Questions & answers · Long-term care insurance
Who pays for an illness or injury — will my long-term care insurance cover it?
Long-term care insuranceWho paysTexasChecked Nov 6, 2026
From K.Actuary, founded by Sangmin Kwon, ASA · sources checked 2026-11-06 · Source: Texas Insurance Code · Chapter 1201 · § 1201.105(a) (Minimum Standards for Benefits for Long-Term Care) View original ↗
In short
- In Texas, the state sets a floor for these benefits by rule.
- This answer does not have the text of those rules.
- Your own policy and its benefit trigger decide what gets paid.
What this means
Texas puts the floor in rules, not in the statute. The commissioner must adopt rules setting minimum standards for long-term care benefits. Those rules cover individual, group and blanket accident and health policies issued in the state [1].
So the statute tells you a floor exists. It does not tell you what the floor says. That text sits in the commissioner's administrative rules, and this answer does not have it.
What decides your claim is your own policy. Read its definition of long-term care. Then read its benefit trigger, such as needing help with a set number of daily activities.
Your next step
Read your own policy first. Find the benefit trigger and the covered-services list. The sources set no deadline for a coverage question. Your policy's notice and proof-of-loss clauses carry the filing deadlines, so read those too.
Check it yourself
Ask TDI which chapter of its rules carries the benefit-trigger language under Section 1201.105. Then compare that language with your own policy.
Where this comes from (1)
[1] Texas Insurance Code · Chapter 1201 · § 1201.105(a) (Minimum Standards for Benefits for Long-Term Care) · checked 2026-11-06
The commissioner shall adopt rules establishing minimum standards for benefits for long-term care coverage under individual, group, and blanket accident and health insurance policies and certificates delivered or issued for delivery in this state.
How we found this
We matched your question to 1 official source, quoted the exact lines, and re-checked each quote against its source on 2026-11-06.
What we don’t know yet
Your own plan or notice may say something different. If your letter cites another rule, send it and we will look again.
Every answer is checked against the official rule it quotes.
Information only — not legal advice. Your plan, insurer or agency decides.
This answer quotes the official sources listed above, with the date we checked them. Your own policy, notice and state rules control. We are not your lawyer or your insurer. We don’t file, argue or negotiate claims for you — you send any letter or form yourself.
Related answers
- Does Medicare pay for a nursing home or long-term care?
- Who pays for long-term care like a nursing home or help with bathing and dressing — Medicare, Medicaid, or insurance?
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