Long-term care is the coverage most Americans will need and the one the industry spent two decades running away from. Carriers mispriced it so badly in the 1990s and 2000s that dozens fled the market — and the ones left holding old policies have spent years clawing the losses back out of their own customers, through rate increases of 50%, 100%, sometimes 143%. This is the story of a broken market, who's still in it, and who pays when it fails.
In the late 1990s, roughly a hundred companies sold long-term care insurance. They priced it on assumptions that turned out to be catastrophically wrong: that many policyholders would drop coverage before ever claiming, that interest on reserves would stay high, and that people wouldn't live as long or claim as much as they did. Almost every one of those assumptions broke the wrong way. Barely anyone lapsed. Interest rates cratered after 2008. People lived longer and claimed more.
The result was a slow-motion exodus. When John Hancock — the second-largest LTC insurer in the country — quit selling new individual policies in December 2016, it left just thirteen carriers standing. Today, the number still writing genuine standalone traditional coverage is down to a small cluster, and the industry's growth has shifted almost entirely to hybrid products that bolt LTC onto life insurance.
The reason this matters isn't nostalgia for a dead product. It's that 70% of Americans turning 65 will need long-term care, a private nursing-home room now runs about $108,000 a year, and Medicare doesn't cover it. The market built to solve that problem largely collapsed — and what replaced it is thinner, pricier, and more complicated.
This is the rare insurance market where the danger to the customer isn't the price at purchase — it's the price increase that lands on a policy you've already paid into for twenty years.
When a carrier discovers its old policies were underpriced, it can't just eat the loss forever. It goes to state regulators and asks to raise premiums on the people who already bought in. Because these customers are now older, often in their 70s and 80s, and can't realistically re-qualify for coverage anywhere else, they're trapped: pay the higher premium, cut their own benefits, or walk away from decades of payments.
No one embodies this like Genworth, once the largest standalone LTC insurer in America. It has secured an estimated $31.8 billion in cumulative rate-increase approvals, with individual policyholders reporting hikes of 79%, 97%, even 143%. It settled the Skochin and Haney class actions, separately settled $219 million over admitted reserve under-funding — and, remarkably, tied executive compensation to hitting rate-increase targets.
When the increase notice arrives, the "options" are all forms of losing: pay the higher premium, reduce your inflation protection (say, from 5% compound to 2.9%), shorten your benefit period, or take a paid-up "nonforfeiture" benefit worth a fraction of what you were promised. And the letters usually warn that more increases are coming.
In auto insurance you rank the giants by market share. LTC doesn't work that way. The carriers split into three groups: the few still bravely selling, the graveyard of those managing old policies they'd rather forget, and the public programs stepping into the gap.
MutualCare · A+ (A.M. Best)
The last big carrier genuinely committed to standalone traditional LTC, with a relatively stable pricing record on current products.
Read the profile →QuietCare + Long-Term Advantage
Premium-priced, advisor-sold, and backed by one of the strongest balance sheets in the industry — you pay for the security.
Read the profile →EssentialLTC → HonestLTC (2026)
A century-old mutual with a striking couples-pricing advantage, just relaunching its product as "HonestLTC."
Read the profile →Lincoln · Nationwide · OneAmerica · Brighthouse
Life-and-annuity policies with LTC bolted on. You can't lose your premium — but you're buying a more complex promise.
Read the profile →$31.8B in rate hikes · lawsuits · re-entry
The poster child of the collapse: massive rate increases, reserve-underfunding settlements, exec pay tied to hikes — and a 2025 comeback attempt.
Read the investigation →John Hancock · Transamerica · CNA · Prudential
Carriers that quit the market and now manage millions of old policies — filing rate increase after rate increase.
Read the profile →Faced with a product that kept blowing up, insurers engineered a workaround: attach long-term care to a life insurance policy or annuity. These "hybrid" or "linked-benefit" products solve the two things people hated about traditional LTC. You can't lose your premium — if you never need care, your heirs get a death benefit — and the premium is typically guaranteed not to rise, because the carrier can't unilaterally re-price it the way it did the old standalone blocks.
The catch is that you're usually funding it with a large lump sum or a fixed set of payments, the coverage can be less generous per dollar than old-style LTC, and the mechanics — cash indemnity versus reimbursement, indexed versus fixed growth — get genuinely complicated. Hybrids fixed the trust problem. They didn't make the underlying care any cheaper. See how the leaders compare →
If you don't have private coverage and can't pay out of pocket, the default payer is Medicaid — but only after you've spent down nearly all your assets to qualify. That's the quiet reality behind most long-term care in America: families impoverish themselves into eligibility.
Washington State built the first alternative. WA Cares, funded by a 0.58% payroll tax, began paying a lifetime benefit of up to $36,500 in July 2026 — modest (about four months of nursing-home care) but a genuine public proof-of-concept. New York and California are moving toward their own versions. Read the state-programs breakdown →
Vermont, New Hampshire, and western Massachusetts are among the oldest-skewing populations in the nation, and care costs in the Northeast run well above the U.S. median — a private room in much of New England pushes well past $130,000 a year. For families here, the collapse of affordable LTC isn't abstract. It's the difference between aging at home and spending down a lifetime's savings to qualify for Medicaid.
Figures reflect the most recent 2025–2026 data available. Analysis and framing are original.