Long-Term Care Insurance

Despite the high cost and growing demand for LTSS, relatively few adults age 40 and older purchase LTCI; that number continues to decline. This downward trend is consistent across nearly all states. Between 2018 and 2021, there were slight decreases in the number of people covered in all states except two, West Virginia (increase of 4 percent) and Washington (increase of 55 percent). The dramatic increase in the number of policy holders in Washington can be attributed at least in part to the new public long-term care insurance program the state is rolling out now. Starting in July 2023, workers who do not have private policies will be automatically enrolled in the public program. In anticipation of this, many residents have started to purchase private policies.

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The number of long-term care insurance policies, group and individual stand-alone policies, in force (for people of all ages) per 1,000 population ages 40 or older in the state. This is not exactly the proportion of people ages 40+ with private LTCI, because data on the age of policyholders at the state level are not available. Historically, about three-fourths of group policyholders and nearly all individual policyholders have been ages 40+.

LTCI policy data are from the AARP Public Policy Institute analysis of 2021 National Association of Insurance Commissioners (NAIC) Long-Term Care Insurance Experience Reporting - Form 5, end-of-year inforce counts, by company type. In addition, California Public Employee Retirement System (CalPERS) group LTCI policies are separately reported as NAIC does not report CalPERS counts. LTCI policy data excludes federal LTCI group policy counts as the Office of Personnel Management would not authorize the release of 2018 data.

Population data are from the US Census Bureau Population Estimates, 2021. 2018 baseline LTCI policy and population data are from the same sources.
National Association of Insurance Commissioners (NAIC) Long-Term Care Insurance Experience Reporting - Form 5, End of Year Inforce Counts, by company type (2021 and 2018); 2022, available at

California total group policy counts separately reported for California Public Employee Retirement System (CalPERS) group LTCI policies.  CalPERS is not an NAIC reporting company.  CalPERS, Long-Term Care Actuarial Valuation, as of June 30, 2021, long-term care program data for participant counts and covered lives, available at  CalPERS 2018 Long-Term Care Program Report, March 20, 2018, available at State level data excludes federal long-term care insurance group policy counts.

U.S. Census Bureau, 2021 American Community Survey 1-Year Estimates, Annual Estimates of the Resident Population for Selected Age Groups by Sex for the United States. (Washington, DC: US Census Bureau, 2021),$0400000&tid=ACSST1Y2021.S0101


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