I The gap
Long-term care is custodial care — help with the activities of daily living: bathing, dressing, eating, moving. It is not medical treatment, and that distinction is what puts it outside everything else you have.
| Programme | Custodial care |
|---|---|
| FEHB | Not covered — acute medical care only |
| Medicare | Skilled nursing, limited period, after a qualifying hospital stay |
| FLTCIP | Yes — but closed to new applicants |
Federal employees reasonably assume FEHB is comprehensive, because for medical purposes it broadly is. It covers physician visits, hospital stays, surgery and prescription drugs. It does not cover someone coming to your home to help you dress — at home or in a facility, indefinitely. Medicare Part A helps with rehabilitation after a hospital stay. Neither addresses years of custodial care.
II Why it is closed
OPM suspended applications for FLTCIP coverage effective 19 December 2022, to allow OPM and the carrier — John Hancock Life and Health Insurance Company — time to assess benefit offerings and establish sustainable premium rates.
That requirement is statutory. 5 U.S.C. 9003(b)(2) requires premiums that reasonably and equitably reflect the cost of the benefits provided.
The suspension was then extended effective 19 December 2024 for a further 24 months, under 5 CFR 875.110(d), on the basis of ongoing volatility in long-term care costs and a diminished insurance market. That extension runs to 19 December 2026.
OPM has said the suspension remains in effect unless a subsequent notice ends or extends it. It has already been extended once, and the conditions cited have not obviously resolved. Check OPM’s long-term care page for any later notice before relying on any date — including the one on this page.
III If you are enrolled
Your position is largely unaffected, with one significant exception.
| During the suspension | |
|---|---|
| Coverage continues | Yes |
| Enrollment status and benefit eligibility change | No |
| Claims reimbursement affected | No |
| Can apply to increase coverage | No |
That last row matters more than it reads. Someone holding a daily benefit amount chosen years ago, against care costs that have risen substantially since, cannot adjust it until the suspension lifts. The coverage you have is the coverage you keep.
IV Exposure Estimator
What Is Actually At Risk?
Use your own local care costs. National figures vary enormously by region and setting.
V What is left
With the federal programme closed, three options remain, and none of them is comfortable.
| Option | The catch |
|---|---|
| Private policy | Individually underwritten, so health decides the price |
| Self-fund | Requires assets sized to the figure above |
| Accept the risk | A decision by default is still a decision |
FLTCIP was a group programme. The private market is individually underwritten, which means your health at the moment you apply carries far more weight than it did. Waiting for a programme that may not reopen, while your own health changes, is itself a wager — and it is the one most people are making without noticing.
This is a significant financial decision that turns on your own assets, health and family situation. It belongs with a fee-only financial planner, not with general reading — including this page.
VI Playbook
| Situation | What to do |
|---|---|
| Want to enrol in FLTCIP | You cannot. Closed since 2022, earliest reopening December 2026. |
| Waiting for it to reopen | Treat that as a possibility, not a plan. It has been extended once. |
| Already enrolled | Coverage continues. You cannot increase it. |
| Daily benefit now looks low | Nothing can be done until the suspension lifts. |
| Assuming FEHB covers this | It does not. Custodial care is excluded. |
| Assuming Medicare covers this | Only skilled nursing, briefly, after a hospital stay. |
| Under 65 and in good health | Underwriting will not get easier. Decide deliberately. |
| Considering a private policy | Fee-only planner, not general reading. |
Three things that cost nothing
- Establish whether you are currently enrolled in FLTCIP.
- If enrolled, find your daily benefit amount and compare it with local care costs.
- Read what your FEHB plan actually excludes.
- Work out what several years of care would cost where you live.
- Check OPM’s long-term care page for any notice after December 2026.
- If you are healthy and under 65, decide consciously whether to wait.
- Discuss self-funding capacity with a fee-only planner.
- Revisit the decision if your health changes.
Questions
No. OPM suspended applications for coverage effective 19 December 2022 and extended that suspension effective 19 December 2024 for a further 24 months, which runs to 19 December 2026. While the suspension is in effect, individuals not already enrolled may not apply for coverage. There is no waiting list and no qualifying life event exception. The suspension was made under 5 CFR 875.110(d) and OPM has said it will remain in effect unless a subsequent notice ends or extends it.
That is the earliest it could, and OPM has not committed to it. The suspension has already been extended once, and the stated reasons — ongoing volatility in long-term care costs and a diminished insurance market — have not obviously resolved. Treat December 2026 as the earliest possible date rather than a plan, and check OPM's own long-term care page for any subsequent notice before relying on any date, including the one on this page.
To give OPM and the carrier, John Hancock Life and Health Insurance Company, time to assess benefit offerings and establish sustainable premium rates that reasonably and equitably reflect the cost of the benefits provided, which is a requirement of 5 U.S.C. 9003(b)(2). OPM then determined that extending the suspension was in the best interest of the programme because ongoing cost volatility and a shrinking insurance market were undermining the ability to do that.
Your coverage continues. The enrollment status and benefit eligibility of current enrollees does not change because of the suspension, and for anyone in a claim status there is no change to coverage or to the claims reimbursement process. The one thing you cannot do is apply to increase your coverage. If you hold a daily benefit amount that now looks inadequate against current care costs, you are stuck with it until the suspension lifts.
No, and this is the most consequential misunderstanding in federal benefits. FEHB covers acute medical care — physician visits, hospital stays, surgery, prescription drugs. Custodial care, meaning help with the activities of daily living such as bathing, dressing and eating, is excluded, whether it is provided at home or in a facility. Long-term care is precisely custodial care, which is why it sits outside the programme that federal employees otherwise rely on for everything medical.
Only narrowly. Medicare Part A covers skilled nursing facility care for a limited period following a qualifying hospital stay, which is a rehabilitation benefit rather than a long-term care benefit. It does not cover custodial care, which is the kind most people need for extended periods. The distance between what Medicare pays for and what a multi-year period of care actually costs is the exposure that long-term care insurance exists to address.
The private market, self-funding, or accepting the risk. Private long-term care policies and hybrid life-and-care products exist and can be bought now, though they are individually underwritten rather than group-rated, which generally makes health at the time of application more decisive than it was under FLTCIP. Any of these is a significant financial decision that turns on your own circumstances, and it is one to take to a fee-only financial planner rather than to settle from general reading.
Three things that cost nothing. Establish whether you are currently enrolled, because a surprising number of people are unsure. Understand precisely what your FEHB plan does and does not cover, so the gap is a known quantity rather than a discovery made during a crisis. And if you are in good health and under 65, decide deliberately whether to wait for a programme that may not reopen, because underwriting generally gets harder rather than easier with time.