WISH Act Proposes Federal Long-Term Care Insurance Program for Seniors

Congress is looking at a new proposal called the "Well-Being Insurance for Seniors to be at Home Act," or WISH Act. This bill aims to create a federal insurance program to help cover the costs of long-term services and support (LTSS) – that's help with daily activities like bathing, dressing, or eating – for seniors. The idea is to help older Americans plan for potential disability, stay in their communities longer, support care workers, and ease the strain on Medicaid, which currently picks up the tab for many after they've exhausted their savings.

Meet the WISH Act: A New Safety Net for Senior Care?

The core of the WISH Act is adding a new benefit category under the Social Security Act. Think of it like another pillar alongside retirement or disability benefits, but specifically for long-term care. The goal, according to the bill's findings, is to address the massive potential costs of LTSS (averaging nearly $300,000 per person) that most seniors can't afford, especially as the 85+ population grows.

Eligibility isn't automatic. To qualify for these proposed benefits, you'd need to:

• Be at Social Security retirement age.
• Have worked and paid into the system for a minimum number of quarters (at least 6 quarters starting in 2026, scaling up).
• Be certified as having a "continuous serious functional disability" expected to last at least a year or until death.
• Wait out a specific "substantial period" after becoming disabled before benefits kick in.

The Fine Print: Who Qualifies and For How Much?

The benefit amount wouldn't be a flat rate. It's proposed to be calculated monthly based on the estimated median cost of hiring someone for 6 hours of personal care per day nationwide, adjusted over time for wage changes in the care sector. However, your actual benefit would be prorated based on how long you paid into the system – the closer you are to 40 quarters (10 years) of coverage, the closer you get to the full calculated benefit.

The waiting period before benefits start also varies. For folks with lower lifetime earnings (defined as the bottom 40th percentile), the wait is 12 months after becoming disabled. For those with higher earnings, that waiting period gets progressively longer – adding an extra month for roughly every 1.25 percentile points above the 40th percentile threshold.

Checks and Balances: Rules for Receiving WISH Benefits

Receiving WISH benefits would come with strings attached. Beneficiaries would need to file annual statements confirming their ongoing disability. If they hire non-family members directly for care, they'd have to comply with minimum wage and tax laws. Living outside the U.S. for more than five years could also stop payments.

Recognizing potential pitfalls, the bill mandates the Government Accountability Office (GAO) to report regularly on the program. These reports would specifically look for ways eligibility could be manipulated, assess the risk of financial exploitation or elder abuse of beneficiaries, and recommend solutions, potentially including financial management services.

Beyond the Benefit: Funding, Education, and Future Gaps

To pay for all this, the bill establishes a new "Federal Long-Term Care Insurance Trust Fund." It outlines initial appropriations ($12 million annually for fiscal years 2026-2028 for setup and early benefits, plus $50 million for public education). The fund would be managed similarly to the existing Social Security trust funds.

Speaking of education, the bill requires the government to launch a 10-year public awareness campaign about long-term care risks, costs, and the importance of planning. Starting a year after enactment, the Social Security Administration would also send notices to individuals at ages 45, 55, 65, and retirement age, detailing their earnings history relevant to WISH and their covered work quarters. This info would also be available online annually for those 35 and older.

Importantly, the bill acknowledges it won't cover everyone. It requires the Secretary of Health and Human Services to report every three years on the LTSS needs of people not eligible for WISH benefits (like those disabled since childhood) and propose strategies to address those gaps.