Long-term care insurance has been a fixture of the US insurance landscape for over half a century. Originally conceived to defray the costs of nursing home care, these policies have evolved to encompass home health services and assisted living arrangements, reflecting the changing needs of an aging population. Today, long-term care coverage can be purchased as a stand-alone policy or integrated with life insurance, either as a combination product or rider. Eligibility for claims hinges on an individual’s need for assistance arising from functional decline or cognitive impairment, with dementia, cancer, stroke, and progressive neuromuscular disorders being the most common triggers. Effective underwriting for long-term care insurance demands careful evaluation of morbidity risks associated with functional loss and cognitive deterioration. This chapter traces the historical development of long-term care insurance, delineates claim eligibility criteria, and explores an underwriting framework that addresses key medical impairments while leveraging commonly used risk assessment tools.