Understanding the Long-Term Care Insurance Elimination Period

When your long-term care insurance claim is approved, benefits don't start immediately. First, you must satisfy what's called the elimination period — a waiting period during which you pay for care out of pocket before your insurer begins reimbursing you.

Most policyholders know their elimination period exists. Far fewer understand exactly how it works.

What Is the Elimination Period?

The elimination period functions like a deductible, but measured in days rather than dollars. Common elimination periods are 30, 60, or 90 days. A 90-day elimination period is the most common in policies sold today because it lowers the premium cost.

During the elimination period, you must receive qualifying care on a sufficient number of days to satisfy the requirement. Once satisfied, your policy begins paying benefits.

How Days Are Counted — And Why It Matters

This is where many policyholders are caught off guard. Not all policies count elimination period days the same way.

• Calendar days: Every day counts, whether or not care is received that day. A 90-day elimination period is satisfied in 90 consecutive calendar days.
• Service days: Only days on which qualifying care is actually received count. If care is received 3 days per week, a 90-day elimination period takes approximately 30 weeks to satisfy.

If your policy uses service days, the out-of-pocket cost during the elimination period can be dramatically higher than anticipated.

Does the Elimination Period Reset?

Some policies include a provision that resets the elimination period if there is a gap in care. For example, if the policyholder recovers and stops receiving care for 180 days, then needs care again, the elimination period may need to be satisfied again from the beginning. Review your policy's continuity of care provisions carefully.

Lifetime vs. Per-Occurrence

Some policies have a lifetime elimination period — meaning once it is satisfied, it never needs to be satisfied again, even if care stops and restarts. Others apply the elimination period per occurrence or per benefit period. This distinction has significant financial implications.

Key Questions to Ask About Your Policy

• Is my elimination period measured in calendar days or service days?
• Is it a lifetime elimination period or per-occurrence?
• What types of care count toward satisfying it?
• Does it reset after a gap in care?

Pro Tip

If you are approaching the start of care, begin tracking qualifying care days immediately — even before your claim is formally approved. Days that qualify can often be counted retroactively once the claim is processed, depending on your policy terms.

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