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As Americans live longer and healthcare costs grow, planning for future care needs has become increasingly important. After all, nearly 70% of Americans aged 65 and older will require some form of long-term care during their lifetime, according to the U.S. Department of Health and Human Services — and the cost of this type of care will likely be difficult to pay out of pocket for many Americans. As of 2025, the average cost of a private room in a nursing home exceeds $120,000 per year, and home health aide services can cost upward of $75,000 per year. These types of expenses are only expected to grow over time, highlighting the financial hurdles that many seniors currently face, or will face, in terms of long-term care.
And, as the population ages, the price of long-term care won’t be the only thing that grows. Demand for long-term care services is also expected to grow substantially. By 2030, all baby boomers will be at least 65 years old, which will almost certainly lead to a sharp increase in the need for assisted living, nursing homes and in-home care. With these services becoming more expensive, long-term care insurance offers a way to mitigate the financial burden while ensuring access to quality care.
But if you plan to purchase this type of coverage, understanding who qualifies for long-term care insurance coverage is an important part of the decision. Below, we’ll break down who exactly qualifies for long-term care coverage this year.
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Who qualifies for long-term care insurance coverage?
Long-term care insurance is generally available to adults aged 18 and 75, though the sweet spot for purchasing coverage typically falls between ages 50 and 65. That said, insurance companies will also evaluate several key factors when determining eligibility, which typically include:
Health status
Applicants must be in relatively good health to qualify for this type of coverage. To determine if this is the case, insurance companies will typically review your medical records and may require a physical examination. Pre-existing conditions such as Alzheimer’s disease, Parkinson’s disease, multiple sclerosis or a history of strokes could result in a denial. Less severe health issues, like well-controlled diabetes or high blood pressure, may be acceptable but could result in higher premiums.
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Activities of daily living
Insurers will also assess your ability to perform basic activities of daily living (ADLs) independently. These include bathing, dressing, eating, transferring (moving from bed to chair) and maintaining continence, among other tasks. Those who already need assistance with these activities typically won’t qualify for long-term care insurance coverage.
Cognitive function
Mental acuity is a crucial factor in terms of qualifying for coverage. Those showing signs of cognitive decline or memory problems are less likely to be approved, as these conditions often lead to long-term care needs.
Age
While coverage is generally available up to age 75, long-term care insurance premiums increase significantly with age, and qualifying becomes more difficult. Some insurers may limit new policies to those under 70 or even 65.
When should you purchase long-term care insurance?
If you want to get the timing right for when to purchase long-term care insurance, it may help to weigh these factors:
- Cost vs. benefits: Premiums increase significantly with age, so purchasing coverage in your 50s rather than your 60s can result in substantially lower premiums over the life of the policy. However, this means paying premiums for a longer period before benefits might be needed.
- Health changes: Waiting too long runs the risk of you developing health conditions that could make you uninsurable. Once you have a serious health condition, it becomes much more difficult or impossible to obtain coverage.
- Financial readiness: Premiums must be paid consistently to maintain coverage, so ensure you can afford them not just now but throughout retirement. It could also make sense to wait until other priorities, like retirement savings and debt reduction, are well under control.
- Family history: If longevity and health conditions requiring long-term care run in your family, purchasing coverage earlier might be prudent.
The bottom line
Long-term care insurance can provide valuable protection against the high costs of extended care needs, but qualifying for coverage requires meeting specific health and age criteria. The best candidates are typically those in good health who purchase policies in their 50s or early 60s, have stable financial resources to maintain premium payments and want to protect their assets from potential long-term care costs.
Before applying, though, be sure to carefully review different insurance companies’ qualification requirements and policy options. And, remember that while long-term care insurance premiums can be substantial, the cost of long-term care without insurance can be financially devastating, making this protection worth considering for many who qualify.
