Long-term care insurance implemented nationwide within 3 years: sharing the care costs for disabled elderly, employees reimbursed at 70%

What experiences has the long-term care insurance pilot program accumulated for national promotion over the past ten years?

Late at night on March 25, the General Office of the Central Committee and the State Council jointly issued the “Opinions on Accelerating the Establishment of a Long-term Care Insurance System,” marking the formal nationwide rollout of the long-term care insurance system. At a press conference held on the 26th, Wang Wenjun, Deputy Director of the National Healthcare Security Administration, stated that this insurance aims to collect funds through universal participation to provide basic daily care and medical assistance for insured individuals who have lost their ability to perform normal activities, with reimbursement for incurred care costs.

Prior to this, the long-term care insurance had undergone ten years of pilot programs in certain regions, and following the release of the document, it is expected to be gradually implemented in other areas over the next three years. The opinions set different contribution rates and models for employed workers, retired workers, unemployed urban and rural residents, and flexible employment individuals, with the government providing subsidies to certain groups.

It is important to emphasize that the long-term care insurance fund is primarily used to pay for the costs incurred by approved long-term care service institutions and personnel in providing basic long-term care services, and in principle, cash will not be directly distributed to disabled individuals. For those insured under the unemployed urban and rural resident policy, the fund will cover approximately 50% of eligible long-term care service costs; for those insured under the employed workers policy, the fund will cover approximately 70%, with retired individuals enjoying the same benefits as employed workers.

On March 26, the State Council Information Office held a press conference to introduce relevant information on accelerating the establishment of the long-term care insurance system.

What services can long-term care insurance reimburse?

What services can be reimbursed after participating in long-term care insurance?

Wang Wenjun stated that for disabled individuals, professional care can significantly improve their quality of life, making bathing, haircutting, eating, and dressing changes no longer “luxuries on the hospital bed.” According to the official catalog, the specific services cover 20 necessary daily living care items such as assistance with eating, bathing, and oral hygiene, as well as 16 basic medical care items like suctioning and catheterization.

To ensure standardized care services across different regions, Huang Xinyu, Director of the Medical Service Management Department of the National Healthcare Security Administration, mentioned that the catalog specifies principles regarding service operational requirements, service personnel, and service duration. For example, the catalog clearly states that to complete the service item of “assisting with eating,” seven procedural steps and specific service requirements are needed, including handwashing before meals, chopping and mixing food, monitoring eating posture and food temperature, preventing choking, and maintaining posture and recording eating conditions after the meal.

Who pays?

As a form of social insurance, long-term care insurance still adopts the model of insured contributions leading to benefits. So how can individuals participate in this insurance? What are the rates?

The aforementioned document states that employers (including enterprises, public institutions, government agencies, and social organizations) as well as employed workers, retirees, flexible employment individuals, and unemployed urban and rural residents will participate in long-term care insurance based on local management principles. The establishment of long-term care insurance systems in various regions can initially cover employed workers, retirees, and flexible employment individuals, gradually including unemployed urban and rural residents in the protection scope.

This insurance employs a diversified funding model involving employers, individuals, the government, and society. At the national level, a baseline rate system for long-term care insurance will be established to standardize contribution base policies, reasonably determine rates, and implement dynamic adjustments. In regions where the basic medical insurance fund for employees has a significant surplus, adjustments to the unit rate for employee basic medical insurance may be made based on sufficient assessments to ensure the rights of insured individuals, while some of the adjustments may be allocated to the long-term care insurance unit rate, with specific regulations to be formulated by the National Healthcare Security Administration, the Ministry of Finance, and the State Administration of Taxation.

Guo Yang, Director of the Social Security Department of the Ministry of Finance, added that in regions where long-term care insurance has been piloted, the coverage has initially started with the employee population and has been further expanded to residents in qualified areas. To support participation, pilot regions have developed relevant financial subsidy policies tailored to their circumstances, including subsidies for participating residents and assistance for those facing difficulties, all of which have accumulated valuable experience for the national-level policy formulation.

How much does participation cost?

So how much does one need to contribute to participate? For employed workers, urban and rural residents, and retirees involved in long-term care insurance, the document also provides initial arrangements. It is said that the long-term care insurance rate is uniformly controlled at around 0.3%, among which:

The rate for employed workers is shared equally between the employer and the employee, with the employer’s contribution base being the total wages of employees and the employee’s contribution base being their own wage income, with both parties contributing together.

The rate for retirees is the same as that for employed workers, with the contribution base linked to the pension level, paid by the individual, with no contributions from the former employer.

The funding for long-term care insurance for unemployed urban and rural residents is reasonably shared between individuals and the government, with individuals contributing and the government providing subsidies as stipulated, with the government subsidies borne jointly by the central and local finances; considering urban-rural differences, localities can reasonably calculate the contribution base based on the previous year’s per capita disposable income of urban and rural residents in the region, or in rural areas, based on the previous year’s per capita disposable income of rural residents, encouraging exploration of more scientific and refined funding mechanisms. In the year localities establish long-term care insurance systems, the rate for unemployed urban and rural residents will be halved, starting at around 0.15%, gradually transitioning to around 0.3% over five years, with qualified regions also able to start from around 0.3%.

