Long-term care insurance sits in a category that most Medicare beneficiaries don't think about until it's too late to buy it affordably — or at all. Medicare, despite being the primary health coverage for 65 million Americans, does not pay for custodial care: the help with bathing, dressing, eating, and daily living that most people eventually need. That gap can cost families hundreds of thousands of dollars, and long-term care insurance exists specifically to fill it. But the market for these policies has changed dramatically over the past decade, and knowing which companies are still writing policies — and what kind — matters enormously.
The long-term care insurance industry contracted sharply after major insurers mispriced policies in the 1990s and early 2000s, underestimating how long people would live and how much care they would use. Many carriers exited the market entirely. Those that remain, including Mutual of Omaha, Transamerica, and Northwestern Mutual, have tightened underwriting standards and, in some cases, raised premiums on existing policyholders — sometimes dramatically. If you already hold a traditional standalone long-term care policy, you may have received premium increase notices. That's not a billing error; it's a structural feature of how these products were designed. Regulators in most states must approve rate increases, but they do get approved.
This is why hybrid policies — which combine a life insurance death benefit or annuity with a long-term care benefit rider — have become the dominant product in 2026. Companies like Lincoln Financial, Pacific Life, Nationwide, and OneAmerica have built strong reputations in this space. With a hybrid policy, you pay a lump sum or fixed premiums, and if you never need long-term care, your heirs receive a death benefit. If you do need care, the policy pays out a monthly benefit — typically ranging from $3,000 to $10,000 or more per month depending on how the policy is structured. Premiums on hybrid policies are generally guaranteed not to increase, which addresses the biggest complaint about traditional LTC insurance. The tradeoff is that hybrid policies typically require a larger upfront commitment, and the long-term care benefit may be smaller relative to a standalone policy of equivalent cost.
When evaluating any long-term care insurance company, financial strength ratings matter more here than in almost any other insurance category. You may not file a claim for 20 or 30 years, so the insurer needs to be financially sound for decades. Look for companies rated A or better by AM Best, and cross-reference with ratings from Moody's or S&P if possible. Mutual of Omaha, for example, has maintained strong ratings and continues to offer both traditional and linked-benefit products. Northwestern Mutual, available only through its own agents, is consistently rated among the strongest insurers in the country by financial strength measures.
Benefit triggers are another critical detail that beneficiaries often overlook. Most policies pay out when you can no longer perform two of six Activities of Daily Living (ADLs) — bathing, continence, dressing, eating, toileting, and transferring — or when you have a severe cognitive impairment like Alzheimer's disease. The elimination period, which works like a deductible measured in days rather than dollars, typically ranges from 30 to 90 days. A 90-day elimination period means you pay out of pocket for the first three months of care before the policy kicks in. Shorter elimination periods cost more in premiums but reduce your exposure.
Inflation protection is perhaps the most important optional rider you can add to a long-term care policy, and one of the most expensive. A policy that pays $5,000 per month today may cover only a fraction of actual care costs in 20 years without some form of inflation adjustment. Compound 3% inflation protection is the standard recommendation from most financial planners, though it adds significantly to the premium. Some hybrid policies build in a fixed pool of money that grows at a set rate, which accomplishes a similar goal.
For Medicare beneficiaries who are already past the ideal purchase window — say, in their mid-70s or dealing with significant health conditions — traditional long-term care insurance may no longer be available or affordable. In those cases, alternatives worth exploring include short-term care insurance (which covers 360 days or less and has looser underwriting), life insurance policies with accelerated benefit riders, and Medicaid planning with the help of an elder law attorney. Medicaid does cover long-term care, but only after you've spent down most of your assets to qualify — a process that can be devastating to a surviving spouse's financial security without proper advance planning.
The bottom line is that no single company is the best choice for every beneficiary. Your age, health status, family history, existing assets, and whether you want a pure insurance product or a hybrid with a death benefit all shape which policy and which carrier makes sense. Getting quotes from at least three companies through an independent broker who specializes in long-term care — not a captive agent who sells only one company's products — is the most reliable way to compare real options. The American Association for Long-Term Care Insurance (AALTCI) maintains a directory of specialists and publishes annual data on premium costs by age and benefit level, which can serve as a useful benchmark before you sit down with any agent.