Can a family member be paid as a caregiver with long term care insurance?

The answer sits in the policy itself, and the published rules vary a lot. The Federal Long Term Care Insurance Program (FLTCIP) allows approved family members as paid caregivers for up to 500 days in the insured's lifetime. Genworth's standard invoice form for independent providers says care from family members is typically not covered. In September 2026 Genworth announced a new optional family caregiver benefit for eligible policyholders in certain states.

Below is what each source says, word for word where it matters, so you can compare it with the language in your own policy.

What does the NAIC consumer guide say about family caregivers?

The National Association of Insurance Commissioners publishes A Shopper's Guide to Long-Term Care Insurance. On elimination periods, it says: "Companies don't pay for care provided by family members during or after the elimination period." It also notes that most policies don't pay family caregivers and may not count their care toward the elimination period.

That is a general statement about the market. Some policies and programs do pay family members, as the examples below show.

How does FLTCIP handle family members as caregivers?

FLTCIP calls a non-professional caregiver an Informal Caregiver. The 3.0 Benefit Booklet defines it as "a person providing Maintenance or Personal Care who is not a Formal Caregiver."

The booklet sets these limits:

• "Benefits for Informal Caregivers who are Family Members are limited to 500 days in your lifetime."
• "Any day during which you receive any amount of Informal Caregiver services from a Family Member counts toward the 500 days." One hour of family care on a given day uses one of the 500 days.
• The term "does not include anyone who lived in your Home at the time you became eligible for benefits."
• Services by your spouse or domestic partner are excluded.

The Using Your FLTCIP Benefits guide adds that family member care must be listed in the written plan of care.

The FLTCIP 3.0 booklet's Family Member definition starts with spouse, domestic partner and child (natural, step or adopted), and continues with in-laws, parents, siblings and grandchildren. The FLTCIP 2.0 booklet carries the same 500-day limit and says days used under a prior booklet reduce it.

What does FLTCIP require on the invoice for family care?

The Invoice Submission and Reimbursement Package says, "If you use an Informal Caregiver (including an approved family member), follow these instructions." The form asks for:

• The informal caregiver's relationship to the insured.
• One date of service per line, with time in and time out rounded to the nearest quarter hour.
• The services provided that day (bathing, continence, dressing, eating, toileting, transferring, supervision and other).
• Handwritten signatures from the caregiver and the insured or legal representative, after the services.
• A check or transaction number for each date of service.

If the family caregiver is also the legal representative signing for the insured, FLTCIP requires a third party's signature to attest to the services, hours and payment. The package also says, "An assignment of benefits is not available for Informal Caregivers."

FLTCIP says cash payments, and checks written to cash, are not reimbursable.

What does Genworth publish about family caregivers?

Genworth's LTC invoice form for independent care providers says care from family members is typically not covered, and directs the reader to review the policy or call Genworth for details. The form includes a field for the provider's relationship to the insured.

Genworth policies are not all written the same way. A published sample Genworth group policy (form 7053POL CA) lists an "Informal Family Care Benefit 1% of the Nursing Facility Maximum per day for 30 days per calendar year." That is one sample group policy, shown here only as an example of how the wording can differ.

On September 22, 2026, Genworth announced a Family Caregiver Benefit. The press release says it gives eligible policyholders "the option to use their benefits for qualified care provided by family members." It also says:

• It is "offered through a voluntary coverage election."
• Policyholders "may choose to modify certain policy features" to get it.
• It rolls out "on a state-by-state basis following regulatory approvals."
• It "can pay up to 75% of the median hourly cost for non-medical care," based on the CareScout Cost of Care Survey.

The release says Genworth will send policyholders more details about eligibility. Watch your mail and your online account for that notice.

What does John Hancock publish about family members?

John Hancock's claims pages describe independent caregivers as people employed directly by the insured or their family, with no agency in between. Those caregivers are paid through the Independent Care Provider service bill or the CareGiver app.

The pages reviewed do not set out separate reimbursement rules for caregivers who are related to the insured. The Independent Care Provider form asks for proof of payment, such as canceled checks or Venmo receipts, and says cash payments are not acceptable.

John Hancock's claims page also says family members can start a claim for the insured or act as claim representative with the required power of attorney or guardianship papers.

Where in your policy should you look?

Most of the answer lives in four places in the policy or certificate:

• The definitions section, for terms like Informal Caregiver, Family Member or Immediate Family.
• The exclusions and limitations section, for any family care exclusion.
• The schedule of benefits, for any informal or family care benefit with its own daily amount or day limit.
• Any rider or later coverage election, such as the Genworth benefit announced in 2026.

Then compare what you find with the claim approval letter and plan of care. FLTCIP's guide, for example, says family member care must be in the written plan of care.

If the policy language is unclear, call the claims number on the policy and ask the question in writing as well, so the answer is on paper.

Do family caregivers create tax paperwork?

They can. IRS Publication 926 says wages you pay your spouse, your child under 21 or your parent are generally not subject to social security, Medicare or federal unemployment tax, with a narrow exception for parents. Wages paid to an adult child, sibling or other relative are counted the same as any other household employee. A tax professional can tell you how this applies to your family.

This is general information, not legal, tax or insurance advice. Your policy and your claim approval letter control who can be paid and for how long.

FAQ

Sources:
https://content.naic.org/sites/default/files/publication-ltc-lp-shoppers-guide-long-term.pdf
https://cdn.ltcfeds.gov/planning-tools/downloads/3.0-Benefit-Booklet.pdf
https://cdn.ltcfeds.gov/planning-tools/downloads/2.0-Benefit-Booklet.pdf
https://cdn.ltcfeds.gov/planning-tools/downloads/2.0-3.0-Using-Your-FLTCIP-Benefits.pdf
https://cdn.ltcfeds.gov/planning-tools/downloads/Invoice-Submission-and-Reimbursement-Package.pdf
https://www.ltcfeds.gov/claims-information/using-your-benefits
https://www.ltcfeds.gov/claims-information/reimbursement
https://www.genworth.com/dam/Americas/US/PDFs/Consumer/Forms/LTC-invoice-form.pdf
https://www.genworth.com/dam/Americas/US/PDFs/Consumer/Product/LTC/7053POL%20CA%20Sample.pdf
https://investor.genworth.com/news-events/press-releases/detail/1063/genworth-introduces-new-family-caregiver-benefit-expanding
https://www.johnhancock.com/individual/help-center/long-term-care/understanding-the-claim-process/benefit-reimbursement
https://www.johnhancock.com/individual/help-center/long-term-care/claims
https://www.johnhancock.com/content/dam/jh-com/us/customer-support-and-self-service/long-term-care/LTC-ICPSB_Fillable.pdf
https://www.irs.gov/publications/p926