Long-Term Care Wellness Primer

October 2025

Authors

Stephanie Moench, FSA, MAAA
Principal, Oliver Wyman

Michael Rustemeyer, FSA
Senior Manager, Oliver Wyman

Ethan Chiu
Consultant, Oliver Wyman

Executive Summary

Wellness programs have been long-established in industries such as health insurance, life insurance, employer groups, and Medicare/Medicaid to lower costs by promoting and supporting healthy living for program participants. Recently, insurers in the long-term care (“LTC”) insurance industry began exploring wellness initiatives. These LTC wellness initiatives generally strive to improve policyholders’ aging experience through various interventions, which currently include, but are not limited to, providing education, health screenings, home assessments, family engagement, medication management, care planning, and durable medical equipment. The purpose of this primer is to provide a holistic overview of LTC wellness programs and create a useful resource for actuaries to understand the range of current LTC wellness program structures, potential outcomes, limitations, and other considerations.

LTC wellness programs have similarities to wellness offerings in other industries (e.g., disease management programs in health insurance) but face unique challenges due to the nature of LTC insurance. One notable hurdle is the lengthy time horizon for LTC insurance. Other industries may be able to observe near-immediate benefits from implementing a wellness program, but the decades-long timeline for LTC insurance introduces complexities related to engaging policyholders and measuring outcomes. Despite this and other hurdles, there has been a significant increase in the number of LTC wellness programs implemented in recent years. The growing investment in these programs may be driven, in part, by the “win/win/win” scenario that they present for policyholders, insurers, and other stakeholders if successful.

Designing and implementing an LTC wellness program typically involves (i) defining program goals and structure, (ii) identifying target participants, (iii) determining communication methods, (iv) selecting the type of interventions to be provided, and (v) deciding on the level of third-party vendor involvement (if any). It may also be prudent to establish a measurement framework as part of the program design phase to ensure that the necessary data is collected to facilitate analysis of program outcomes. Measurement approaches vary based on program design, but success is often defined based on multiple metrics that span both non-financial and financial indicators. Financial metrics can take months (or years) to evaluate, so evaluating non-financial metrics can be helpful to provide an early indication of potential success.

To date, most LTC wellness programs are in the pilot stage, which can facilitate program measurement by enabling carriers to establish control and test groups. If carriers can demonstrate that their pilot programs produce favorable results, it is expected that carriers will shift focus to longer-term sustainability. This may involve expanding LTC wellness offerings to a broader population, identifying opportunities for integration and coordination with wellness programs in other industries, adjusting forward-looking actuarial assumptions, and reducing other in-force management actions (e.g., premium rate increases). And, while most current LTC wellness programs have been implemented on closed blocks of traditional LTC insurance, a handful of pioneering carriers have introduced LTC products with embedded wellness features (e.g., riders). These features typically reward policyholders for taking healthy actions by providing additional benefits or reducing required premiums. If these innovative products are a proven success, more carriers may design LTC insurance products that integrate wellness initiatives from inception.

Material

Long-Term Care Wellness Primer

Acknowledgements

The researchers’ deepest gratitude goes to those without whose efforts this project could not have come to fruition: the Project Oversight Group for their diligent work overseeing, reviewing, and editing this report for accuracy and relevance.

Project Oversight Group members:

Joan Barrett, FSA, MAAA

Howard Bolnick, FSA, MAAA, HonFIA

Cailyn Canty, FSA, CERA, MAAA

John Cutler, JD

Ian Duncan, FSA, FIA, FCIA, MAAA, FCA

Matthew Klaus, FSA, MAAA

Roger Loomis, FSA, MAAA

Francois Millard, FSA, FIA, MAAA

Nicholas Sheahon, FSA, MAAA

Alex Vichinsky, FSA, MAAA

At the Society of Actuaries Research Institute:

Achilles Natsis, FSA, MAAA, Practice Research Actuary

Steven Siegel, ASA, MAAA, Senior Practice Research Actuary

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