The document encourages flexible employment individuals to participate based on the rate standard for employed workers, with the contribution base determined as a certain percentage (not less than 60%) of the previous year’s average social wage in the region, with individuals contributing as regulated; flexible employment individuals may also choose to participate under the unemployed urban and rural resident policy.

The government will provide classified subsidies for the personal contribution portion of qualified disadvantaged groups. Individuals under 18 can be insured by following their parents or other legal guardians and are not required to contribute separately.

Additionally, the personal accounts of the basic medical insurance for employees can be used for the personal contributions of themselves and close relatives (including spouses, parents, children, siblings, grandparents, and grandchildren) participating in long-term care insurance.

“We have made corresponding arrangements in the 2026 budget for the transfer payments from the central government to localities. Considering that the participation process for residents in various regions will be gradual, this year, the central finance will provide advance payments based on the estimated number of participants in each region, and in the following year, actual participant numbers will be used for final settlement to ensure that subsidy funds are fully allocated. In the future, as the number of participants increases, the financial support will continue to be strengthened,” Guo Yang said.

How much can be reimbursed?

How much of the relevant care costs can be reimbursed after participating in long-term care insurance?

The document states that the national level has clarified the baseline benefit standards for long-term care insurance, which can be moderately adjusted based on local actual conditions. There is no set threshold for benefit enjoyment. For eligible long-term care service costs, the fund will cover approximately 50% for those insured under the unemployed urban and rural resident policy; for those insured under the employed workers policy, the fund will cover approximately 70%, with retirees enjoying benefits equivalent to employed workers; flexible employment individuals will receive corresponding benefits based on the type of insurance policy chosen.

Officials believe that in regions where there are significant differences in actual contribution levels between residents and employees, the benefits for the two groups may differ, reflecting the principle of rights and responsibilities being equal.

However, the opinions also state that on the basis of improving the funding mechanism and balancing the contribution responsibilities of employed versus non-employed individuals, the benefit levels should be gradually and moderately balanced. The fund’s annual maximum payment limit should not exceed 50% of the previous year’s per capita disposable income of urban and rural residents in the coordinated area. Different treatment protection policies will be implemented based on disability levels and service provision methods. The use of home and community care services is encouraged, with appropriate preferential treatment in payment ratios.

Wang Wenjun believes that for families of disabled individuals, long-term care insurance is a “burden reduction.” Through the security provided by the system, families can alleviate the dual burden of economic and care responsibilities. With professional care, the dilemma of “one person disabled, the whole family unbalanced” can be mitigated. With socialized and professional services, other family members can also be freed from the heavy burden of care and can return to normal work and life.

It is reported that during the ten years of the pilot program, the coverage of long-term care insurance expanded from 15 regions at the start in 2016 to 92 by the end of 2025, with the covered population reaching 308 million. The cumulative expenditure of the fund has exceeded 100 billion yuan, providing care service support for over 3.3 million disabled individuals and reducing the burden on families. The ten-year pilot has paved the way for the nationwide rollout of the system and accumulated valuable experience.

It is important to emphasize that this document clarifies that the fund is mainly used to pay for the costs incurred by approved long-term care service institutions and personnel in providing basic long-term care services, and in principle, cash will not be directly distributed to disabled individuals.

How to apply for use?

When there is a disabled elderly person at home who needs to use long-term care services, how can one apply for fund reimbursement?

Zhang Xifan, head of the Benefits Guarantee Department of the National Healthcare Security Administration, introduced that all insured individuals who have undergone a disability assessment and meet the conditions for benefit enjoyment can receive corresponding care services and reimbursement. According to current assessment standards, disability is classified into three levels: mild, moderate, and severe. In the initial phase of the system, the beneficiaries are those who are most in need and have the heaviest family burdens, primarily severely disabled individuals who are bedridden for a long time and need assistance from others for daily activities. In the future, as the economy develops and benefit levels rise, the national level will uniformly study expanding coverage to include individuals with moderate disabilities.

Currently, there are three main types of places providing long-term care services for disabled individuals, which can be chosen by the insured. For those selecting home care, designated agencies will send staff to provide services at home; for those opting for designated day care centers or community care, they can receive non-full-day services nearby; for those choosing to stay in designated institutions to receive institutional care, the institution will provide full-day services. Since most elderly individuals wish to “age at home,” the “Opinions” encourage the use of home and community care, providing preferential treatment in fund payments, allowing the elderly to receive services and support at home or nearby.

Regarding the application process, Huang Xinyu explained that disabled individuals or their family members can go to healthcare service windows or local online application channels to submit applications and provide relevant materials. These materials include identification documents, application forms, hospitalization records, or medical diagnoses. After receiving the materials, the handling agency will review and provide feedback. If there are no issues with the material review, the handling agency will organize assessment institutions to conduct disability assessments for the insured, and after assessment, the handling agency will negotiate service methods with the disabled individual, formulate care service plans, and guide relevant institutions to provide corresponding services for the insured disabled individuals.

“We hope to make the application process very hassle-free,” he said.

Reported by: Nandu N Video reporter Song Chenghan from Beijing