A comprehensive guide to long-term care insurance: How to enroll? Where does the funding come from? What are the benefit coverage standards?

What key experiences have been accumulated from the decade-long pilot of long-term care insurance?

On March 25, the General Office of the Communist Party of China and the General Office of the State Council issued the “Opinions on Accelerating the Establishment of a Long-Term Care Insurance System,” clearly stating that by the end of 2028, the long-term care insurance system will basically achieve full coverage nationwide.

The long-term care insurance system has been piloted for 10 years, going through the process of “pilot - evaluation - re-pilot - re-evaluation - initiation of nationwide rollout.” The number of pilot areas has expanded from 15 at the start in 2016 to 92 by the end of 2025, covering a population of 308 million, with cumulative fund expenditures exceeding 100 billion yuan, providing care service support for over 3.3 million disabled individuals, thereby alleviating family burdens.

“Graceful aging” is moving from vision to reality.

1. What is the long-term care insurance system?

The long-term care insurance system is a social insurance system that provides services or financial guarantees for the basic daily care and closely related medical care for disabled individuals. It is an important part of China’s social security system and a key component of the national strategy to actively respond to population aging.

2. What are the differences between long-term care insurance, health insurance, pension insurance, and commercial care insurance?

Long-term care insurance is a new type of social insurance primarily addressing the basic保障问题 for long-term care for disabled individuals, covering basic daily care as well as closely related medical care;

Health insurance mainly addresses the reimbursement of medical expenses, medicines, and medical services;

Pension insurance addresses income replacement after retirement;

Commercial care insurance is a market-oriented insurance product, serving more as supplementary protection rather than a systemic safety net.

In other words, long-term care insurance is neither a pension subsidy nor a regular health insurance reimbursement but rather a systemic arrangement specifically designed for the risk of disabled care.

3. Why is it being fully promoted now?

Currently, there are 320 million elderly individuals aged 60 and above in China, among whom about 35 million are disabled. Disabled care is no longer just a problem for individual families; it has become a widespread livelihood issue.

Since the 18th National Congress of the Communist Party, the Party and government have repeatedly made key deployments, indicating the direction for solving the problem of disabled care. The release of this “Opinions” marks a transition of long-term care insurance from localized pilot projects to nationwide implementation.

4. Who can participate in the insurance, and who will be included first?

The coverage is directed towards the entire population, with employers (including enterprises, public institutions, government agencies, and social organizations), as well as employees, retirees, flexible employment workers, and unemployed urban and rural residents eligible to participate in the insurance.

However, the pace of advancement will not be “one step to full coverage.” Each region can start by covering employees, retirees, and flexible employment workers, gradually including unemployed urban and rural residents into the protection scope.

5. Where does the funding come from?

A framework of shared responsibility and diversified funding sources will be established, including units, individuals, government, and society, along with a dynamic funding mechanism that adapts to the level of economic and social development and the level of protection.

The long-term care insurance premium rate will be uniformly controlled at around 0.3%.

For employees: The rate will be shared proportionally between the employer and the individual, with the employer’s contribution based on the total salary of employees, and the individual’s contribution based on their own salary, with both parties jointly contributing.

For retirees: The rate will be the same as that for employees, with the contribution base linked to the pension level, paid by the individual, with the original employer not contributing.

For unemployed urban and rural residents: The costs will be reasonably shared between individuals and the government, starting at approximately 0.15% and gradually transitioning to around 0.3% over five years; in conditions where feasible, it may also start at around 0.3%.

For flexible employment workers: They can participate at the employee rate standard or choose to participate under the unemployed urban and rural resident policy.

For individuals under 18: They will be covered under their parents or other legal guardians without separate funding.

6. How to pay the premiums?

Long-term care insurance premiums will be paid alongside basic health insurance premiums.

7. Who can enjoy the benefits?

Participation in the insurance does not automatically grant benefits; long-term care insurance covers eligible disabled individuals.

According to current policy guidelines, during the initial phase, the focus will be on providing support to severely disabled individuals who have been in a disabled state for more than six months and have been assessed and approved after application, with the scope of coverage expanding gradually according to national deployment and dynamically adjusting rates based on fund expenditure needs.

8. Are the benefits cash or services?

The overall principle is to prioritize service support rather than direct cash payments.

The fund is primarily used to cover the costs incurred by qualified long-term care service institutions and personnel in providing basic long-term care services, and in principle, cash will not be directly disbursed to disabled individuals.

Service scenarios mainly include home care, community care, and institutional care, with policies encouraging home and community care, and providing appropriate support in fund payments.

9. What are the approximate standards for benefits?

At the national level, the basic benefit standard for long-term care insurance has been clarified, and local adjustments can be made based on actual conditions. There is no set threshold for receiving benefits.

For qualifying long-term care service costs, those participating under the unemployed urban and rural resident policy will have a fund payment ratio of about 50%;

For those participating under the employee policy, the fund payment ratio will be about 70%;

Retirees will enjoy benefits equivalent to those under the employee policy;

Flexible employment workers will receive corresponding benefits based on the type of insurance policy they choose.

10. How is disability assessed?

Disability assessment is a key threshold for the implementation of long-term care insurance. The application process, documentation, and system are unified nationwide.

Disabled individuals or their family members can apply through the health insurance service window or local online channels, submitting identification documents, application forms, hospitalization records, or diagnosis certificates, among other materials;

After the materials are reviewed and approved, the handling agency will organize evaluation institutions to conduct the disability assessment. Upon passing the assessment, the handling agency will negotiate service methods and develop care service plans with the disabled individuals, with relevant institutions providing the services.