Long-term care insurance nationwide rollout! Who are the eligible groups? Here's the explanation.

The long-term care insurance system is a social insurance system established to provide services or financial guarantees for basic daily care and related medical care for individuals with disabilities or dementia.

On March 25, the General Office of the Central Committee 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,” requiring the basic establishment of a long-term care insurance system suitable for China’s national conditions within about three years. This marks the transition of the long-term care insurance system from localized pilot programs to nationwide implementation.

How is long-term care insurance different from basic medical insurance and pension insurance?

The long-term care insurance system covers everyone, with all employees and residents participating in long-term care insurance. Long-term care insurance no longer distinguishes between employed and non-employed individuals; in the same coordinated area, expenses are reimbursed from the same fund pool, allowing everyone to enjoy benefits.

Guan Bo, a researcher at the Macroeconomic Research Institute of the National Development and Reform Commission: Our social insurance emphasizes the law of large numbers; the broader the group of insured individuals, the stronger the fund’s ability to withstand risks.

What is the premium for long-term care insurance? Wang Zhen, a researcher at the Economic Research Institute of the Chinese Academy of Social Sciences, stated that employed workers are required to contribute 0.3% of their personal wages for funding, which is an average burden shared by individuals and employers. Non-employed urban and rural residents will use the local per capita disposable income as the contribution base, with individuals and government financial departments each bearing half, starting from 0.15%. Individuals will bear approximately 30 yuan annually.

It is understood that long-term care insurance is funded in conjunction with basic medical insurance, with separate accounts established and managed independently.

Guan Bo: Basic medical insurance already has a relatively complete enrollment mobilization mechanism, which can ensure that long-term care insurance covers all eligible individuals and provides full benefits. This fund operates independently, reflecting the characteristics of long-term care insurance as a separate insurance type.

Do retirees need to pay premiums, and do minors pay premiums to enjoy benefits?

Which groups need to contribute to long-term care insurance? Unlike medical insurance, retirees are also required to pay premiums, while individuals under 18 years old can enroll with their parents or guardians without needing to pay premiums to enjoy benefits.

Wang Zhen, a researcher at the Economic Research Institute of the Chinese Academy of Social Sciences: More than 90% of disabled individuals are elderly, so requiring elderly individuals to pay premiums reflects the alignment of rights and obligations; retired employees use their personal pensions as the basis for premium contributions.

Who can enjoy the benefits of long-term care insurance?

At the initial stage of the system, the beneficiaries are those with the most urgent needs and the heaviest family burdens, specifically “severely disabled individuals,” primarily those who are bedridden long-term and unable to care for themselves.

Wang Zhen: They have lost all basic living abilities, lying in bed, unable to feed themselves, unable to drink water, unable to use the toilet, and even more unable to bathe themselves—these are the severely disabled individuals.

In the future, as China’s economy develops and the capacity for protection improves, the national level will conduct unified research to expand coverage to moderately disabled individuals. To ensure equitable benefits and fund security, the determination of disability levels will be standardized across regions, using a unified national assessment standard.

How is long-term care insurance reimbursed? What is the reimbursement ratio?

Long-term care insurance funds do not directly distribute cash to disabled individuals; instead, they reimburse expenses through services provided by institutions. Long-term care insurance does not set a threshold for payment; to ensure fund sustainability, a maximum annual payment limit is established for each beneficiary, which should not exceed 50% of the per capita disposable income of urban and rural residents in the coordinated area from the previous year.

Currently, there are three main types of places providing care for disabled individuals, from which insured individuals can choose.

For home care, designated institutions send personnel to provide services at home;

For designated day care centers or community institutions, care services are provided nearby for convenience;

For those choosing to stay in designated long-term care institutions, comprehensive care services are provided around the clock.

Since most elderly individuals hope to “age in place,” the Opinions encourage the use of home and community care services, favoring funding for these options.

Long-term care insurance provides a helping hand to families of disabled individuals.

Since the pilot began in 2016, China’s long-term care insurance system has been continuously improved and now covers 308 million people, benefiting over 3.3 million disabled individuals and alleviating care burdens by over 100 billion yuan.

Last year, Zhejiang achieved full coverage of the long-term care insurance system, with an enrollment rate of 93%, cumulatively reducing the burden on 212,000 disabled individuals by 4 billion yuan. In Ningbo, services were established for remote areas such as mountains and islands, recruiting and training surplus rural labor as caregivers. Villager Huang Qiuchun, after qualifying through training, cares for six elderly individuals in her village, earning over 4,000 yuan a month.

In addition to providing 42 items of daily care for disabled individuals, Ningbo also offers 10 items of home medical care.

Li Qianqian, from a long-term care service institution in Ningbo, Zhejiang Province: For instance, we are currently serving an elderly person who has been bedridden for many years. Every time she needs to go to the hospital to change her catheter, her three children have to lift her from the bed to the tricycle, cover her with a quilt, and then go to the hospital to queue for registration and catheterization. Now, with our nursing station’s nurses going to perform the operation, the entire process takes just about 15 minutes.

Shenyang, Liaoning, officially implemented the long-term care insurance system starting January 1 of this year, benefiting 80-year-old paralyzed resident Wang Zhenhai.

Wang Zhenhai’s wife, Wei Qi: I used to pay 6,000 yuan a month for a caregiver, and that was just enough for one person’s salary. Since the government has this policy, they provide us with free massages and free bathing services; I am simply overjoyed.

Based on Wang Zhenhai’s home care needs, the long-term care insurance fund can cover up to 24 hours of home care per month, with 80% reimbursed by the fund and 20% paid by the individual.

Disability level assessment tightens the “tap” on long-term care insurance.

To enjoy long-term care insurance benefits, a strict disability level assessment is required. To gain a deeper understanding of this policy, reporters followed a long-term care insurance assessment team composed of two doctors from the District People’s Hospital and one staff member from the District Medical Insurance Bureau to conduct home visits in Xindu District, Chengdu, Sichuan Province.

To ensure that limited insurance funds are used effectively, assessors strictly follow the “Long-Term Care Disability Level Assessment Standard,” evaluating the elderly individuals’ daily living abilities, cognitive abilities, etc., striving to ensure that “those who should enjoy benefits do enjoy them, and all eligible benefits are provided.”