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Long-term-care insurance

Most of what is written about long-term-care insurance is written by someone selling it. We do not sell it. Here is what it costs, what the guarantees really guarantee, and the background most sales material leaves out.

First, the background

Federal projections put private insurance at about 5% of lifetime long-term-care costs for people turning 65 in 2021–2025. That is $6,000 out of a projected average of $120,900, in 2020 dollars. Medicaid pays 43% and families pay 37% from their own pockets.[5] That is not a reason not to buy a policy. It is the honest background: most care in this country is not paid for this way. So a policy is one tool among several, not the whole answer. What care costs has the rest.

What it costs, and what those numbers assume

A trade group, the American Association for Long-Term Care Insurance (AALTCI), publishes sample prices each year. These are from its 2026 list, for people in its "select" health class who start with $165,000 in benefits:[1]

  • Age 55, single man: about $950 a year if benefits stay level; $2,200 if they grow 3% a year; $3,710 if they grow 5%.
  • Age 55, single woman: about $1,500 level; $3,750 at 3%; $6,400 at 5%. Women pay more because they make more claims.
  • Age 55, a couple: about $2,080 together for level benefits; about $5,050 together at 3%.
  • Age 60, single woman: about $4,450 a year for $165,000 in starting benefits.
  • Age 65, a couple: about $7,030 together for $165,000 in starting benefits each, growing 3% a year.

Look at what changes those numbers. The choice to have benefits grow with inflation nearly quadruples the 55-year-old man's price, from level benefits to 5% growth. Health class, sex, the discount for couples, the state and the size of the benefits all change it too. So treat these as examples for certain buyers, not as what you will be quoted. An earlier version of this page gave $5,010 for the couple at 55, which does not match the current list. It also said the same coverage can differ by more than 50% between insurers, which we could not find on the price list page. Both are fixed.

What "guaranteed renewable" really means

NAIC is the national group of state insurance regulators. Its shopper's guide says: "Long-term care insurance is guaranteed renewable. Guaranteed renewable means you can keep your coverage if you pay your premium on time. This is not a guarantee that you can renew at the same premium."[2]

Here is what that protects and what it does not. An insurer can raise the price on these policies, but only if it raises it on all policies of the same kind in that state. It cannot raise yours alone because you made a claim or your health changed.[2] So the risk is an increase for everyone in your group. The way to size up that risk is to look at the insurer's history:

  • NAIC says to ask companies if they have raised prices on the policies they sell.[2]
  • It also says to ask for the company's "personal worksheet," which includes its history of price increases.[2] Ask for that in writing, from every company you look at.
  • Check with several companies and agents. Compare the benefits, the kinds of facilities covered, and the prices.[2]

Each state regulates prices in its own way. California, for example, has a law meant to keep prices steady. Under it, the Department of Insurance has its experts review prices, and increases get extra review and must be justified.[3] Ask your own state insurance department if your state does anything like that.

And here is NAIC's plainest advice, which no salesperson will lead with: do not buy long-term care insurance if the only way you can afford it is by not paying other bills.[2] Think about your age, health, retirement goals, income and savings.[2]

When benefits really start

For a tax-qualified policy, California's insurance regulator says the law requires the policy to pay "if you are impaired in two out of the following six ADLs: bathing, dressing, transferring, eating, toileting, and continence," or when there is "substantial supervision due to severe cognitive impairment."[3] In plain words: the person needs help with two of those six daily activities, or needs close watching because of severe memory or thinking problems. ("Transferring" means moving, such as from a bed to a chair. "Continence" means bladder and bowel control.)

Then there is the elimination period. That is a waiting period of 0 to 100 days when you pay the full cost of care yourself.[3] With a 90-day elimination period, you pay three months of nursing home bills before a dollar comes in. Ask how long the period is. Ask if days of home care count toward it, or only days in a facility.

Policies that are not tax-qualified work differently, and the wording of each contract decides. Read the definitions in the policy, not the brochure.

Hybrid policies

Hybrid policies (also called linked-benefit policies) attach long-term-care benefits to life insurance or an annuity. If care is never needed, the policy pays a death benefit to heirs. The price is fixed by the contract. People usually pay for them with one large payment or a set number of yearly payments.

We did not find a neutral list of prices for hybrids, so this section has no numbers. The practical advice is to get quotes for both kinds side by side. Compare the total dollars you pay in with the benefits you can get out. Then ask NAIC's questions above about each one.

The public option, in one state

Washington State's WA Cares Fund is the first public long-term-care insurance program in the country. Workers pay for it through a deduction from their pay. Benefits are now available across the state. In 2026 the full benefit is $36,500, and it grows with inflation each year. It can be used for covered services from a WA Cares provider. These include personal care at home, meals brought to the home, housework, special equipment, assisted living, nursing home care and professional nursing. To qualify, a person must have paid in enough and must need enough care. There are several ways to meet the paid-in test.[4]

If you work in Washington, that benefit is there for you. Other states have studied programs like it. We have not checked where any of them stand now, so we are not going to list them. Everywhere else, planning means private tools and Medicaid.

What only quotes can tell you

Does a policy make sense at your person's age, health and savings? That depends on them, and getting quotes is the only way to answer it.

Who to ask: your SHIP, for free insurance counseling from someone with nothing to sell; your state insurance department, about price rules and complaints; and an independent agent who gets quotes from several companies.

