Long-term care and the FLTCIP suspension
Long-term care is the largest expense your federal benefits do not cover. Neither FEHB nor Medicare pays for extended help with daily living. The federal insurance program built for it, FLTCIP, is currently closed to new applicants, which leaves most people planning around it rather than through it.
6 min read · By RetireCiv Editorial · Updated July 19, 2026
Does FEHB or Medicare cover long-term care?
No, and this is the assumption worth correcting early. Health insurance pays for treatment. Long-term care is help with ordinary daily living, which is a different category of service and sits outside what your health coverage does.
Medicare is the one people most often expect to step in. It covers skilled nursing care for a limited period after a hospital stay, which is genuinely useful and genuinely short. It does not cover the ongoing custodial help that long-term care actually means.
FEHB works the same way in retirement. Your plan covers medical care, including recovery at home after an illness or surgery, but not years of assistance with bathing, dressing, and moving around the house.
The gap is why a separate program exists at all. OPM created FLTCIP specifically to help pay for care when enrollees need help with activities they perform every day, or have a severe cognitive impairment such as Alzheimer's disease.
Does Medicare pay for a nursing home?
Only in narrow circumstances and only briefly. Medicare covers skilled nursing care for a limited period following a qualifying hospital stay, aimed at recovery rather than ongoing support. It does not pay for custodial care, meaning long-term help with daily activities, which is the kind of care most people actually need and the kind that costs the most.
What counts as long-term care?
Help with the ordinary activities of daily living, provided over an extended period, or supervision needed because of a serious cognitive impairment. It can happen at home, in an assisted living facility, or in a nursing home. What distinguishes it from health care is that it supports daily functioning rather than treating an illness.
Why can you not apply to FLTCIP right now?
Because OPM closed it to new applications. The suspension took effect in December 2024 and remains in place unless OPM issues a further notice. It had already been extended once before that, so treat any end date you see as provisional.
The closure is broad. If you are not currently enrolled, you cannot apply. If you are enrolled, you cannot apply to increase your coverage either.
OPM has been direct about why. Volatility in long-term care costs and a shrinking insurance market have made it hard to set premium rates that reasonably reflect what the benefits cost, which is a standard the program is required by law to meet.
Check the current status rather than trusting this page or any other secondhand source. This is the one genuinely time-sensitive fact in the whole track, and OPM's long-term care page is where the answer actually lives.
Can I apply for FLTCIP?
Not while the suspension is in effect. OPM closed the program to new applications in December 2024 and has extended the closure before, so confirm the current status on OPM's long-term care page rather than relying on any date you read elsewhere. Existing enrollees also cannot apply to increase their coverage during the suspension.
Why did OPM suspend FLTCIP?
Because it could not set defensible premium rates. OPM cited volatility in long-term care costs and a diminished insurance market, which together undermined its ability to offer benefits at rates that reasonably and equitably reflect their cost. The program is required by law to meet that standard, so suspending applications was the alternative to pricing the coverage unsustainably.
What if you are already enrolled?
Your coverage continues. The suspension applies to new applications and to increases, not to policies already in force, and enrollees keep their coverage by paying premiums as usual.
Claims work normally too. If you need to use the benefit while the program is suspended, the claims process is unaffected by the closure.
The one thing you cannot do is buy more. Enrollees are barred from applying to increase coverage during the suspension, so the policy you hold is effectively the policy you keep for now.
That constraint is worth knowing if your circumstances change. Someone who bought a modest amount of coverage years ago cannot top it up today, which makes the rest of the plan matter more.
Will I lose my FLTCIP coverage because of the suspension?
No. Existing enrollees keep their coverage as long as they continue paying premiums, and the claims process runs normally. The suspension only blocks new applications and applications to increase coverage. If you are already enrolled, the practical effect is that your current coverage amount is locked in for the duration.
How do federal employees plan for care without the program?
The honest answer is that most people self-insure, whether or not they frame it that way. If no policy covers the risk, the money comes from savings, from family, or from Medicaid once assets are largely gone.
Family care is the quiet default. A large share of long-term care in this country is delivered unpaid by spouses and adult children, which is a real cost even though it never appears in a budget.
Medicaid is the backstop rather than a plan. It pays for nursing home care but is means-tested, so it generally begins only after personal resources have been spent down. Planning to rely on it means planning to arrive there.
Private long-term care insurance and hybrid policies that combine life insurance with a care benefit exist outside the federal program. We are not licensed to advise you on whether any of them fits your situation, and this is a decision where a fee-only financial planner or an elder law attorney earns their fee.
- Personal savings, which is what most people actually use.
- Unpaid care from a spouse or adult children, the most common source of all.
- Medicaid, which is means-tested and generally follows a spend-down.
- Private long-term care policies purchased outside the federal program.
- Hybrid life insurance products that include a long-term care benefit.
What are my options if I cannot get FLTCIP?
Private long-term care insurance and hybrid life policies with a care benefit exist outside the federal program, and many people fall back on personal savings, family care, or eventually Medicaid. Each carries very different costs and tradeoffs. This is genuinely a case for professional advice, since the right answer depends on your health, your assets, and your family situation.
How does long-term care risk fit into retirement planning?
It behaves differently from ordinary expenses because it is rare, expensive, and open-ended. Most retirees never face a long stay, and those who do can see costs that dwarf every other line in their budget. That shape is why it is usually treated as an insurable risk rather than a budget item. Model your baseline income first with your free readiness score, then consider how you would absorb a shock on top of it.