FLTCIP is closed: what to do before December 19

Where the programme stands

• Closed to new applications since December 19, 2022. OPM cited volatility in long-term care costs and a shrinking insurance market.
• Extended in November 2024 for a further 24 months, to December 19, 2026.
• Existing enrollees keep their coverage and claims are paid as normal, but nobody can apply to increase their benefit during the suspension.
• Premiums rose sharply for existing enrollees, by as much as 86% for some, phased across January 2024, 2025 and 2026.

Why this matters more than it sounds

Long-term care is not medical care, and that distinction is what catches people.

• FEHB does not cover it. Your health plan pays for doctors, hospitals, surgery and drugs. Help with bathing, dressing, eating and moving around is custodial care, and it is excluded.
• Medicare barely touches it. Part A can pay for up to 100 days in a skilled nursing facility after a qualifying hospital stay. Custodial care, which is what most long stays actually involve, is not covered at all.
• Your FERS annuity and TSP are the fallback. Which means, in practice, that the cost lands on the same money your spouse expects to live on.

That is the gap. It is the single largest uninsured financial exposure most federal families carry, and the programme built to cover it is shut.

If you are already enrolled

• Keep the policy unless you truly cannot pay. You cannot get back in during the suspension, and re-underwriting later at an older age with any new diagnosis is a different proposition entirely.
• If the premium increase hurt, the usual lever is adjusting the benefit rather than dropping cover: a shorter benefit period, a lower daily amount, or reduced inflation protection.
• You cannot increase coverage while the suspension runs, however much your circumstances change.
• Check what your policy actually pays. A daily benefit set a decade ago against today's care costs is the thing to look at, not the premium line.

Your four options right now

• Wait for December. Reasonable if you are young and healthy, and a gamble if you are not. Health changes do not wait for OPM.
• Buy a private long-term care policy. Available today, underwritten individually, and priced on your age and health.
• Buy a hybrid policy. Life insurance or an annuity with a long-term care rider, where the money pays out either way. More expensive per dollar of care benefit, but nothing is lost if care is never needed.
• Self-fund deliberately. Legitimate with enough assets, but it has to be a plan with a number attached, not an intention.

The one option that is not on the list is assuming FEHB or Medicare will handle it.

Buying privately: what to know

• Age drives the price. The conventional window is the mid-50s to early 60s. Earlier means more years of premiums; later means a steeper rate and a real chance of being declined.
• Underwriting is strict. Long-term care insurers look hard at cognitive and mobility history, more so than life insurers do.
• Premiums are not guaranteed. FLTCIP's own 86% increases are the cautionary tale, and private carriers can seek increases too, subject to state approval.
• Inflation protection is the expensive part, and usually the part worth keeping. A fixed daily benefit erodes badly across twenty years.
• Tax treatment can help. Premiums for qualified policies are deductible as a medical expense up to an age-based limit the IRS sets each year, and some states add their own break.
• Partnership policies in many states let you protect assets from Medicaid spend-down equal to the benefits the policy paid.

Get quotes from more than one carrier through a broker who writes long-term care regularly. This is not a market where the first quote is the market.

If it reopens in December

• Apply early if you are healthy and under 65. FLTCIP's group underwriting has historically been more forgiving than individual policies.
• Expect the pricing to reflect the last few years. A reopened programme is unlikely to be cheaper than the one that closed.
• Compare it against a private quote rather than assuming the federal option wins. It sometimes does, and it is no longer automatic.
• Do not cancel a private policy you bought in the meantime until the federal coverage is actually in force.

Whatever OPM announces, the underlying question is unchanged: who pays for several years of custodial care, and from which pot of money.

Common questions