Moon Insurance Managers, Inc. · TDI license #5595

Individual Long-Term Care (LTC) Insurance

The Texas Department of Insurance describes long-term care as the personal care you may need if you become unable to care for yourself because of a prolonged physical illness, a disability, or a cognitive impairment such as Alzheimer’s disease.

It draws a line worth holding on to: long-term care is different from medical care that tries to treat or cure something. It helps you keep going. It is not trying to fix anything. That distinction is why a separate policy exists, and it is why health insurance and Medicare do not answer this question.

Call (281) 484-8320 or start with what triggers a claim

26 U.S.C. § 7702B Trigger and benefit limits

What the law fixes, and what it does not

Chronically ill: § 7702B(c)(2)
Qualifying hospital stay: Three days, 42 CFR § 409.30
Admission window: 30 days
Skilled nursing: 100 days per benefit period
Partnership disregard: 1 Tex. Admin. Code § 358.355

Agent of record

The Internal Revenue Code, the CFR and the Texas Administrative Code — general information only.

The certification

What actually starts the payments

Most pages on this subject say a long-term care policy pays “when you need help with daily activities.” That is a paraphrase. The actual test is a certification, and it is worth reading in something close to its own words, because it is what a claim is decided on.

Under the federal definition that tax-qualified long-term care contracts are built around, you are a chronically ill individual when a licensed health care practitioner certifies that you are either:

unable to perform, without substantial assistance from another person, at least two of six activities of daily living, for a period expected to last at least 90 days, because of a loss of functional capacity; or
in need of substantial supervision to protect you from threats to your health and safety because of severe cognitive impairment.

The six activities of daily living

Eating Feeding yourself once food is prepared and made available
Toileting Getting to and from the toilet, and the associated personal hygiene
Transferring Moving in and out of a bed, a chair or a wheelchair
Bathing Washing, in a tub or shower or by sponge bath
Dressing Putting on and taking off clothing, including any braces or artificial limbs
Continence Managing bladder and bowel function, including the associated hygiene

A contract has to take at least five of those six into account.

Two activities, not one; expected to last 90 days; and a practitioner certifies it, so it is a clinical judgment rather than a self-assessment. And the cognitive route is separate and complete on its own — somebody with dementia who can still dress and eat can meet the trigger through the second path. That is the part families most often do not know.

Which five or six activities your contract counts, and how it words “substantial assistance,” is a contract question. Ask for the definition section, not the brochure.

Source: 26 U.S.C. § 7702B(c)(2) — chronically ill individual. Verified 31 July 2026.

The boundary

What Medicare pays for, and what it does not

This is the misconception that costs families the most money. Medicare covers post-hospital skilled nursing facility care, and every word of that phrase is doing work:

You must first have been an inpatient in a hospital for at least three consecutive calendar days, not counting the day you were discharged.
You must be admitted to the facility and receive the care within 30 calendar days of leaving the hospital.
The benefit runs up to 100 days in a benefit period, with a daily coinsurance from the 21st day through the 100th. The 100 days start again when a new benefit period begins.

Skilled care, following a hospitalization, finite, and cost-shared for most of its length.

It is not long-term care coverage. Custodial care — help with the activities of daily living listed above, for as long as you need it, whether or not you were ever in a hospital — is not what this benefit is. If you take one sentence away from this page, take that one. Our Medicare page explains the parts of the program; this is the boundary between them.

We publish no Medicare dollar figure here: CMS resets them annually and a number on this page would be wrong for most of its life. Medicare.gov publishes the current ones.

Sources: 42 CFR § 409.30 — qualifying hospital stay; 42 CFR § 409.61 — benefit period limits. Verified 31 July 2026.

Two clocks and a third question

The periods, and what they are worth in twenty years

The elimination period — how long the need for care must continue before the policy pays. Ask one specific thing: is it counted in service days or calendar days? Ninety days of paid care at three days a week is a far longer wait than ninety calendar days, and this is rarely on the front of anything.
The benefit period — how long it pays, or the size of the pool it will pay out in total. Either way, ask what happens when the pool is gone.
Inflation protection — a policy bought at 58 may not be claimed on until 82. It is generally priced and structured at issue rather than added later, so ask what the benefit is worth at the ages you are actually planning for, not on day one.

