Last Updated: 7/23/2026

Issue: The long-term care insurance (LTCI) market has evolved significantly since the introduction of LTCI in the 1960s. In 2010 U.S. spending on long-term care (LTC) services was about 1% of gross domestic product, but by 2050 that is expected to grow to 3%. According to the Health and Human Services office of the Assistant Secretary for Planning and Evaluation “70% of adults who survive to age 65 develop severe LTSS needs before they die and 48% receive some paid care over their lifetime.”

According to LongTermCare.gov there are now 100 companies that offer LTCI nationally, but only 15–20 insurers sell most policies.

Additionally, premium rates for newly issued policies have risen as the remaining writers have refined their pricing. 

LTCI policies incorporate several LTC service alternatives, including: 

• Home health care
• Respite care
• Hospice care
• Personal care in the home
• Services provided in assisted living facilities
• Adult day care centers and other community facilities

Public programs, such as Medicare and Medicaid, also cover certain limited LTC services. As our population ages, the need for LTC support and services will increase and require innovative new approaches. You can find more on this topic and other issues related to the aging population in the presentation videos for the Center for Insurance Policy and Research’s (CIPR's) June 16, 2015, symposium Boom or Bust? A Look into Retirement Issues Facing Baby Boomers. 

The decision to purchase LTCI, and the premium charged, may be influenced by factors such as age, gender, family circumstances, health status, and financial resources. Younger buyers typically pay lower premiums, while longer life expectancy may increase the likelihood of needing care. Women are generally more likely than men to require long-term care. Family support availability, personal and family health history, and the ability to protect income and assets may also influence LTCI decisions.

There are several ways to purchase coverage in the LTCI market: 

Individual policies: Most LTCI policies are purchased by individuals through insurance agents. Benefits provided by individual policies can vary among different insurers. Each insurer may also offer policies with different combinations of benefits. 
Group policies: Some employers offer group LTCI coverage to their employees. Employer group plans generally offer a base plan of benefits with less stringent underwriting than for individual policies. Sometimes they offer enhanced benefits contingent upon additional underwriting. 
Association Policies: Many associations let insurance companies and agents offer LTCI to their members. Benefits and underwriting for association policies are generally more like those for individual policies than for group policies. 

The primary challenges for insurers and state insurance regulators in LTCI markets come from older issue year policies. These policies were initially priced when LTCI experience used to calculate rates was not fully developed. As experience developed, it became apparent that the initial pricing assumptions for the number of policyholders qualifying for LTC benefits and the length of time claimants would remain on claim were understated. Additionally, actual policy lapse rates proved to be much lower than initially assumed, resulting in higher insurer exposure to claims payments. Misestimation of initial pricing assumptions has made it necessary for insurers to increase LTCI rates to ensure their future solvency. 

The analysis of decades of experience generated by older issue year policies has enabled LTCI insurers to more accurately price newer issue year policies, making rate increases to them far less likely and of a lesser magnitude. 

The NAIC formed the Long-Term Care Insurance (EX) Task Force established in 2019 under the Executive (EX) Committee disbanded in late 2024. Its focus was on nationwide LTCI rate increase coordination and consistency. In 2016, the Task Force appointed the Long-Term Care Innovation (B) Subgroup to examine the future of LTCI. The Subgroup developed two documents:  

• Federal Policy Options for Congress
• Private Market Options for Financing Long-Term Care Services

The Task Force also updated the NAIC's A Shopper's Guide to Long-Term Care Insurance. The NAIC wrote this guide to help you understand LTC and the insurance options that can help you pay for LTC services.

In 2020, the Task Force developed and adopted guidance for the evaluation and communication of reduced benefit options associated with LTCI rate increases. In 2022, the Task Force adopted the Long-Term Care Insurance Multistate Rate Review Framework as a consistent national approach for reviewing LTCI rates that result in actuarially appropriate increases being granted in a timely manner and to eliminate cross-state rate subsidization. Long-Term Care insurance is now monitored by the Senior Issues Group. 

The Senior Issues (B) Task Force continues to monitor LTCI, and develop appropriate regulatory standards and revisions, as necessary, to the NAIC models, consumer guides, and training material on LTCI, including the study and evaluation of evolving LTCI product design, rating, suitability, and other related factors. Monitor ongoing research and maintenance of guidance regarding reduced benefit options (RBOs) and make necessary modifications to the Long-Term Care Insurance Model Act (#640) and the Long-Term Care Insurance Model Regulation (#641). Work with federal agencies, as appropriate.. 

The LTCI benefit obligations of insolvent insurers are covered under the Life and Health Insurance Guaranty Association Model Act (#520). The NAIC membership modified Model #520 in 2017 to allow for the expansion of the guaranty fund assessment base. 

The Long-Term Care Actuarial (B) Working Group continues to monitor and evaluate the actuarial approach used in the MSA rate review process as outlined in the MSA Framework document, and make modifications, as appropriate. Additionally, the working group monitors and evaluates the progress of the MSA rate review process and the state insurance department rate review actions related to the MSA Framework.