By: RIGHT ACCORD Private Duty–Home Health Care

Long-Term Care Insurance: Use It or Lose It --- What Families Need to Know

The Misunderstood Safety Net

For many families, long-term care insurance feels like a lifeline---something purchased years ago to prepare for future needs. But when the time comes, many don’t know how to actually use it, what it covers, or worse, they delay filing claims until it’s too late.

The truth is: long-term care insurance is a “use it or lose it” benefit. If families wait too long or don’t follow the right steps, they may lose access to valuable coverage they’ve been paying into for years.

At RIGHT ACCORD Private Duty—Home Health Care, we’ve seen families in Sarasota, Venice, Manatee, Lee, and Charlotte Counties struggle to understand their policies. This blog will break it down in simple terms: why it’s important to use your long-term care insurance, what happens if you don’t, and how to make the most of it before the benefits disappear.

What Is Long-Term Care Insurance?

Long-term care insurance (LTCI) is designed to cover services not typically included in traditional health insurance or Medicare. This includes:

In-home care (like personal care, companionship, or dementia support)
Assisted living or nursing home stays.
Adult day care programs.

The idea is to help families offset the high costs of ongoing care---costs that can otherwise drain savings quickly.

Why It’s “Use It or Lose It”

Unlike health insurance, which renews annually, long-term care insurance has a benefit pool (a set amount of money available) and a time window in which it must be used.

Unused benefits do not roll over. If you never file a claim, the insurance company keeps the money.
Delaying claims means lost coverage. Waiting until care needs are too severe may disqualify you from receiving full benefits.
Premiums increase over time. Families may end up paying more out-of-pocket while never accessing the care they’re entitled to.

In short: if you don’t activate your policy when you’re eligible, those benefits may vanish.

Common Reasons Families Don’t Use Their LTCI (and Why That’s Risky)

Confusion About Coverage
Many people don’t know what services their policy covers. For example, some assume it’s only for nursing homes, when in reality it can often cover in-home care.
Fear of Premium Increases
Families sometimes believe using benefits will raise premiums, but this is usually not the case. Premiums may rise due to market factors---but not because you filed a claim.
Waiting “Until Things Get Worse”
One of the biggest mistakes. Most policies require that the insured need help with at least two Activities of Daily Living (ADLs)---like bathing, dressing, or mobility---before benefits kick in. If you wait too long, your loved one may no longer meet policy requirements.
Complicated Paperwork
Filing a claim can feel overwhelming, leading families to delay or avoid it.

What to Do if You Have Long-Term Care Insurance

1. Review Your Policy Now

Don’t wait for a crisis. Find your policy documents and check:

The daily or monthly benefit amount.
The maximum lifetime benefit (or benefit pool).
What types of care are covered.
Elimination period (the waiting time before benefits start).

2. Contact the Insurance Provider

Call the insurance company and ask them to explain eligibility requirements and covered services in plain language. Document the call for future reference.

3. Get a Care Assessment

RIGHT ACCORD can help with an in-home assessment to determine whether your loved one qualifies for benefits now. This ensures you don’t miss the eligibility window.

4. Start Small if Needed

Even part-time in-home care can often be covered under LTCI. You don’t have to wait until 24/7 care is necessary.

5. Keep Records

Insurance companies will ask for documentation---doctor’s notes, care plans, and proof of services. Keep everything organized.

How RIGHT ACCORD Helps Families Navigate LTCI

We know long-term care insurance can be confusing. That’s why we assist families every step of the way:

Policy Review Support: We help you understand what your plan covers.
Care Coordination: We create care plans that align with insurance requirements.
Claims Assistance: We provide documentation to support benefit approval.
Maximizing Benefits: We ensure you get the most out of your policy before benefits expire.

Real-Life Example: A Sarasota Family’s Story

One Sarasota family had been paying into a long-term care policy for over 20 years but assumed it was only for nursing homes. When their mother needed in-home dementia support, they were hesitant to file a claim.

With guidance from RIGHT ACCORD, they filed correctly and discovered the policy covered daily in-home care services. This allowed their mother to stay safely at home while reducing out-of-pocket costs by thousands of dollars.

The Financial Risk of Waiting Too Long

Consider this: the average cost of home care in Florida is $25—$30 per hour. For families needing 40 hours a week, that’s more than $4,000 per month. Over a year, it can reach nearly $50,000.

If you’re paying LTCI premiums but not using the benefits, that’s money out the door---while still paying for care from savings. By using your policy early, you protect your finances and your loved one’s well-being.

Don’t Leave Benefits Behind

Long-term care insurance is a valuable resource---but only if families use it. Remember: it’s not a savings account, it’s a benefit designed to be used before it disappears.

By reviewing your policy, filing claims early, and working with a trusted provider like RIGHT ACCORD, you can maximize your benefits and ensure your loved one receives the best possible care.

Call to Action

Do you have a long-term care insurance policy but aren’t sure how to use it? RIGHT ACCORD can help you review your coverage and guide you through the claims process.

📞 Call us today at 941-366-0801 🌐 Visit rightaccordhealth.com to learn more. 📍 Serving Sarasota, Venice, Manatee, Lee, and Charlotte Counties

Long-Term Care Insurance: Use It or Lose It — What Families Need to Know