Using your coverage · Section 4 of 5
Approved providers: your care options
Care received from a non-qualifying provider is generally not reimbursable — even if the care itself was exactly what was needed.
What policies typically cover
Most comprehensive policies cover care across several settings:
- Home care
- Adult day programs
- Assisted living and residential care facilities (RCFEs)
- Memory care
- Skilled nursing facilities
- Hospice care
For facility options across the Tri-Valley, see the care directory.
How benefits are paid: reimbursement, indemnity, and cash
Before comparing providers, understand how your policy pays — it shapes your cash flow throughout the claim.
- Reimbursement
Most policies. The family pays the provider first, submits invoices, and the carrier reimburses covered costs up to the daily or monthly maximum. Some carriers can send payments directly to the provider.
- Indemnity
Less common. Pays the full daily benefit whenever qualified care is received, regardless of the actual cost of care that day.
- Cash benefit
Found mainly in newer hybrid products. Pays the monthly benefit once the benefit trigger is met, with no receipts required, giving families total flexibility in how care is arranged.
Questions to ask any home care provider
- How are caregivers screened? Background checks, registry verification, reference checks, skills evaluation?
- Will my insurance carrier accept your documentation? Have you billed long-term care insurance before?
- What happens if the caregiver is sick or quits? How quickly is a replacement available?
- Can I interview and choose the caregiver? Can I request a change?
- What is the total hourly cost, and what does it include? Are there minimums, per shift or per week?
- Who supervises care quality, and how often is the care plan reviewed?