Don’t Sign Away Your Rights: The Risks of Alternative Plans of Care in LTC Insurance Claims

Long-term care (LTC) insurance policies are designed to provide financial support when individuals require assistance with daily living due to age, chronic illness, or cognitive decline. Many of these policies include a provision known as an Alternative Plan of Care (APC). This mechanism allows the insurer and policyholder to agree on customized care arrangements that may fall outside the policy’s strict terms.

While APCs can offer flexibility and personalized care solutions, they are increasingly being misused by insurers. At Disability Insurance Law Group, we’ve seen firsthand how some companies manipulate APCs not to help the insured, but to reduce or avoid their financial responsibility. Understanding how APCs work—and how they can be abused—is critical to protecting the benefits you’ve paid for.

What Is an Alternative Plan of Care (APC)?

An Alternative Plan of Care is a negotiated agreement between the insurer and the policyholder to cover services not explicitly listed in the original LTC contract.

Ideally, APCs are used to:

• Enable in-home care instead of institutional care.
• Provide for newer, non-traditional services that didn’t exist when the policy was written.
• Accommodate evolving care needs with more appropriate or cost-effective solutions.

When appropriately used, APCs can offer flexibility and compassion, especially when a policy’s rigid requirements don’t reflect real-world care needs.

How Insurers Misuse APCs to Limit Your Benefits

Unfortunately, APCs are sometimes used as a backdoor method to reduce covered benefits, rather than extend them. In many cases, insurers will deny coverage for services that are clearly covered under the policy, then present an APC as a “solution.” The proposed APC may contain terms that significantly reduce, restrict, or override existing benefits, and policyholders often don’t realize what they’re signing away.

Common red flags in misused APCs include:

• Requiring the insured to waive future claims for covered services.
• Offering only partial reimbursement for care that should be fully covered.
• Introducing new limitations or requirements not in the original policy.
• Using vague or conditional language that favors the insurer’s interpretation.

These tactics create a false sense of compromise when, in reality, the insurer may be sidestepping its contractual obligations.

Why You Should Never Sign an APC Without Legal Review

APCs are legally binding agreements. Once signed, they may permanently alter your rights under the original policy. Even well-meaning families, under stress and facing mounting care expenses, can be misled into signing agreements that ultimately reduce their long-term care benefits.

Before signing any APC, it is essential to:

• Have the document reviewed by a qualified attorney specializing in long-term care insurance.
• Compare the APC terms against the original policy language.
• Understand what benefits you may be giving up, both now and in the future.
• Explore whether the services in question are already covered and don’t require an APC.

Protect Your Rights Before You Sign

At Disability Insurance Law Group, we’ve helped countless clients nationwide review and challenge unfair APCs. Insurers may frame these agreements as cooperative solutions—but too often, they’re veiled attempts to minimize payouts. If you’ve received an APC proposal from your insurer, don’t sign it without legal guidance.

Contact us at 954-989-9000 or online today to schedule a complimentary consultation. We’ll help ensure that any care plan you agree to truly reflects your rights, not just the insurer’s bottom line.