The Policy You Forgot You Had
Long-term care insurance (LTCI) is one of the most commonly misunderstood assets in a senior care planning file. Arizona families frequently discover that a parent purchased a policy in the 1990s or 2000s and never looked at it again. By the time a care need arises, they are uncertain whether the policy is in force, what it covers, and how to file a claim.
Start with two basic questions: (1) Is the policy still in force? (2) Has the care need already met the policy's benefit trigger? The answers tell you whether to engage the insurer immediately or whether you have time to plan.
Benefit Triggers: The Gate That Opens Coverage
Every LTCI policy has a benefit trigger — the clinical threshold that must be met before the policy begins paying. For most policies issued since the mid-1990s, the trigger is either:
(1) Dependency in two or more Activities of Daily Living (ADLs): bathing, dressing, eating, toileting, transferring, and continence. The policy specifies what standard it uses — most require 'substantial assistance' rather than mere supervision.
(2) Cognitive impairment requiring supervision: the policy usually requires certification by a licensed health professional. This trigger covers dementia patients who may be physically capable of ADLs but need supervision due to cognitive inability.
Important: the benefit trigger must be certified by a licensed health professional — typically a physician. Keep a copy of the certification form.
Daily Benefit, Benefit Period, and Inflation Protection
The daily benefit amount is the maximum the policy pays per day in a qualifying setting. Policies purchased in the 1990s often had daily benefits of $100 to $150/day — in 2026, Phoenix ALF costs can run $150 to $300/day. Policies with inflation protection have grown significantly; policies without it have lost real value.
Inflation protection types: 5% compound inflation protection doubles the daily benefit in about 14 years. A $150/day benefit from 2000 with 5% compound growth is now approximately $360/day in 2026.
The benefit period is how many years the policy pays. Common choices: 2 years, 3 years, 5 years, or lifetime. The elimination period (deductible period) is the number of days the insured must pay out of pocket before the policy begins. Ninety days is common — those 90 days at an ALF base rate can represent $13,000 to $22,000 in out-of-pocket costs.
Filing a Claim in Arizona
Notify the insurer as soon as the care need meets the benefit trigger — do not wait until after the elimination period. The claim process typically involves: (1) contacting the insurer to request claim forms; (2) having the treating physician complete the medical certification; (3) submitting the care plan from the receiving ALF; (4) insurer review (30 to 60 days is typical).
Keep copies of everything you submit. Document every phone call — date, time, representative name, and what was discussed.
If the insurer denies the claim, you have the right to appeal. Arizona's Department of Insurance and Financial Institutions (DIFI) handles LTCI complaints. The DIFI consumer line is (602) 364-2499. Our Phoenix advisors work with families who are simultaneously navigating an LTCI claim and an ALF selection.