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Autumn 2026·8 min read·Bruce Tollefson

How to Use Long-Term Care Insurance for Care at Home in Minnesota

A working guide to the policy your parent bought years ago: what it pays for, and how to get a claim for care at home paid.

Why this article exists

Every month or so we hear the same story from a family in Washington County. Dad is home from the hospital, or Mom has stopped managing the stairs, and someone remembers that their parents bought long-term care insurance in the 1990s. The folder comes out. The policy is thirty pages long and nobody is sure whether it pays for help at home or how to get it started.

If that is where you are, you have not missed anything obvious. These policies were sold by agents who explained them once, decades ago, and the claims process was never designed to be started by a tired daughter on a Tuesday night. Most policies written since the 1990s do cover care in the home. Getting them to pay takes some paperwork, and the waiting period affects how you should schedule care, so it is worth understanding before the first visit.

First, find out what the policy really covers

Get a complete copy of the policy. If the original is gone, the insurer's claims department will send one, though they may want a power of attorney on file first.

Then write six things on one sheet. The daily or monthly benefit, meaning the most the policy pays per day or month of care. The benefit period or pool of money, the total it will pay over its life. The elimination period, the waiting period before benefits start. Whether home care is paid at the same level as nursing home care, at some percentage of it, or not at all under some older policies. Who is allowed to provide the care, which is where home care claims most often go wrong. And whether the policy has inflation protection; if it does, today's daily benefit is higher than the number on the original schedule page, so ask the insurer for the current figure.

There is one Minnesota detail worth knowing. If the policy was sold under the Minnesota Long-Term Care Partnership, the Department of Commerce explains that the benefits it pays out are later disregarded, dollar for dollar, if the person ever applies for Medical Assistance. Some families hold off on filing to "save" the policy for later. Under a Partnership policy, that costs them twice.

What the insurer needs to see before it pays

There are two ways to qualify for benefits under a tax-qualified policy, and both are set by federal law. Under 26 U.S.C. 7702B, a person is "chronically ill" when a licensed health care practitioner certifies either that she cannot perform at least two of six activities of daily living without substantial help from another person, for a period expected to last at least 90 days, or that she needs substantial supervision to stay safe because of severe cognitive impairment.

The six activities are bathing, dressing, eating, toileting, transferring (getting in and out of a bed or chair), and continence. Cooking, housework, driving, and remembering pills are not on that list. They are real needs, and usually the reason a family starts looking for help, but on their own they do not open the policy. If your mother needs someone's hands to get into the shower and out of the recliner, she meets the test. If she mostly needs lunch made and a ride to the pharmacy, she usually does not, unless dementia is part of the picture.

Dementia changes the picture because the second test is about supervision. A person with Alzheimer's disease may still bathe and dress on her own and still qualify. The insurer will want a diagnosis in the medical record, a cognitive screening score, and specific examples: the stove left on, or a wrong turn on a route she has driven for forty years.

The elimination period, and why service days matter

Think of the elimination period as the deductible, except that it is counted in days instead of dollars. Ninety days is the most common length; some policies have none, some have 180. The family pays out of pocket until it is satisfied.

How those days get counted surprises nearly everyone. Some policies count calendar days from the date the person became eligible. Many count service days, meaning only the days on which paid, covered care was delivered. Under a service-day policy, three caregiver visits a week means a 90-day elimination period takes thirty weeks to satisfy. Under a calendar-day policy, the same schedule gets there in three months.

So if the policy counts service days, a fuller schedule early on does double duty: it helps your parent, and it moves the family through the waiting period sooner. And open the claim the week care begins, so the insurer's clock starts as early as the policy allows; do not wait until you think the waiting period is over. It does not have to be decided the day the folder comes out, only before the first caregiver visit goes on the calendar.

Who is allowed to provide the care

More home care claims fail here than anywhere else. Most policies pay only for care from a licensed home care agency, and some go further: the aides have to work under a supervised care plan, or the agency has to be able to produce care notes on request. Care given by a family member is excluded under nearly all policies, and care from an independent caregiver found online usually is too.

In Minnesota, home care agencies are licensed by the Minnesota Department of Health under Minnesota Statutes chapter 144A. State law requires a licensed provider to complete a written service plan within 14 days of the first visit, and a provider with a comprehensive license must have a registered nurse assess the client within five days and review the plan at least every 90 days after that. Those happen to be the documents an insurer asks for: a plan of care prepared under nursing oversight, dated, signed, and kept current.

Before care begins, ask the agency a few questions. Will you fill out the insurer's provider forms and send care notes when the insurer asks for them? Do your invoices show the date, the hours, the kind of care, and who delivered it? Is the plan of care signed by a registered nurse? And if the policy requires something you do not do, will you tell us plainly? Abloom Senior Living answers those questions the same day they are asked, and the invoices and nursing notes it produces for private-pay clients are the same documents an insurer needs to see. It does not take Medical Assistance or waiver funding for in-home care, and says so up front.

