Federal Long-Term Care Insurance Program

The Federal Long-Term Care Insurance Program (FLTCIP) allows federal employees, retirees, their spouses, and even certain parents and adult children to buy long-term care insurance through a group program administered by OPM. For the companion group health and life insurance programs for federal employees, see FEGLI federal life insurance. For the income tax deduction that applies to qualifying long-term care insurance premiums, see long-term care insurance tax treatment. Long-term care covers things Medicare doesn't — extended nursing home stays, assisted living, and home care for chronic conditions or disability. The program is entirely employee-funded (no government contribution), but OPM negotiates group rates and contract terms that may not be available on the individual insurance market.

Current Law (2026)

Legal Authority

• 5 U.S.C. § 9001 — Definitions (defines who is eligible: employees, annuitants, uniformed service members, retirees, and "qualified relatives" including spouses, certain parents, and adult children 18 or older)
• 5 U.S.C. § 9002 — Availability (OPM must establish and administer the program; only qualified long-term care contracts from qualified carriers allowed; coverage not guaranteed; premiums guaranteed renewable)
• 5 U.S.C. § 9003 — Contracting authority (OPM contracts with one or more carriers without competitive bidding requirement; 7-year terms; premiums may not change without mutual agreement; once enrolled, coverage is not affected by status changes such as retirement or divorce)
• 5 U.S.C. § 9004 — Financing (100% enrollee-paid; premiums may be withheld from pay, annuity, or military retired pay; carriers maintain separate accounting; OPM's administrative costs funded through a Long-Term Care Administrative Account)
• 5 U.S.C. § 9005 — Preemption (federal contract terms preempt state insurance law; states cannot impose premium taxes on FLTCIP policies)
• 5 U.S.C. § 9006 — Reports and audits (GAO evaluates the program at year 3 and year 5; carriers must allow OPM and GAO to review their records)
• 5 U.S.C. § 9008 — Administrative functions (OPM must provide comprehensive disclosure to each applicant: benefit comparisons, cost projections, inflation impact, premium history for the last 10 years, lapse rates, and comparison to other ways to fund long-term care)

Implementing Regulations

The OPM regulations implementing the Federal Long Term Care Insurance Program live at 5 CFR Part 875 — Federal Long Term Care Insurance Program. Key provisions:

• §§ 875.201–875.205 — Eligibility: federal civilian and Postal employees whose positions convey FEHB eligibility are eligible; annuitants (including deferred annuitants and MRA+10 postponed annuitants) are eligible; uniformed service members on active duty for more than 30 days and Selected Reserve members are eligible; retired uniformed service members with retirement pay are eligible; qualified relatives — spouses, domestic partners, adult children 18 and older, and parents/in-laws of workforce members — are eligible to apply based on the sponsoring workforce member's status
• § 875.301 — Premium structure: there is no government premium contribution — FLTCIP is 100% enrollee-funded; premiums may be deducted from pay, annuity, uniformed service retirement pay, by pre-authorized bank debit, or by direct billing; coverage does not lapse as long as premiums are paid regardless of employment status (§ 875.410)
• §§ 875.402–875.403 — Enrollment: there are no regularly scheduled open seasons for FLTCIP; eligible individuals may apply at any time outside a suspension period; applicants outside special application periods are subject to full underwriting (medical history, health conditions) and may be declined for health reasons; OPM may hold special application periods when abbreviated underwriting applies for active workforce members and their spouses
• § 875.104 — Dispute resolution: benefit eligibility and claims payment disputes require a written reconsideration request to the Carrier within 60 days of the decision; if the Carrier denies reconsideration, the enrollee may request OPM review; contract disputes between OPM and the Carrier are heard by the Civilian Board of Contract Appeals (§ 875.109)
• § 875.107 — OPM as regulator: OPM exercises insurance regulatory authority over FLTCIP, preempting state insurance law — states cannot impose their own requirements on the Carrier's FLTCIP administration or tax premiums, allowing the program to operate uniformly across all 50 states with a single benefit design
• § 875.110 — Suspension authority: OPM may suspend new applications for FLTCIP coverage (including coverage increases) if it determines suspension is in the best interest of the Program; OPM exercised this authority in January 2022 and as of 2026 new enrollments remain suspended
• §§ 875.410–875.413 — Portability and reinstatement: coverage automatically continues when active workforce members leave federal service, provided premiums keep being paid; qualified-relative coverage also continues after the qualifying relationship ends (e.g., divorce); reinstatement is available within 6 months of termination for lapses caused by cognitive impairment or functional incapacity

Part 875's practical significance is its enrollment structure: unlike FEHB (annual open seasons) and FEGLI (automatic enrollment with opt-ups), FLTCIP requires proactive enrollment with full medical underwriting outside of special application periods — making early enrollment in a federal career the most cost-effective approach, when the employee is young and likely to qualify without underwriting complications.