What to ask them:

  • At this age and health class, what would quotes look like for regular and hybrid policies from several companies?
  • What is this insurer's history of price increases? May I see the personal worksheet?
  • What exactly makes benefits start in this policy? How long is the elimination period?
  • Does this state regulate price increases on these policies? How?
  • How would this policy work with Medicaid if the benefits run out?
  • What happens if I miss a payment? Is there a way to keep some benefit if I stop paying (a "non-forfeiture" option)?

Free local help. Your Area Agency on Aging will talk through your choices with you for free, and your state's SHIP gives free insurance counseling. Find an Area Agency on Aging through the federal Eldercare Locator at 1-800-677-1116 or eldercare.acl.gov (run by the Administration for Community Living).[6] To learn about the four kinds of local helpers, see Who helps me locally.

Quick answers

How much does long-term-care insurance cost in 2026?

A trade group, the American Association for Long-Term Care Insurance, publishes sample prices each year. Its 2026 examples are for people in its "select" health class who start with $165,000 in benefits. At 55, a single man pays about $950 a year if benefits stay level, $2,200 if they grow 3% a year, and $3,710 if they grow 5%. A single woman pays about $1,500, $3,750 and $6,400 for the same three. A couple who are both 55 pay about $5,050 together with 3% growth. At 60, a single woman pays about $4,450 on average. A couple who are both 65 pay about $7,030 together. Both of those are for $165,000 in starting benefits. These are examples for certain buyers and benefits. They are not quotes and not market averages. Health class alone changes them. [1]

Can the premium go up?

Yes, and this is the sentence to understand before you buy. NAIC, the national group of state insurance regulators, says: "Guaranteed renewable means you can keep your coverage if you pay your premium on time. This is not a guarantee that you can renew at the same premium." An insurer can raise the price on these policies, but only for all policies of the same kind in that state. It cannot raise yours alone because you made a claim or your health changed. NAIC says to ask each company if it has raised prices on the policies it sells, and to ask for its "personal worksheet" showing its history of price increases. [2]

What triggers the benefits?

For a tax-qualified policy, California's insurance regulator says the law requires the policy to pay "if you are impaired in two out of the following six ADLs: bathing, dressing, transferring, eating, toileting, and continence," or when you need "substantial supervision due to severe cognitive impairment." (ADLs are activities of daily living. "Transferring" means moving, such as from a bed to a chair. "Continence" means bladder and bowel control.) Policies also have an elimination period. That is a waiting period of 0 to 100 days when you pay the full cost of care yourself. Policies that are not tax-qualified, and each contract's own wording, can differ. Read the policy. [3]

Sources and what they support

Sources checked 2026-09-19 using AI-assisted editorial research. This is a source check, not insurance advice, and we sell nothing.

  1. American Association for Long-Term Care Insurance, 2026 price index. Supports every premium example on this page, including the select health class, the $165,000 initial benefit pool, the level / 3% / 5% growth options at age 55 for a single man and single woman, the $2,080 and $5,050 combined couple figures at 55, the $4,450 average for a single woman at 60 and the $7,030 combined for a couple at 65. AALTCI is the industry's own trade association, and these are illustrations for specified applicants and benefit designs — not quotes, not national market averages, and not applicable to an applicant in a different health class or state. Our previous figure of $5,010 for a couple at 55 does not match this index.
  2. NAIC, A Shopper's Guide to Long-Term Care Insurance (©2022, revised 2019). Supports every quoted sentence about guaranteed renewable coverage and premium increases, that an insurer may raise premiums only across all identical policies in a state and cannot single out an individual for claiming or health changes, the advice to ask about premium increase history and to request the company's personal worksheet, the advice to check several companies and compare benefits, facility types and premiums, the factors to weigh before buying, and the warning not to buy if affording it means not paying other bills. A national regulators' consumer guide, revised in 2019, so it does not carry current prices and state rate-review rules have moved since.
  3. California Department of Insurance, long-term care insurance. Supports the quoted two-of-six activities-of-daily-living trigger and its list, the quoted substantial-supervision cognitive trigger, the 0-to-100-day elimination period and that you pay the full cost of care during it, and California's rate stabilisation law with actuarial review of rates and additional justification for increases. This is a state regulator writing about tax-qualified policies sold in California. Non-qualified policies differ, each contract's definitions control, and the rate-regulation part is California law, not a national rule.
  4. WA Cares Fund, benefits. Supports that benefits are now available statewide, that the full benefit amount in 2026 is $36,500 and grows automatically with inflation each year, the list of covered services and supports from a WA Cares provider, and that qualifying requires meeting both contribution and care-needs requirements with multiple pathways to the contribution test. This page does not state the payroll premium rate, so this page no longer quotes one. It is a Washington program and applies to Washington workers only.
  5. HHS / ASPE, Long-Term Services and Supports for Older Americans: Risks and Financing, 2022 (official GovInfo copy). Supports the $6,000 private-insurance share of a projected $120,900 average lifetime long-term-care cost, and the 43% Medicaid and 37% family out-of-pocket shares, for adults turning 65 in 2021–2025 in 2020 inflation-adjusted dollars. A modelled projection for one birth cohort, not observed spending, and not a statement about whether insurance is worthwhile for an individual.
  6. Administration for Community Living, Eldercare Locator. Supports the referral route to a local Area Agency on Aging. It does not advise on insurance products.

Removed in this pass, for want of a source: that identical coverage can differ by more than 50% between insurers; the WA Cares payroll premium rate, which is not on the cited benefits page; and the list of states said to have studied similar programs, whose current status we did not check. The claim that buying makes actuarial sense mainly between the late fifties and mid sixties has also gone — NAIC lists age among several factors rather than naming a window.

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