If you've spent any time thinking about what happens to your savings if you need a nursing home or years of home health aide visits, you already understand why long-term care insurance exists. Medicare — the program most people over 65 rely on — does not pay for custodial care. That means help with bathing, dressing, eating, or moving around your home. It covers skilled nursing facility stays only after a qualifying three-day hospital admission, and only for up to 100 days, with a significant daily copay kicking in after day 20. In 2025, that copay was $204 per day. After day 100, Medicare pays nothing. The financial exposure is enormous, and long-term care insurance is one of the few tools designed specifically to address it.
The national median cost of a private room in a nursing home reached approximately $108,405 per year in 2024, according to Genworth's annual Cost of Care Survey, which has tracked these figures for over two decades. Assisted living facilities averaged around $64,200 annually. Home health aide services, which many people prefer, ran about $75,504 per year for 44 hours of weekly care. These are median figures — costs in high-cost states like California, New York, Massachusetts, and Alaska run significantly higher. A beneficiary in San Francisco or Manhattan could easily face costs 40 to 60 percent above those national medians. Without insurance, those costs come directly out of retirement savings, home equity, or eventually Medicaid — which requires spending down most of your assets before it kicks in.
The long-term care insurance market has changed dramatically over the past 15 years. Many insurers that once dominated the traditional standalone LTC market — including major household names — exited the business entirely after underestimating how long policyholders would live and how much care they would actually use. Those who stayed in the market have raised premiums substantially, sometimes by 50 to 80 percent on existing policies, leaving beneficiaries with difficult choices: pay the higher premium, reduce their benefits, or drop coverage entirely. This history matters because it shapes which companies are considered reliable today.
As of June 2026, the companies most consistently recognized for financial strength, claims-paying history, and policy flexibility in the long-term care space include Mutual of Omaha, Northwestern Mutual, New York Life, Nationwide, and Lincoln Financial Group. Each approaches the market somewhat differently, and the right fit depends heavily on your age, health status, budget, and whether you want a traditional standalone policy or a hybrid product that combines life insurance with long-term care benefits.
Mutual of Omaha has remained one of the most active writers of traditional long-term care insurance and is frequently cited for competitive pricing and a straightforward underwriting process. Their policies typically offer inflation protection options — including 3 percent compound inflation riders — which are critical for anyone buying coverage in their 50s or early 60s, since benefits purchased today may not be used for 20 or 30 years. Without inflation protection, a $200-per-day benefit that seems adequate today could cover less than half of actual costs by the time you need it. Mutual of Omaha holds strong financial strength ratings from AM Best, which is the primary rating agency for insurance company stability.
New York Life and Northwestern Mutual are mutual companies — meaning they are owned by policyholders rather than shareholders — and both carry among the highest financial strength ratings in the entire insurance industry. New York Life's long-term care products include both traditional policies and hybrid options. Northwestern Mutual focuses more heavily on hybrid life/LTC products, which have become the dominant product type in the market. The appeal of a hybrid policy is straightforward: if you pay a $100,000 lump sum or a series of premiums into a hybrid policy and never need long-term care, your heirs receive a death benefit. With traditional LTC insurance, if you never file a claim, you receive nothing back. That return-of-premium feature has made hybrids far more palatable to people who are uncomfortable with the idea of paying for coverage they may never use.
Lincoln Financial Group and Nationwide are also significant players in the hybrid space. Lincoln's MoneyGuard product line is one of the most widely sold hybrid LTC products in the country and is available through a large network of financial advisors and insurance agents. Nationwide's CareMatters product similarly combines a universal life insurance chassis with long-term care acceleration benefits. Both products allow policyholders to access the death benefit early — typically two to three times the base amount — if they meet the benefit trigger, which is usually the inability to perform two of six activities of daily living (ADLs) or a cognitive impairment such as Alzheimer's disease. These triggers are standardized by federal law under the Health Insurance Portability and Accountability Act (HIPAA), which also governs the tax treatment of qualified LTC policies.
One of the most important and frequently misunderstood aspects of long-term care insurance is the elimination period — essentially a deductible measured in days rather than dollars. Most policies have a 90-day elimination period, meaning you must pay for care out of pocket for 90 days before the insurance begins paying. Some policies offer a 30-day or 60-day elimination period at higher premiums. If you're evaluating a policy, calculate what 90 days of care would cost in your area and make sure you have liquid assets to cover that gap. A 90-day elimination period at $300 per day in a nursing home means roughly $27,000 out of pocket before your first insurance dollar arrives.
The question of when to buy long-term care insurance is almost as important as which company to choose. Premiums are based heavily on age and health status at the time of application. The American Association for Long-Term Care Insurance (AALTCI) consistently reports that the sweet spot for purchasing traditional LTC coverage is between ages 52 and 64. By age 70, premiums for new policies can be two to three times higher than they would have been at 60, and a significant percentage of applicants are declined for health reasons. Common disqualifying conditions include Alzheimer's or other dementia diagnoses, Parkinson's disease, current use of a walker or wheelchair, insulin-dependent diabetes with complications, and certain heart conditions. If you're reading this in your late 60s and still in good health, the window is narrowing but not closed — it's worth getting a quote now rather than waiting.
For Medicare beneficiaries who are already past the ideal purchase age or who have health conditions that make traditional LTC insurance unaffordable or unavailable, there are alternative strategies worth understanding. Medicaid planning — working with an elder law attorney to structure assets in ways that may preserve some wealth while qualifying for Medicaid long-term care benefits — is a legitimate and widely used approach, though it involves complex rules that vary significantly by state. Some states have Partnership Programs that allow people who purchase qualified LTC insurance policies to protect additional assets from Medicaid spend-down requirements equal to the benefits their insurance pays out. As of 2026, most states participate in the Long-Term Care Partnership Program, and policies that qualify are specifically designated as such.
Short-term care insurance is another option that often gets overlooked. These policies, sometimes called recovery care insurance, typically cover 180 to 360 days of care and are far easier to qualify for medically. They won't protect you from a multi-year nursing home stay, but they can bridge the gap that Medicare leaves after day 100 and provide meaningful protection for the most common care scenarios — recovery from a hip replacement, a stroke, or a serious illness. Premiums are substantially lower than traditional LTC insurance, and several companies including Mutual of Omaha and LifeShield offer these products with relatively lenient underwriting.
When comparing long-term care insurance policies, look beyond the monthly premium to the benefit period (how many years the policy will pay), the daily or monthly benefit amount, whether the benefit pool is shared between spouses, the inflation protection option, the elimination period, and the financial strength rating of the insurer. A policy from a company with an AM Best rating below A- carries meaningful risk that the company may not be around — or may not be financially healthy — when you need to file a claim 20 years from now. The claims-paying experience also matters: ask agents about the company's history of premium increases on in-force policies, since this is where many policyholders have been blindsided.
Finally, be cautious about where you get your information and who you buy from. Long-term care insurance is a complex product, and commission structures can be substantial, which creates incentives for agents to recommend higher-premium products. Working with an independent broker who represents multiple companies — rather than a captive agent who sells only one company's products — gives you a better chance of finding the right fit at a competitive price. Your State Insurance Commissioner's office can verify that any agent you work with is properly licensed and can help you check whether a company has a history of complaints. The National Association of Insurance Commissioners (NAIC) maintains a consumer information database at naic.org where you can look up complaint ratios for specific insurers. Taking the time to compare at least three quotes, understand the benefit triggers, and verify the financial strength of any company you're considering can make the difference between a policy that protects your retirement and one that disappoints you when it matters most.