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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 actually guarantee, and the context that most sales material leaves out.
The context first
Federal projections put private insurance at about 5% of lifetime long-term-care costs for people turning 65 in 2021–2025 — $6,000 of a projected $120,900 average, in 2020 dollars — against 43% from Medicaid and 37% from families out of pocket.[5] That is not an argument against buying a policy. It is the honest frame: most care in this country is not paid for this way, so a policy is one tool among several rather than the solution. What care costs has the rest.
What it costs, and what those numbers assume
From AALTCI's 2026 price index, for applicants in its select health class with an initial $165,000 benefit pool:[1]
- Age 55, single man: about $950 a year for level benefits; $2,200 with 3% yearly growth; $3,710 with 5%.
- Age 55, single woman: about $1,500 level; $3,750 at 3%; $6,400 at 5%. Women pay more because they claim more.
- Age 55, a couple: about $2,080 combined for level benefits; about $5,050 combined at 3%.
- Age 60, single woman: about $4,450 a year at $165,000 initial benefits.
- Age 65, a couple: about $7,030 combined at $165,000 initial benefits each, with 3% compound growth.
Look at what moves those numbers. The inflation option alone nearly quadruples the 55-year-old man's premium between level benefits and 5% growth. Health class, sex, marital discount, state and benefit pool all move it too. So treat these as illustrations for particular applicants, 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 index, and said identical coverage can differ by more than 50% between insurers, which we could not find on the index page. Both are corrected.
What "guaranteed renewable" actually means
NAIC's shopper's guide, in its own words: "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]
What that protects and what it does not: an insurer can raise premiums on guaranteed renewable policies, but only if it raises them on all policies that are the same in that state. It cannot single you out because you claimed or because your health changed.[2] So the risk is a class-wide increase, and the way to price that risk is to look at the insurer's history:
- NAIC says to ask companies whether they have increased premiums on the policies they sell.[2]
- And to request the company's personal worksheet including its premium increase history.[2] Ask for that in writing, from every carrier you consider.
- Check with several companies and agents, and compare benefits, the types of facilities covered, and premiums.[2]
Rate regulation is state business. California, for example, applies a rate stabilisation law under which premium rates go to actuarial review by the Department of Insurance and increases face additional review and justification.[3] Whether your state does anything comparable is a question for your own insurance department.
And NAIC's plainest piece of 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] Consider your age, health, retirement goals, income and assets.[2]
When benefits actually start
For a tax-qualified policy, California's insurance regulator states that the law requires benefits to be paid or reimbursed "if you are impaired in two out of the following six ADLs: bathing, dressing, transferring, eating, toileting, and continence", or where there is "substantial supervision due to severe cognitive impairment".[3]
Then there is the elimination period — a waiting period of 0 to 100 days during which you pay the full cost of care yourself.[3] A 90-day elimination period on a policy is three months of nursing-home bills before a dollar arrives. Ask what the period is, and whether it is satisfied by home-care visits or only by facility days.
Non-qualified policies work differently, and every contract's own definitions control. Read the definitions, not the brochure.
Hybrid policies
Hybrid or linked-benefit policies attach long-term-care benefits to life insurance or an annuity: if care is never needed there is a death benefit for heirs, and premiums are contractually fixed. They are usually funded with a large single premium or a fixed multi-year schedule.
We have no neutral price index for hybrids and did not find one, so this section carries no figures. The practical advice is to get quotes for both shapes side by side and compare total dollars in against benefits out, then apply NAIC's questions above to each.
The public option, in one state
Washington's WA Cares Fund is the first public long-term-care insurance program in the country, funded by a payroll premium. Benefits are now available statewide, and in 2026 the full benefit amount is $36,500, growing automatically with inflation each year. It can be used for covered services from a WA Cares provider, including in-home personal care, home-delivered meals, housework, adaptive equipment, assisted living, nursing home services and professional nursing. Qualifying requires meeting both contribution and care-needs requirements, and there are several pathways to the contribution test.[4]
If you work in Washington, that benefit exists for you. Other states have studied similar programs; we have not verified the current status of any of them, so we are not going to list them. Everywhere else, planning runs through private tools and Medicaid.
Where the public record stops
Whether a policy makes sense at your person's age, health and savings is a question about them, and the quotes are the only way to answer it.
Who to ask: your SHIP, for free unbiased insurance counselling; your state insurance department about rate regulation and complaints; an independent agent who quotes several carriers.
What to ask them:
- At this age and health class, what would traditional and hybrid quotes look like from several carriers?
- What is this insurer's premium increase history — may I see the personal worksheet?
- What exactly triggers benefits in this policy, and what is the elimination period?
- Does this state regulate rate increases on these policies, and how?
- How would this policy coordinate with Medicaid if the benefit pool runs out?
- What happens if I miss a premium, and is there a non-forfeiture option?
Who helps you locally, free. Your Area Agency on Aging gives free options counseling, and your state's SHIP gives free insurance counselling. Reach an Area Agency on Aging through the federal Eldercare Locator at 1-800-677-1116 or eldercare.acl.gov (Administration for Community Living).[6] More on the four people who help on Who helps me locally.
Quick answers
How much does long-term-care insurance cost in 2026?
The American Association for Long-Term Care Insurance's 2026 price index gives examples for applicants in its select health class with an initial $165,000 benefit pool. At 55, a single man pays about $950 a year for level benefits, $2,200 with 3% yearly growth, $3,710 with 5%; a single woman about $1,500, $3,750 and $6,400 for the same three; a couple both 55 about $5,050 combined with 3% growth. At 60 a single woman averages about $4,450, and a couple both 65 about $7,030 combined, both at $165,000 initial benefits. These are illustrations for specified applicants and benefits, not quotes and not market averages — the health class alone moves them. [1]
Can the premium go up?
Yes, and this is the sentence to understand before buying. NAIC: "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 premiums on guaranteed renewable policies, but only across all policies that are the same in that state — it cannot single you out for claiming or for a change in your health. NAIC's advice is to ask each company whether it has increased premiums on the policies it sells, and to ask for its personal worksheet showing its premium increase history. [2]
What triggers the benefits?
For a tax-qualified policy, California's insurance regulator states the law requires payment or reimbursement "if you are impaired in two out of the following six ADLs: bathing, dressing, transferring, eating, toileting, and continence", or on "substantial supervision due to severe cognitive impairment". Policies also carry an elimination period — a waiting period of anywhere from 0 to 100 days during which you pay the full cost of care yourself. Non-qualified policies and each contract's own definitions can differ, so 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.