee. If premium comes out of a payroll or pension deduction, the designation does not have to be in place until 60 days after you leave that plan. Under section 10235.50, a lapse notice must also list reduced-coverage options and their premiums, with at least 30 days to choose one. Lapse rules vary by state; check with your state insurance department.
How a claim gets certified
Under federal law (26 U.S.C. 7702B), a tax-qualified contract covers qualified long-term care services that a chronically ill individual requires and that are provided under a plan of care prescribed by a licensed health care practitioner. A "chronically ill individual" is someone a licensed health care practitioner has certified as unable to perform at least 2 activities of daily living without substantial assistance for a period of at least 90 days due to a loss of functional capacity, or as needing substantial supervision for protection from threats to health and safety due to severe cognitive impairment. That certification must have been made within the preceding 12 months.
For federally qualified policies, California Insurance Code section 10232.8 adds rules on how certification works:
- Independent practitioner. The certifying practitioner must be independent of the insurer: not an insurer employee and not paid in any way linked to the outcome. You can also ask the insurer to arrange the assessment.
- Prompt, then renewed. Assessments must be done promptly so benefits are not delayed, and the written certification is renewed every 12 months.
- Costs stay off your benefits. The cost of certification and of written plans of care does not count against the policy's lifetime maximum.
- Second assessment after a denial. If a practitioner finds you do not qualify, the insurer must tell you that you may request a second assessment by a practitioner who personally examines you, unless the first practitioner already did.
Policies not intended to be federally qualified work differently. If they include home care benefits, eligibility for those benefits must be at least as permissive as impairment in two of seven activities of daily living (the usual six plus ambulating) or impairment of cognitive ability. When I compare policies, I check which standard each one uses.
Long-term care insurance, answered
Doesn't Medicare cover nursing home care?
Only skilled nursing facility care for a limited time, up to 100 days, and only when daily skilled care is needed. Medicare doesn't pay for long-term custodial care, such as help with bathing or dressing, at home or in a facility.
When does a long-term care policy start paying?
A tax-qualified policy pays when you can't perform two of six activities of daily living without substantial help, or need substantial supervision because of severe cognitive impairment. The six are bathing, dressing, transferring, eating, toileting and continence. After that, the elimination period has to pass.
Can my long-term care premium go up?
Yes. Individual policies are guaranteed renewable, so the company can't cancel you because of age or health, but it can raise premiums if the state insurance regulator allows it. In California you can look up a company's long-term care rate history on the Department of Insurance website.
Why have long-term care rates risen so often?
According to NAIC, many older policies were priced before claims were well understood. Insurers underestimated how many people would claim and for how long, and fewer policyholders dropped coverage than expected. Newer policies are priced with decades more experience.
What is a California Partnership policy?
The California Partnership for Long-Term Care is a state program run with participating insurance companies. Partnership policies must be cleared by both the Department of Insurance and the Department of Health Care Services, include automatic inflation protection, and can only be sold by agents with special Partnership training.
Are long-term care premiums tax deductible?
For a federally tax-qualified policy, some or all of the premium may be deductible as a medical expense, depending on your age and the premium. Your tax advisor can confirm what applies to you.
Can I return a long-term care policy?
In California, individual buyers have 30 days after receiving the policy to return it for a full refund. Keep a record of when you received it and when you sent it back.
Can I lower my long-term care coverage in California without a rate increase?
Yes. Under Insurance Code section 10235.50, any time after the first year you can keep the policy while reducing coverage and lowering the premium, for example by reducing the lifetime maximum or the daily, weekly or monthly benefit. If the insurer sells nursing-facility-only or home-care-only policies in California, you can also convert a comprehensive policy to one of those.
Do you offer long-term care insurance outside California?
Yes. Clients across the country send the same quote form. Sam Alishahi is licensed in all 50 states and Washington, DC and places policies there directly. The shopping across carriers works the same way. Rules, minimums and markets differ by state — see insurance requirements by state.
Official sources
- California Department of Insurance: long-term care insurance guide
- California Department of Insurance: Long-Term Care Insurance Rate and History Guide
- Medicare.gov: long-term care coverage
- NAIC: long-term care insurance
- Cal. Insurance Code 10235.40 (lapse designee, notice, reinstatement)
- Cal. Insurance Code 10235.50 (reducing coverage)
- Cal. Insurance Code 10235.35 (contingent benefit upon lapse)
- Cal. Insurance Code 10236.11 (rate schedule approval)
- Cal. Insurance Code 10232.8 (eligibility and certification)
- Cal. Insurance Code 10233.5 (outline of coverage)
- 26 U.S. Code 7702B (Cornell LII)
- California Department of Aging: HICAP
- Cal. Insurance Code 10236 (guaranteed renewable)
Tell me who it's for and where care would happen.
Ages and whether you'd prefer care at home are enough to start.
Alishahi Insurance · Saman Alishahi, independent insurance broker, California License #4348151. General information, not a quote or a promise of coverage; coverage depends on underwriting and the terms, conditions and exclusions of the policy actually issued.
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(877) 711-4545Answered 24/7 · CA License #4348151
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