Filing the claim

Open the claim in writing. Contact the insurer's claims department and ask for the claim packet for home care. Write down the date. Many policies give you 30 to 60 days from that date to return the forms; miss it and the claim closes.

Three forms come back in the packet. A claimant statement, filled out by the family or the person receiving care. A physician or licensed practitioner statement, where the two-ADL or cognitive certification lives. And a provider statement or plan of care, filled out by the home care agency.

Most insurers then send a nurse out, or arrange a phone or video visit, to confirm what the doctor certified. Be plain about the bad days. Families have a habit of describing a parent at her best, and the assessor needs to hear what happens at six in the morning when she tries to stand up alone.

Most policies reimburse. You pay the agency, send in the invoices, and the insurer pays back covered charges up to the daily benefit. A smaller number pay the full daily benefit once eligibility is established. Some insurers will pay a licensed agency directly under an assignment of benefits; ask. It is also worth asking about waiver of premium, since many policies stop charging premiums once benefits begin.

Keep one folder with every invoice, care note, and insurer letter, plus a log of every phone conversation with dates and names. If the insurer ever disputes something, that folder is what you will appeal with.

When the answer is no

Denials happen, and the reasons are usually ordinary: the physician statement did not clearly certify two ADLs, a form arrived late, an invoice was missing, or the caregiver was not from a licensed agency. Most of those can be fixed. Ask for the denial in writing, with the policy language the insurer relied on, gather the missing piece, and ask for reconsideration through the insurer's written appeal procedure. If the insurer holds its position, the Minnesota Department of Commerce, which regulates long-term care insurers, accepts consumer complaints through its Consumer Services Center. Minnesota Aging Pathways, the state's free information line formerly known as the Senior LinkAge Line, can help families sort through options and find local help.

What the policy will not do

Long-term care insurance does not pay before the benefit trigger is met, so early help with housekeeping and driving is usually a private-pay expense. It does not pay above the daily benefit. Medicare does not fill the gap either; Medicare's own site says it does not pay for ongoing help with bathing, dressing, and using the bathroom at home. And if care at home ever stops working and the next step is a small residential home, read the facility section of the policy before assuming the daily benefit carries over. For the wider money picture, see how families pay for care at home, the companion article in this journal.

A next step

If you have a policy in hand and a parent who needs help now, start both things at once: open the claim with the insurer this week, and begin care with a licensed agency that will produce the documentation the claim requires. If you would like a second set of eyes on the schedule page, tell us about your parent's week, along with the insurer's name and the year the policy was issued, and we will read it before we reply and tell you what to look for. You are welcome to request a visit at your parent's home anywhere in the East Metro, or to come see the five-resident house in Woodbury. And if what your family needs is something we do not do, we will say so and point you to someone who does.

A note on this article. This article is general information from a care provider. It is not legal, financial, or medical advice, and it is not insurance advice. Policy terms vary, and the policy document itself controls. For advice about a specific policy or a specific person's situation, talk with the insurer, a licensed insurance counselor, or an elder law attorney.

Frequently asked questions

Does long-term care insurance pay for in-home care? Most policies sold since the late 1990s cover care in the home, either at the same daily benefit as facility care or at a stated percentage of it. Some older policies cover only nursing home care. The "covered services" or "home and community care" section of the policy will say which applies.

How long is the elimination period for home care? Ninety days is the most common, though policies range from zero to 180 days. Check whether yours counts calendar days or only days on which paid care was delivered; under a service-day policy, a light schedule can stretch a 90-day waiting period across many months.

What qualifies someone for long-term care insurance benefits? Under federal tax-qualified policies, a licensed health care practitioner must certify that the person cannot perform at least two of six activities of daily living (bathing, dressing, eating, toileting, transferring, continence) without substantial help for at least 90 days, or needs substantial supervision because of severe cognitive impairment such as dementia.

Can a family member be paid by long-term care insurance to provide care? Under nearly all policies, no. Care by a family member is a standard exclusion, and most policies require care from a licensed home care agency. A small number of newer policies include a cash or indemnity benefit that the family may spend as it chooses; read the policy to see whether yours does.

Does Medicare cover in-home care for an aging parent? Medicare pays for short-term skilled care at home in limited circumstances, such as intermittent nursing or therapy after a hospital stay. It does not pay for ongoing personal care, meaning help with bathing, dressing, and using the bathroom, which is what most families need. Long-term care insurance, private pay, or Medical Assistance for those who qualify are the usual sources.

Sources

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