How It Works

Long-term care insurance pays for extended care that Medicare generally doesn't cover: nursing home stays beyond 100 days, assisted living facilities, home health aides, adult day care, and similar services. The benefit is typically triggered by an inability to perform a defined number of activities of daily living (eating, bathing, dressing) or by cognitive impairment. The FLTCIP uses contracts that must qualify under IRS § 7702B — tax-qualified long-term care insurance — which means premiums may be deductible and benefits are generally received tax-free. Eligibility is deliberately broad: beyond active federal employees and retirees, the program extends to their spouses, parents, in-laws, and adult children (18 and older), making FLTCIP one of the few group long-term care products a federal employee can use to protect aging parents or family members with no direct federal employment connection. Eligible relatives pay premiums the same way — withheld from the sponsoring employee's or retiree's pay on their behalf. OPM contracts with qualified carriers — insurers licensed in all states — for 7-year terms; premiums cannot be increased during the contract term without OPM and the carrier agreeing, unlike individual long-term care policies where carriers can raise rates on a class basis at renewal.

Once enrolled, the carrier cannot drop coverage because of a health change, a claim, or leaving federal service — premiums are locked for the contract term. What is not guaranteed is the ability to enroll in the first place: applicants who miss their first enrollment window (typically when first hired) face stricter medical underwriting and can be declined. Before enrollment, OPM must provide comprehensive disclosure: how FLTCIP benefits compare to other available policies, example costs of long-term care in different settings, the inflation-adjusted value of benefits over time, projected premium changes and the 10-year premium history for each carrier, the expected lapse rate among enrollees, and a comparison of long-term care insurance versus other savings vehicles (retirement accounts, investment strategies) for funding future care.

How It Affects You

If you're a federal employee in your 40s or 50s: Enrollment in FLTCIP has been suspended since January 2022 — new applicants cannot enroll as of April 2026. If you have existing coverage, it remains in force. If you don't, you currently cannot apply through the federal program and would need to shop the individual long-term care market, where rates for a 50-year-old typically run $1,500–$3,500/year for a solid benefit design. Federal employees often overlook long-term care planning entirely because FEHB covers acute care — but FEHB doesn't pay for the extended nursing home or home care costs that average $95,000–$120,000/year for nursing home care or $60,000–$80,000/year for full-time home care.

If you're an existing FLTCIP policyholder: Your coverage is protected. The enrollment suspension does not terminate existing policies. However, premium increases have been significant — many enrollees saw premium hikes in prior contract cycles, and you should verify your current coverage terms, daily benefit amount, inflation protection, and elimination period against the actual cost of care in your area. Nursing home costs in high-cost areas (Northeast, California) can exceed $150,000/year.

If your parents are approaching the age where long-term care becomes likely: Federal employees could previously purchase FLTCIP coverage for eligible parents and in-laws — an unusual feature unavailable in most employer group policies. That option is currently suspended along with all new enrollments. Your best near-term alternative is the individual long-term care market, a hybrid life/LTC policy, or a linked-benefit annuity. For context: the median private nursing home room cost in the U.S. was approximately $9,700/month ($116,000/year) in 2024, with costs growing about 4–5% annually.

If you're considering retiring: Your existing FLTCIP coverage doesn't end when you leave federal service. The portability protection in 5 U.S.C. § 9003 means you keep your coverage through retirement as long as you pay premiums. Premium payments switch from payroll deduction to annuity withholding or direct billing.

State Variations

FLTCIP preempts state long-term care insurance laws — federal contract terms govern coverage and benefits. States cannot tax FLTCIP premiums, though insurers still pay standard income taxes. Actual care received under the policy is subject to state licensing requirements for providers (nursing homes, home health agencies).

Pending Legislation

No major standalone legislation pending in the 119th Congress to restructure FLTCIP's legal framework. The more pressing question is when and whether OPM will reopen enrollments and on what terms, which is an administrative rather than legislative question.

Recent Developments

• January 2022 enrollment suspension — still in effect as of April 2026: OPM suspended all new enrollments and the open season enrollment for existing federal employees in FLTCIP, citing the need for an actuarial review and carrier negotiations. The suspension has continued for over three years. Existing policyholders retain their coverage; new applicants have been unable to enroll through the federal program.
• Premium history and actuarial pressure: Prior to the suspension, FLTCIP policyholders experienced significant premium increases in multiple contract cycles — increases of 25–83% were authorized in some periods as carrier loss experience worsened. The actuarial review underlying the 2022 suspension reflects the industry-wide challenge that long-term care insurance carriers have faced: people are living longer, care costs are higher than projected, and lapse rates were lower than expected, meaning more policyholders are collecting benefits for longer periods.
• Individual market as the alternative: With FLTCIP closed to new enrollees, federal employees who want long-term care coverage must use the individual market. Hybrid life insurance/LTC products (which return unused premiums as a death benefit) have grown in popularity as a hedge against the "use it or lose it" concern with standalone LTC policies.
• No reopening timeline announced: As of April 2026, OPM has not announced a specific reopening date or the terms under which new enrollments might resume. Federal employees who want to plan for long-term care risk should not assume FLTCIP will be available when they want to apply.