Long-term care insurance has become increasingly complex in 2026, with families across California and nationwide facing new challenges when filing claims or purchasing policies. At Kantor & Kantor, LLP, we’ve observed significant shifts in how insurance carriers handle long-term care benefits—changes that directly impact policyholders who have paid premiums for years, expecting coverage when they need it most.
Understanding this year’s trends is essential for families planning ahead or currently navigating the claims process. Here’s what you need to know about the long-term care insurance landscape in 2026.
Rising Premium Issues: The Affordability Crisis Deepens
Premium increases have accelerated dramatically in 2026, with many policyholders receiving notices of rate hikes ranging from 20% to 50% or more. Insurance carriers cite increasing longevity, higher-than-expected claim rates, and low interest rates as justifications for these increases. However, these substantial hikes put families in impossible positions: either pay significantly more for coverage they’ve maintained for decades or let their policies lapse and lose their investment entirely.
What makes this trend particularly concerning is the timing. Many policyholders now facing these increases purchased their policies 15 to 20 years ago when they were in their 50s and 60s. Now in their 70s and 80s—precisely when they’re most likely to need care—they’re being priced out of coverage they’ve faithfully maintained.
At Kantor & Kantor, we help families evaluate their options when facing premium increases, including reviewing policy provisions, assessing reduced-benefit alternatives, and determining whether carriers have properly justified rate increases under state regulations.
Stricter ADL Interpretations: The New Barrier to Benefits
Activities of Daily Living (ADLs) form the foundation of most long-term care insurance claims. Policies typically require that a policyholder be unable to perform two or more ADLs—such as bathing, dressing, eating, toileting, transferring, or continence—to qualify for benefits. In 2026, insurance carriers have become increasingly strict in interpreting ADL limitations, creating new barriers for legitimate claimants.
We’re seeing carriers demand higher levels of impairment before acknowledging an ADL deficit. For example, a policyholder who needs substantial assistance with bathing due to fall risk or mobility limitations may be denied because they can technically perform some aspects of bathing independently. Carriers are parsing policy language more aggressively, distinguishing between “hands-on assistance” and “standby assistance,” often to the detriment of claimants.
This trend is particularly troubling because ADL assessments are inherently subjective. Different evaluators may reach different conclusions about the same individual’s functional abilities. In 2026, carriers are increasingly relying on independent medical examinations (IMEs) conducted by physicians who have never treated the policyholder and who may spend only 30 to 60 minutes evaluating complex medical conditions.
Families should be aware that ADL determinations are not final simply because a carrier says so. Medical documentation from treating physicians, occupational therapists, and caregivers often provides a more accurate picture of functional limitations. If your loved one has been denied benefits based on ADL interpretations, a thorough review of the claim file and medical records may reveal grounds for appeal.
New Policy Riders: Innovation or Complication?
Insurance carriers have introduced several new policy riders in 2026, marketed as enhancements but often adding layers of complexity. These include:
- Hybrid Riders: Combining long-term care benefits with life insurance or annuities. While these products offer death benefits if long-term care isn’t needed, they often provide less comprehensive coverage than traditional policies and include complex triggering mechanisms.
- Inflation Protection Modifications: Some carriers now offer “step-rated” inflation protection that increases benefits periodically but also increases premiums at each step—a departure from traditional compound inflation riders.
- Shared Care Provisions: Allowing spouses to share a pool of benefits sounds appealing, but families should understand how these provisions work if one spouse exhausts benefits or if the couple divorces.
- Restoration of Benefits Riders: Promising to restore previously used benefits if the policyholder recovers and remains claim-free for a specified period. The eligibility requirements for restoration can be stringent.
While some riders provide genuine value, others primarily benefit carriers by increasing premium revenue or limiting benefit exposure.
Early Warning Indicators for 2026
Families should watch for several red flags that may signal problems with long-term care insurance claims this year:
- Delayed Claims Processing: Carriers taking 60, 90, or even 120+ days to process initial claims, leaving families to pay out-of-pocket for care while waiting for decisions.
- Increased Documentation Requests: Repeated requests for additional medical records, caregiver logs, or functional assessments—sometimes appearing designed to frustrate claimants into abandoning claims.
- Benefit Calculation Disputes: Disagreements about daily benefit amounts, elimination periods, or whether specific care services are covered under the policy.
- Care Setting Restrictions: Carriers are more frequently denying coverage for home care or assisted living, arguing that policyholders should be in nursing facilities instead—even when policy language doesn’t require institutional care.
- Cognitive Impairment Claim Denials: Stricter standards for proving cognitive impairment sufficient to trigger benefits, particularly for early-stage dementia.
How Kantor & Kantor Can Help
For over 45 years, Kantor & Kantor, LLP has represented policyholders in insurance disputes, including long-term care insurance claims. We understand the tactics carriers use to delay, reduce, or deny legitimate claims, and we know how to hold them accountable.
Whether you’re facing a claim denial, dealing with unreasonable premium increases, or have questions about your policy’s coverage, we provide experienced guidance. We represent clients throughout California and nationwide, offering consultations to help families understand their rights and options.
Long-term care insurance should provide peace of mind and financial protection when you need it most. When carriers fail to honor their obligations, we’re here to help you fight back.
5 Long-Term Care Insurance FAQs
Q: How long does my insurance carrier have to process my long-term care claim?
A: While timeframes vary by state, California law generally requires carriers to acknowledge claims within 15 days and make coverage decisions within 30 to 40 days after receiving all necessary documentation. Unreasonable delays may violate state insurance regulations and constitute bad faith.
Q: Can my insurance carrier force me to use a nursing home instead of receiving home care?
A: This depends on your policy language. Many modern policies cover various care settings, including home care, assisted living, and nursing facilities. If your policy includes home care coverage, the carrier generally cannot force you into a nursing facility unless specific policy provisions allow it.
Q: What should I do if I receive a large premium increase notice?
A: Don’t panic or immediately let your policy lapse. Review the notice carefully, check whether your state insurance department approved the increase, and evaluate your options. These may include paying the increase, reducing benefits to lower premiums, or exploring whether the increase was properly justified.
Q: My claim was denied because the carrier says I don’t meet the ADL requirements, but my doctor disagrees. What are my options?
A: You have the right to appeal the denial. Gather supporting documentation from your treating physicians, therapists, and caregivers that demonstrates your functional limitations. Insurance carriers often rely on brief independent examinations that don’t capture the full picture of your condition. A well-documented appeal with comprehensive medical evidence can overturn initial denials.
Q: Is it too early to consult an attorney about my long-term care insurance issues?
A: No. In fact, early consultation often prevents problems from escalating. Whether you’re facing a claim denial, dealing with premium increases, or simply have questions about your policy’s coverage, speaking with an experienced insurance attorney can clarify your rights and options. At Kantor & Kantor, we offer consultations to help families navigate long-term care insurance issues before they become crises.
Contact Kantor & Kantor, LLP
If you have questions about your long-term care insurance policy or need assistance with a claim, contact Kantor & Kantor, LLP. Our experienced attorneys represent policyholders throughout California and nationwide. Don’t wait until a small issue becomes a major problem—reach out today for a consultation.
