Who can benefit from long-term care insurance? How much do they receive? The National Healthcare Security Administration responds

At today’s press conference hosted by the State Council Information Office, Deputy Director Zhang Xifan of the Medical Insurance Bureau’s Benefits Security Department stated that the most important concerns for the public are who can receive benefits, what benefits they can enjoy, how much they can receive, and where they can enjoy them. This is also the top priority in policy design.

Who can enjoy the benefits: Any insured person who has been assessed and certified as disabled and meets the eligibility criteria can receive appropriate care services and reimbursement. According to current assessment standards, disability is categorized into mild, moderate, and severe levels. In the initial stage of the system, coverage focuses on those with the most urgent needs and the heaviest family burdens—specifically, individuals with severe disabilities who are bedridden, unable to care for themselves, and require assistance. As the economy develops and the capacity for support improves, the country will consider expanding coverage to include those with moderate disabilities. It is important to emphasize that, to ensure fairness and fund safety, the assessment of disability levels will be standardized nationwide using a unified evaluation standard. Regardless of the region, the assessment criteria and procedures are the same. This approach aims to minimize human factors and ensure every penny is spent on those truly in need.

What benefits can be enjoyed: The Long-term Care Insurance Fund mainly covers expenses for basic long-term care services that meet regulations. In principle, it does not directly provide cash payments to disabled individuals. By offering services and reimbursing costs, the system ensures that the funds are used for caring for disabled persons, allowing them to truly benefit. Based on the most urgent needs of disabled individuals, the national government has established a unified catalog of long-term care services, including assistance with eating, bathing, and other daily activities, as well as routine medical dressing changes. Eligible insured persons can choose specific services based on their needs and the recommendations of care providers.

How much can be received: There is no deductible for the Long-term Care Insurance. Regarding reimbursement rates, there are differences between urban and rural residents and employees of different units, reflecting the balance of rights and responsibilities. To ensure the sustainability of the fund, an annual maximum payout limit has been set, which does not exceed 50% of the per capita disposable income of urban and rural residents in the previous year in the pooled region.

Where to enjoy the services: Currently, there are three main types of care settings for disabled persons, and insured individuals can choose freely. Those opting for home care will have designated providers visit their homes to offer services; those choosing community care at designated day centers will receive part-time services nearby; and those who opt to stay in designated long-term care facilities will receive full-day care services. Since most elderly people prefer to “age in place,” the policy encourages the use of home and community care services, with preferential funding to allow seniors to receive support at home or nearby.