A Texas program

The Texas Long-Term Care Partnership Program

Texas runs a program most pages in this market never mention, and it is why a Texan should not buy this off a national comparison site without asking one extra question.

If you hold a qualifying Partnership policy and it pays benefits on your behalf, Texas gives you a dollar-for-dollar disregard of your resources when Medicaid eligibility is calculated — a disregard equal to the sum of the benefit payments the policy made. If the policy paid out $300,000, then $300,000 of your resources is disregarded. To qualify, the policy has to meet the Texas Department of Insurance’s requirements. And if the program were ever discontinued, somebody who bought before that date keeps the disregard.

And here is the part that must never be separated from it: a Partnership policy does not qualify you for Medicaid. Every other Medicaid eligibility requirement still applies. The disregard changes one input to the calculation. It does not decide the outcome, and anybody who sells it to you as though it does has oversold it.

Whether a Partnership policy is right for a particular household reaches into tax, family and estate questions that are past insurance. We will tell you what the program is and whether a policy qualifies. We are not the right people for the rest of it, and we will say so.

Sources: 1 Tex. Admin. Code § 358.355 — Partnership resource disregard; TDI — long-term care resources. Verified 2 August 2026.

The elephant

The rate-increase question, answered honestly

Long-term care insurance has a reputational problem and it is not imaginary. Policyholders who bought decades ago have received premium increases on policies they understood to be stable. We are not going to tell you it cannot happen.

What to ask instead: which renewability provision does this contract use, and what exactly may the carrier change? — “level premium” and “guaranteed renewable” are contract terms with specific meanings and one of them permits class-wide increases. Then: what does the contract offer if an increase arrives and you cannot pay it? Many offer reduced benefits, a shortened benefit period or a paid-up benefit. Find out which yours has before you need it.

Plainly

We do not sell this, and here is where to go

Moon Insurance does not place long-term care insurance. Everything above is here because the questions are real, the contract language decides the outcome, and almost nobody explains the trigger before selling the policy.

Where to actually go:

HICAP, on 2-1-1 — the Texas Health Information, Counseling and Advocacy Program. Free benefits counselling from somebody who is not selling you anything, and the Texas Department of Insurance routes people to it directly. If your question is about Medicaid eligibility or a benefit you already have, this is the right call.
The Texas Department of Insurance’s long-term care resources — including the Partnership Program and how to check whether a policy qualifies.
An agent who writes the line. When you find one, take the four questions above with you: the trigger, the two periods, the inflation protection, and what happens if a rate increase arrives.
Already hold a policy and a rate-increase notice has arrived? The first call is the carrier that issued it. Our support page is where existing policy questions start.

Moon Insurance Managers, Inc. · 360 FM 1959, Houston, TX 77034 · (281) 484-8320 · Texas Department of Insurance license #5595

Questions people ask

Does Medicare pay for a nursing home?

Not for long-term custodial care. Medicare’s skilled nursing facility benefit requires a qualifying hospital stay of at least three consecutive days, admission within 30 days of discharge, and it runs up to 100 days per benefit period with a daily coinsurance from day 21. That is skilled care after a hospitalization. It is not the same thing as needing help at home or in a facility for years.

Can my premium go up after I buy?

It depends on the renewability provision in the contract, and on some contracts the answer is yes, for a whole class of policyholders. This has happened in this market. Ask which provision your contract uses and what options it gives you if an increase arrives.

Is a life insurance policy with a long-term care rider the same thing?

No. That is a life insurance contract with a benefit that can be accelerated, and it is governed by different rules and priced differently. If that is what you are being shown, start with our individual life insurance page — the rider is judged against what a standalone contract would have done, which is what this page is for.

Moon Insurance Managers, Inc. — 360 FM 1959, Houston, TX 77034 — (281) 484-8320